Vulvodynia is a gynecological problem that affects around 8 and 10% of women at different stages of life, reaching 28% of the female population in the case of women of reproductive age.

Vulvodynia is described as aburning pain that lasts about three months: “The diagnosis requires a complete clinical history, clinical examination and specific diagnostic tests, although it is ultimately a diagnosis by exclusion, once  fungal and bacterial infections and other causes have been ruled out vulvar pain and discomfort (cancers, traumas, neurological causes, hormone deficiency such as in menopause …)”. 

And, how to treat vulvodynia to combat itching and burning in the vulva? “The treatment of vulvodynia requires a multidisciplinary approach: the goal is to reduce pain and improve quality of life,” answers Domínguez and qualifies: “As the cause is unknown, the treatments continue to be unsatisfactory.” Along the same lines, the doctors point out that there are currently many therapeutic alternatives, but the key lies in combining them to improve the symptoms of vulvodynia. “In any case, a multidisciplinary approach is necessary for the proper treatment of this pathology,” they stress. 

In their experience, the doctors comment that the current treatments to control vulvodynia are the following:

  1. Topical treatments such as lidocaine , gabapentin, amitriptyline and baclofen, hormone therapy with estrogens and/or testosterone and capsaicin.  
  2. Oral medication such as tricyclic antidepressants, selective serotonin reuptake inhibitors, and gabapentin or pregabalin.  
  3. Pelvic floor physiotherapy and biofeedback therapies to learn how to relax the pelvic muscles and reduce pain.   
  4. Nerve blocks and use of botulinum toxin .  
  5. Alternative therapies such as acupuncture or hypnosis .  
  6. Psychotherapy .  
  7. Gynecological laser .   
  8. Surgery

Regarding the use of psychotherapy to treat vulvodynia, the Codem spokesperson maintains that this type of treatment is very important because “vulvodynia has a negative effect on the quality of life of women and their partners and entails a profound emotional burden personal and social”. Regarding pelvic floor physiotherapy, this nurse recalls that its benefits have been proven and that it can be a good complement in the treatment of vulvodynia.


First and second choice treatments

There is a wide variety of therapies to control the itching and burning caused by this gynecological problem that, most of the time, is of unknown origin . For her part, Belén Lampaya , a gynecologist at the Gynecology Service of the Sanitas La Zarzuela University Hospital , agrees that vulvodynia does not have a single treatment: the essential thing is to carry out a multidisciplinary approach. In her opinion, the first therapeutic option is topical creams with 5% lidocaine which, being an anesthetic, relieves pain, although it does not cure the underlying pathology. “In menopausal women, topical compounds with estrogens can also be beneficial,” adds this specialist. Likewise, this expert indicates that sometimestopical treatment is associated with antidepressants because they help control chronic pain.

At this point, Lampaya highlights that “4 or 10% gabapentin cream in topical preparations has been used in the treatment of vulvodynia with good tolerability and a low incidence of systemic effects .” According to this gynecologist, in the case of women with generalized vulvar pain, it is advisable to apply this cream three times a day. On the other hand, there are topical creams made up of amitriptyline and ketamine or amitriptyline and baclofen that are useful for those women who want to avoid the side effects of oral drugs.. “Amitriptyline compound creams could represent an alternative to gabapentin compound cream for women with generalized vulvodynia: In a prospective study of 150 women with vulvodynia treated with amitriptyline 2% cream, 56% reported mild to excellent improvement and 10% of the improved participants indicated that sexual intercourse was comfortable and pain-free”, emphasizes Lampaya.

For this gynecologist at the Sanitas La Zarzuela University Hospital, infiltration of botulinum toxin in the area is a second-option treatment and results are obtained with it, although it is necessary to repeat the infiltration every 4 or 5 months. “There are therapeutic novelties being studied and it seems that they can alleviate some patients, such as pudendal nerve blocks, acupuncture and hypnotherapy . The recently incorporated treatments include the use of stimulators”, specifies this specialist.

As for surgery, Lampaya warns that “it is not very resolute and is not recommended from the outset , only some cases that are very refractory to other medical or topical treatments would be good candidates for surgery.” 


Reappearance of pain and burning in the vulva

Once this problem has been treated, how can you prevent its reappearance? “It is essential to avoid all triggers that can sensitize the vulva and cause pain again. If necessary, we can use lubricants during sexual intercourse, or use compresses or wash with cold water to avoid pain”, suggests Domínguez. In addition, this nurse advises preventing infections such as candidiasis and repeated trauma to the vulvar area, as well as the use of aggressive chemical products.

For Martínez and Jiménez, it is important to follow self-care guidelines that include proper intimate hygiene (use soft, fragrance-free toilet paper, use neutral soaps , avoid panty liners, opt for cotton pads and apply emollient creams after cleaning); the use of suitable tissues and a series of habits during sexual intercourse (use of lubricants without propylen-glycol, application of cold compresses after having sex and urinating after having sex).

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