Vulvodynia

Vulvodynia is a complex condition that is difficult to treat. The nature of the condition often makes it hard to find a physician whom you feel comfortable with and can provide the proper treatment. Our specialists understand the impact of vulvodynia and how deeply your life and relationships can be affected. We will try multiple treatments and continue to search for the optimal treatment option with you for as long as it may take to do so.

New York Bone and joint Specialists strives to provide you with the best experience possible when visiting our offices. You can receive treatment either our Upper East Side or Midtown Manhattan locations, so we are always easily accessible. Our dedicated staff will schedule appointments at your convenience and will handle all insurance processes on your behalf. You can be sure that you will receive the top care at New York Bone and Joint Specialists. Our patients come to us by referrals from loved ones who have honored us with their trust.

DESCRIPTION

Vulvodynia is pain and discomfort in the vaginal area that does not come from any particular source. Many women experience varying pain without any sort of infection, inflammation, neurological disorder, or neoplasia (growth or tumor). Vulvodynia refers to pain in the vaginal area despite the vagina appearing fine. This pain is often present most during sexual intercourse or other sources of pressure, like sitting for long periods of time. Vulvodynia can be present from the first intercourse experience or develop over time. Pain from vulvodynia occurs in various areas, and the type of pain varies. Women describe the pain in a multitude of ways, including burning, rawness, stabbing, and stinging.

Vulvodynia is classified in two ways:

Vulvar Vestibulitis Syndrome – This type of vulvodynia is characterized by pain occurring mostly when provoked and being limited only to the vaginal vestibule. Primary VVS means that this pain has been present since the first sexual intercourse experience. Secondary VVS means that this pain was once not an issue, but it developed over time. Pain will occur during or after pressure is applied as in:

  • sexual intercourse
  • wearing tight pants
  • sitting for too long
  • inserting a tampon

Generalized vulvodynia – For women with generalized vulvodynia, pain is almost always present and can occur spontaneously as well as under provocation. For this type of vulvodynia, pain can occur anywhere in the vaginal region, including the vestibule, labia, clitoris, and even as far as the inner thighs.

CAUSES

Vulvodynia does not have any discernable cause. Pelvic floor muscle dysfunction or weakness is the most common factor present in vulvodynia cases and is the most helpful link in discovering the cause. It is likely that vulvodynia results from a combination of issues that are speculated to include:

  • Injury or irritation of the nerves in the vulva
  • Increased nerve fiber density in the vestibule
  • Inflammatory substances in vulvar tissue
  • Abnormal immune response in the vulvar to infection, trauma, or other environmental factors
  • Hormonal responses
  • Genetic factor that may affect inflammation, chronic pain, and infection immunity in the vulvar
  • Pelvic floor muscle weakness

DIAGNOSIS

You should always begin your diagnosis at an OB/GYN office. They will be able to administer all the appropriate tests to ensure that your pain is not caused by infection, inflammation, or any other evident factor. Your Ob/Gyn can also order a blood test to evaluate hormone irregularities. If none of these tests provide any evidence into your condition, you should visit discuss the possibility of vulvodynia. We will ask you extensive questions to determine when and where your pain appears and the possible triggers. Your medical history will be a very good indication of vulvodynia.

TREATMENT OPTIONS:

No single treatment is appropriate for every woman. A personalized, multi-disciplinary approach is necessary to completely relieve pain. Treatments include:

  • Pelvic Floor Physical Therapy – Very specific physical therapy targeted at evaluation and treatment of pelvic floor muscles. This is perhaps the most effective long lasting pain relief solution for vulvodynia.
  • Diet modifications
  • Oral Medications
  • Topical Medications
  • Ultrasound Guided Nerve Blocks – These are injections targeting nerves that may be sending pain signals to the vaginal area. The nerve blocks are temporary, however they help to desensitize the nerve and decrease the pain signals the nerve is sending to the vaginal area.
  • Ultrasound Guided Trigger Point Injections to Pelvic Floor Muscles – Trigger Point injections help to break up trigger points and improve blood flow to the muscles of the pelvic floor.
  • Ultrasound Guided Botox Injections to the Pelvic Floor – Botox injections to the Pelvic Floor Muscles help to relax the muscles of the pelvic floor and to block pain signals to the Brain.

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