vulvodynia | pudendal neuralgia | pcos | fibroids | interstitial cystitis | vulvar vestibulitis | endometriosis
Vulvodynia
What is vulvodynia?
Vulvodynia causes pain around the vulva and opening of the vagina. The word literally means "pain of the vulva" (-dynia means pain in Latin), so it's not an incredibly specific diagnosis. However, if vulvodynia describes your symptoms, that can help immensely with getting the medical support you need to feel better.
Typically, vulvodynia pain cannot be explained or traced to an identified cause. The location and severity of the pain differs among women, but the most commonly-reported symptom is a painful burning sensation. Some providers break vulvodynia into two sub-diagnoses: localized and generalized vulvodynia. Localized vulvodynia describes pain immediately surrounding the vaginal opening, and generalized vulvodynia describes pain around the vulva but not immediately or solely near the vaginal opening. Remember that not all providers use these specific definitions, so focus on describing your symptoms rather than the technical terms like "localized vulvodynia."
What are the symptoms?
The most common symptom is burning, but it can also feel like stabbing pain. Also reported is stinging, rawness, aching, soreness, throbbing, or itching. These symptoms can be constant or intermittent and may be agitated by certain activities (inserting tampons, biking, sex) or just seem to appear randomly.
How is it diagnosed?
A diagnosis of vulvodynia when a woman presents with pain or discomfort in the vulvar region is made after a doctor has ruled out infections or dermatology abnormalities and the patient has shown pain in response to light pressure on the labia or surrounding areas. The presence of a rash or skin abnormality is not consistent with vulvodynia so the patient would need further examination.
Your doctor may perform a pelvic exam (to look for other causes of symptoms) and a cotton swab test (to check for specific areas of pain).
What causes it?
The exact cause of vulvodynia is unknown, but the majority of women with this type of pelvic pain experience more heightened or prolonged pain with or following activities such as sex, inserting a tampon, a gynecologic exam, sitting for long periods of time, or wearing tight pants.
There is no evidence that STDs cause vulvodynia, but researchers are trying to identify causes, which may include nerve injury, infection, trauma, genetic factors, allergies, or hormonal changes.
How is it treated?
Vulvodynia patients can identify what works best for their treatment and may need to try several treatment plans and combine remedies before finding what works for them. Most women found it helpful to avoid potential irritants such as shampoos and chlorine, wear 100% cotton underwear and tampons, rinse the vulva with cool water after urination and sex, wear loose-fitting pants, and keep the vulva clean and dry (changing out of swim suits and gym clothes as soon as possible). Other treatments may include medications to decrease nerve hypersensitivity, local treatments, and cognitive behavioral therapy.
Unfortunately, many healthcare providers do not know much about vulvodynia so it is important for women to advocate for themselves and find a provider that listens and validates their recounting of their pain and what treatments do and do not work.
Who should I see?
See your gynecologist or your regular physician to get an evaluation for vulvodynia if you feel these symptoms match your pain. If you have been diagnosed, find a doctor that will work with you to find a treatment plan that works best.
Where can I learn more?
National Vulvodynia Association
WebMD
Mayo Clinic
American Academy of Family Physicians
Interstitial Cystitis
What is interstitial cystitis?
Interstitial cystitis is a painful bladder condition that causes bladder pressure and pain as well as pelvic pain. It usually affects women and can have long term impact.
What are the symptoms?
If you had this condition, the most baseline symptom is feeling like you need to urinate more often than most people and your urine would be in smaller volumes that normal. This is because the signals from bladder to brain are communicating through pelvic nerves, and with interstitial cystitis, the pelvic nerves fire too frequently with no signal from the bladder that it is full.
The accompanying signs will vary from patient to patient and will sometimes vary over time. Many symptoms may also be aggregated by menstruation, sitting for long periods of time, exercise, and sex. These symptoms include pain in the pelvic area (including the vagina and anus), discomfort while the bladder is filling, and relief after the bladder is emptied.
How is it diagnosed?
For an accurate diagnosis, your doctor will ask you to describe your symptoms and possibly keep a bladder diary. You will also receive a urine test and a pelvic exam. Your doctor will do other procedures and tests to rule out things such as cancer, urinary tract infection, sexually transmitted disease, or kidney stones.
What causes it?
The exact cause of interstitial cystitis is unknown, but it is believed that some factors may contribute to it. Possible factors are defects to the lining of the bladder, heredity, infections, or allergies. Also, fair skin and red hair has been associated with a higher risk of interstitial cystitis.
How is it treated?
Because there is no cure for interstitial cystitis, you may need to try various treatments and combinations to see what will relieve your symptoms the best. This may include physical therapy, oral medications such as ibuprofen and Claritin, nerve stimulation, surgery, and acupuncture.
Who should I see?
See a gynecologist, urogynecologist, or physician if you would like to be evaluated for interstitial cystitis.
Where can I learn more?
American Urological Association
MedlinePlus (U.S. Library of Medicine)
Mayo Clinic
WebMD
Pudendal Neuralgia
What is pudendal neuralgia?
Pudendal neuralgia is a rare condition that affects the pudendal nerve which runs through the pelvic area (genitals, urethra, anus, and perineum). It typically causes pain when sitting.
What are the symptoms?
The baseline symptom of pudendal neuralgia is pain in the anus and perineum. For women, this includes the clitoris, vagina, and labia. For men, this includes the penis and scrotum. Possible symptoms include burning, numbness, pinching, stabbing pain, sensitivity, pain during urination, defecation, or sex, and persistent arousal—or the opposite—loss of sensation.
How is it diagnosed?
For an accurate diagnosis, your doctor will ask you to describe your symptoms and possibly keep a bladder diary. You will also receive a urine test and a pelvic exam. Your doctor will do other procedures and tests to rule out things such as cancer, urinary tract infection, sexually transmitted disease, or kidney stones.
What causes it?
In many cases, a specific cause may be identified because this condition occurs when the pudendal nerve is damaged, irritated, or compressed. Incidents that may cause this include prolonged sitting, horseback riding, or constipation over many months or years, previous pelvic surgery, a pelvic bone break, or childbirth.
How is it treated?
Because there is no cure for interstitial cystitis, you may need to try various treatments and combinations to see what will relieve your symptoms the best. This may include physical therapy, oral medications such as ibuprofen and Claritin, nerve stimulation, surgery, and acupuncture.
Who should I see?
See a gynecologist, urogynecologist, or physician if you would like to be evaluated for interstitial cystitis.
Where can I learn more?
MedlinePlus
National Health Service
Mayo Clinic
WebMD
Health Organization for Pudendal Education
Vulvar Vestibulitis
What is vulvar vestibulitis?
Vulvar vestibulitis is a type of vulvodynia that is characterized by extreme pain during vagina penetration (either during sex or tampon insertion) and redness of the vulva. It is not just one disease but a combination of different conditions and physicians at the Centers for Vulvovaginal Disorders have identified a dozen different diseases that cause vestibulitis. Differences in the conditions can help distinguish the triggers of pain and lead to the best treatment plan for each patient.
What are the symptoms?
The most common symptoms of vulvar vestibulitis are severe pain with vaginal entry, burning, stinging, or rawness around the vagina and vulva, and the urge to urinate frequently or suddenly.
How is it diagnosed?
Your doctor will perform a pelvic exam to check the vulva and surrounding area for common skin redness associated with this condition. He or she may also test the area for pain by touching a cotton tip to the vulva. Your doctor will also want to rule out any chance of infection by testing vaginal discharge and urine.
What causes it?
The exact cause of vulvar vestibulitis is not known, but it has been found that HPV, chronic yeast infections, chronic urinary tract infections, and changes to the acid-base balance in the vagina can lead to this condition. It can also be associated with insufficient hydration and lubrication, emotional stress, and allergies.
How is it treated?
Treatments for vulvar vestibulitis vary for each patient, ranging from local anesthetic creams, vaginal dilators, pelvic floor physiotherapy, sexual counseling, and possibly surgery.
Who should I see?
Find a doctor that can prescribe you a local anesthetic for safe daily use. Find the right clinician for you who will find the root of your pain and help you find the treatment plan that works best for you.
Where can I learn more?
Vulval Pain Society
University of Iowa Health Care
Center for Vulvovaginal Disorders
Endometriosis
What is endometriosis?
Endometriosis is a common condition (about 1 in 10 American women are affected) in which the tissue that normally lines the inside of the uterus (the endometrium) has grown on the outside of the uterus instead. The endometrium is the layer of the uterus that responds to hormonal changes during menstruation. When the endometrium lies outside of the uterus like with endometriosis, it still responds to these hormones but causes excruciating pain because it is not in the right place. It is most common in women in their 30s and 40s but can affect any menstruating woman.
What are the symptoms?
The most common symptoms of endometriosis are pain and menstrual irregularities. Main areas of pain include the lower abdomen, lower back, pelvis, rectum, and vagina. Pain can occur in everyday life with no trigger or can increase during sex. Women with endometriosis experience abnormal menstruation, meaning their periods may be heavy, irregular, and painful. Other symptoms may include infertility, pain with urination, fatigue, constipation, or nausea.
How is it diagnosed?
Endometriosis is diagnosed through a pelvic exam. During the exam, your doctor will feel areas in your pelvis for abnormalities normally associated with this condition, such as cysts on reproductive organs or scars on your uterus. Your doctor may also choose to do an ultrasound to capture images inside the body, which can detect cysts.
What causes it?
Although the exact cause of endometriosis is unclear, a possible explanation is retrograde menstruation. This is when menstrual blood containing endometrial cells flows backwards into the fallopian tubes and stick onto the pelvic wall where they continue to grow. Other factors may include surgery (C-section, etc), or an immune system disorder.
How is it treated?
Your health care provider will help select a treatment that is best for you based on your age, how severe your symptoms are, and whether or not you want to be able to get pregnant. Pain treatments usually fall into one of three categories: pain medication, hormone therapy, and surgical treatment. Medication works the best with mild symptoms, and hormone therapy can be used to stop ovulation and the cycle of hormones that cause the painful endometrium activity. Birth control pills or progesterone are usually recommended for this. Surgery is an option for women who need cysts or growths removed, which will provide significant although short term relief.
Who should I see?
Talk to your gynecologist about getting a pelvic exam or ultrasound if you think you may have endometriosis.
Where can I learn more?
National Institutes of Health
Mayo Clinic
Endometriosis Association
Uterine Fibroids
What are uterine fibroids?
Uterine fibroids are noncancerous growths of the uterine lining that can develop during childbearing years. They can range from fibroids undetectable by the human eye to masses that can distort the uterus. Patients with this condition can have just one or many fibroids. Many women will have a fibroid throughout their lifetime but never know because they usually do not cause any symptoms.
http://www.mayoclinic.org/diseases-conditions/uterine-fibroids/home/ovc-20212509
What are the symptoms?
Most fibroids do not cause any symptoms, but ones that do can have painful periods, the feeling of fullness or bloating, enlargement of the lower abdomen, frequent urination, pain during sex, lower back pain, and complications during pregnancy and labor.
How is it diagnosed?
In addition to your doctor completing a full physical and pelvic exam, she will want to complete an ultrasound to confirm the presence of and map and measure the fibroids.
What causes it?
The exact cause of uterine fibroids is not known, but fibroids begin when cells overgrow in the muscular wall of the uterus with the influence of hormones estrogen and progesterone. Your body produces the most hormones during childbearing years, which is when these occur, and during menopause the fibroids usually disappear.
How is it treated?
Many treatment options exist for women with uterine fibroids. Since fibroids rarely interfere with pregnancy and aren’t cancerous, if your doctor finds them during a routine exam, just watch them and let your doctor know if they become more than just mild symptoms that do not occur frequently and do not disrupt your lifestyle. If they do, then medications that regulate your menstrual cycle may help shrink the fibroids. You may also choose to do a noninvasive procedure to target and destroy fibroids with ultrasound waves. A hysterectomy is the only option that will permanently remove uterine fibroids and might be the right one for you if your symptoms are severe and you do not want to bear children.
Who should I see?
Talk to your gynecologist about getting a pelvic exam or ultrasound if you think you may have uterine fibroids.
Where can I learn more?
WomensHealth.gov
WebMD
Mayo Clinic
Polycystic Ovarian Syndrome (PCOS)
What is PCOS?
PCOS is a common disorder affecting women in their reproductive years. In women with PCOS, the ovaries are enlarged and contain cysts (fluid-filled sacs). PCOS is an endocrine disorder, meaning that it results from a hormonal imbalance. Statistics indicate that about 10% of women of reproductive age suffer from PCOS.
What are the symptoms?
The common symptoms include irregular menstrual periods (either extra-long or absent), obesity, and elevated androgen (male hormone) levels. The increased androgen levels can cause excess facial or body hair, acne, or male-pattern baldness. Women may also have mild to severe pain from the cysts in their ovaries. But, while PCOS itself may not cause pelvic pain, complications of PCOS can cause discomfort, pain, or other health challenges. These include diabetes, high blood pressure, high cholesterol, increased risk of heart disease, abnormal uterine bleeding (and periods), liver inflammation, infertility, sleep apnea, depression and anxiety, or endometrial cancer.
How is it diagnosed?
It can often be detected by ultrasound, and many teenage girls are screened for it if their periods are infrequent or absent. Adult women may be screened if they’re struggling to get pregnant. Unfortunately, PCOS is often a diagnosis of exclusion – meaning that a woman will receive a PCOS diagnosis after other disorders have been ruled out.
When you visit your doctor to discuss your concerns, expect her to give you a physical and pelvic exam (she’ll want to measure things like your weight and blood pressure, and she’ll want to check your abdomen for enlarged ovaries or masses). She may also draw blood to measure your hormone levels. Lastly, if she suspects PCOS or a similar condition, she may perform a transvaginal ultrasound. This test should not hurt, although it can feel uncomfortable when she places the ultrasound wand in your vagina. Learn more about transvaginal ultrasounds here.
What causes it?
PCOS is an endocrine disorder, but its exact cause is unknown. PCOS is often a hereditary condition, so it’s important to know your family history if you suspect you might have this disorder.
How is it treated?
Treatment typically includes a weight management program, which can help reduce your symptoms. Unless you’re actively trying to get pregnant, your doctor may also put you on a hormonal contraceptive (birth control pills, a patch, a ring, or a hormonal IUD) to manage your periods. Birth control pills might also help to lower your androgen levels, but they don’t work well for everyone. There are also numerous other medications that can help to regulate your periods and androgen levels.
Who should I see?
If you suspect that you might have PCOS, see a reproductive endocrinologist (ask your gynecologist for a referral). If you’ve already been diagnosed with PCOS, ask your provider whether she or another doctor will be monitoring your condition. You may also want to see a nutrition counselor to help manage your diet. Check out this great blog from Girls Gone Strong with info about how to eat if you’re active and have PCOS.
