Many women with vulvodynia suffer for many years before they actually get an accurate diagnosis and receive treatment. Many seek out a variety of health care professionals before they receive a correct diagnosis. Sometimes women are hesitant to discuss these symptoms and they have often been labeled with a psychological pain problem. Women are often told that the pain is in their head.
There are a variety of treatment options and no one specific treatment plan works for all sufferers. It is important to have adequate follow up and modify the treatment plan often if symptoms are persistent and do not improve with time. Vulvar specialists will create individualized treatment plans to suit the individual’s pain and concerns. Some woman may find complete resolution of symptoms with certain treatments, when others only have temporary or only partial relief. Response rate is variable. According to the National Vulvodynia Association, some of the treatment options include: prescription medications, biofeedback/physical therapy/relaxation practices, local anesthetics and gentler vulvar hygiene
Prescription medications: Tricyclic antidepressants that may help lessen chronic pain include amitriptyline, desipramine (Norpramin) and nortriptyline (Aventyl, Pamelor). Gabapentin (Neurontin) and Tegretol may also help decrease the chronic pain. Antihistamines such as hydroxyzine (Vistaril®) and Montelukast Sodium (Singular®) can reduce itching. Patients have some success using topically applied creams and gels, including those which contain estrogen and/or testosterone. Some of these topical creams may need to be made from a compounding pharmacy.
A new anesthetic-free topical cream called NEOGYN® Vulvar Soothing Cream has been shown beneficial for vulvodynia when used for a sufficient long period of time. The cream was studied in more than 200 women by two gynecologists in Switzerland and a controlled study realized by gynecologist Professor G. Donders (Belgium) corroborated the positive results. The study showed that the use of NEOGYN® Vulvar Soothing Cream resulted in significant reduction of pain during sexual activity when used twice daily for 12 weeks, while redness became also less visible. The improvements were most evident in women who had acquired the vulvodynia symptoms with time and not at first tampon insertion or intercourse. The cream was very well tolerated. More information about the study can be found at http://www.vulvodyniatreatment.com.
NEOGYN® Vulvar Soothing Cream can be used in combination with antidepressant medications, pelvic floor or physical therapy, after surgery or with local anesthetics and topical creams (when administered after those products have completely absorbed, i.e., after at least 30 minutes).
NEOGYN® Vulvar Soothing Cream is a cosmetic product and not a medication. It is suggested as part of a skincare approach in combination with treatments for vulvodynia. For more information about Neogyn, click here.
Biofeedback/Physical Therapy/Relaxation: this therapy, often done by a specially trained physical therapist, can help the woman learn to control her pain response. It can help the woman learn how to relax tense pelvic floor muscles. Specifically trained genitopelvic floor therapists can do internal vaginal manipulation to help stretch out and relax tense muscles. It is not uncommon that some women who have vulvar vestibulitis may also have vaginismus. Treatment for vaginismus may also be warranted. Read more about treatments for vaginismus.
Local anesthetics: medications such as lidocaine ointment can be applied on a regular basis or as needed to decrease some of the symptoms associated with vulvodynia and vulvar vestibulitis. Some women find it helpful to use it approximately 30 minutes before intercourse to decreased pain. Read more about treatments for dyspareunia.
In some specialized refractory cases, some specialist advocate injection of Botulinum toxin into the hypertonic pelvic floor muscles and vestibulodynia. Other specialists recommend pudendal nerve blocks to decrease pain transmission.
In severe cases where pain is uncontrollable and local treatments have failed, some women may choose to have surgical removal of the area where the pain is localized. A vestibulectomy or removal of the affected skin and tissue is very successful and should only be preformed by a vulvar expert. According to a recent article from the Journal of Sexual medicine, success rates from vestibulectomies are variable and in the range of 60-90%
Vulvar hygiene is important to the overall treatment for vulvodynia. In addition to good vulvar care and avoidance of irritants, lubricants without caustic additives, such as glycerin or parabens, should be used during intercourse. Some women also find natural oils, like vitamin E, almond or extra virgin olive oil helpful. Good Clean Love®, Yes® and Pjur® water-based lubricant are helpful.
Sexual counseling and therapy maybe helpful for women and their partners who are suffering from sexual complaints as a result of vulvodynia. Alternatives to penetration can be encouraged and help may be needed in order to preserve the lines of communication. Sexual counselors and therapists will help maintain couple intimacy and improve sexual self image as treatment progresses. Some women may also suffer from anxiety, depression and frustration concerning their chronic condition and mental health care professional may be especially helpful.
Educational materials and resources are also essential for the woman and her partner so they can have accurate information concerning the disease process and about cutting edge treatment options.