Exploring Women’s Healthcare: Treatment for Vulvodynia Is as Unique as Each Woman
Margaret is a 51-year-old Caucasian woman who presented with pain in the near the vulva. The pain started gradually, roughly two years ago, with no long-term relief. Although she saw three different physicians, only one prescribed treatment — in the form of an estrogen cream. The treatment was unsuccessful and the pain now interferes with her daily routines. In another case, 22-year-old Alicia, an Asian woman, reported that while she has no significant pain on a daily basis, she cannot bear the pain of attempted sex, or even of using tampons. She, too, consulted a number of physicians; none offered lasting treatment. Though these women have different symptoms and different types of pain, they have two things in common: They suffer from vulvodynia, and they haven’t been given a diagnosis or treatment for vulvodynia.
Part of that is because many physicians and pharmacists do not understand what vulvodynia is, much less what treatment options are available today. Vulvodynia is loosely defined as chronic vulvar pain that does not have an identifiable cause.1 The location, frequency, and level of pain can be quite different among patients, with “burning” and “stabbing” listed as the most common symptoms. There are two main types of vulvodynia, which can occur individually or together:
- Generalized vulvodynia, which is when pain is constant but occurs spontaneously and may occur in one or multiple locations. Activities that put pressure on the area, such as sitting for a long time or wearing tight clothes, can worsen symptoms.
- Vulvar vestibulitis syndrome, also known as provoked vestibulodynia, is when pain is limited to the area around the vaginal opening, and occurs when pressure is put on the area, such as during sexual intercourse, using tampons, a gynecology exam, sitting for a long time, or wearing tight clothes.
The disease has been further defined as one caused neither by infection nor by sexually transmitted diseases (which can both cause vulvar pain), but rather, is associated with genetics, hormone levels, inflammation, musculoskeletal activity, and even other pain syndromes, such as fibromyalgia or painful bladder syndrome.2
Vulvodynia Treatments Patients Should Be Aware Of
- Topical therapy: Amitriptyline cream is often the first-line therapy for provoked vestibulodynia. Anesthetics, such as lidocaine and capsaicin, as well as estrogen-based creams, are other treatments that are good options for vulvodynia.
- Oral medications: Tricyclic antidepressants, namely amitriptyline, as well as anticonvulsants, such as gabapentin, can provide pain relief in some patients.
- Injections: Patients with chronic pain who are unresponsive to other, less invasive treatments may benefit from local nerve blocks or intralesional injections.
- Physical therapy: Some patients with vulvodynia have tension in the muscles that support the uterus, bladder, and bowel. Exercises relaxing those muscles may provide some pain relief. Biofeedback methods can also aid in self-regulating pain.
- Surgery: For patients who have localized pain, surgery to remove the affected skin and tissue can be an effective treatment for vulvodynia.
What Can Pharmacists Do to Best Help Their Patients?
There are a few best practices pharmacists should follow to help the overcome vulvodynia.
Encourage patients to ask questions. Vulvodynia, like other female genital pain conditions, is rarely discussed. The prevalence of the condition lies between 3% and 18% in women of reproductive age.5 However, 60% of these women go to an average of three different clinicians before they get a proper diagnosis. The other 40% remain undiagnosed. Pharmacists can help change these statistics by providing a safe space for patients to get information. Patients looking for products that help for vaginal irritation or pain, for example, may not know what questions to ask their physicians, and what their options are for treatment of vulvodynia.
Help patients manage the condition as best they can. There are several self-care options that may give patients some pain relief:
- Tight clothing should be avoided.
- Cotton underwear should be worn during the day, and no underwear should be worn at night.
- Cool gel packs may be applied to reduce pain in the area.
- Perfumed or irritating soaps, as well as douching, should be avoided.
- If possible, cleansing the area should be done with water and perhaps a mild soap.
- Cotton pads are recommended during menstruation.
- Lubrication during sexual intercourse is recommended.
Direct patients on how to learn more on their own. There are some good websites that provide accurate details on what vulvar pain is, what symptoms to look for, and how to determine if pain is due to an infection or STD versus vulvodynia. Giving out pamphlets that direct patients to these sites can encourage patients to ask more questions and develop a better rapport with their pharmacists. Sites to include are the National Vulvodynia Association and the Vulval Pain Society.
Talking about women’s health issues is the first step in learning more about how to treat those issues. In cases of vulvodynia, where not even physicians seem to be hearing their patients and offering treatment, asking questions is key, and pharmacists are well-trained to offer their expertise.
Treatment for vulvodynia and other women’s health issues are an essential part of providing excellent health care. Pharmaceutica North America is committed to providing safe and high-quality compounding materials so pharmacists can give their patients that excellent care. Contact us today to learn more.
- “What Is Vulvodynia?” 2016, https://www.nva.org/what-is-vulvodynia/ ↩
- January 23, 2015, http://issvd.org/wp-content/uploads/2016/02/terminology-vulvar-pain-BornsteinCURRENT-ISSVD-TERMINOLOGY-AND-CLASSIFICATION-OF-VULVAR-DISEASES.pdf ↩
- “Vulvodynia: An Evidence-Based Approach to Medical Management,” May 2010, http://www.turner-white.com/pdf/jcom_may10_vulvodynia.pdf ↩
- “Vulvodynia,” 2016, http://www.mayoclinic.org/diseases-conditions/vulvodynia/basics/treatment/con-20020326 ↩
- “Vulvodynia and Interstitial Cystitis: Causes of Pelvic Pain,” October 30, 2012, http://www.medscape.com/viewarticle/773575 ↩