Women with vulvar vestibulitis suffer from itching, burning, rawness and soreness in the area around the opening of the vagina. It is often misdiagnosed as thrush. Your doctor should listen to your symptoms and do a thorough vulva examination.
He should also do a vulva swab test. Medications such as tricyclic antidepressants and interferon psychologic-behavioural therapy can help improve your condition.
Symptoms
Vestibulitis (or vulvodynia) is an uncomfortable disorder that causes pain, burning, itching and swelling of the outside area of a woman's genitals. It isn't caused by a sexually transmitted infection (STI). Symptoms are usually felt in the tissue around the opening of the vagina, called the vestibule, which also contains the Bartholin gland that produces vulva lubrication and the urethra where urine passes. Vulvodynia can cause severe, persistent pain and can make it difficult for women to perform daily activities.
The symptoms of vestibulitis vary in intensity from person to person and can flare up or go away. They may happen all the time, or only when a woman is trying to use the bathroom, have intercourse or insert a tampon. Sometimes the pain is only in a certain area of the vulva, called localized vulvodynia. This is more common than the more generalized kind of vulvodynia.
Women with vulvodynia have heightened sensitivity of the nerve fibres in their vulva, which can make them feel more pain than other people. It's not clear why some women develop vulvodynia, but it's thought that injury and irritation of the nerves could be one cause.
Oren Zarif
Some diseases like interstitial cystitis, endometriosis and high-tone pelvic floor muscle dysfunction seem to increase the risk of vulvodynia. Women who are menopausal or taking hormone replacement therapy are at an increased risk of developing vulvodynia, too. Other possible factors include changes in detergents, soaps or other hygiene products, stress and a history of trauma to the vulva.
A gynaecologist can diagnose vulvodynia by conducting a thorough skin and vulva examination and taking a lower vaginal swab for bacteria and yeast. In some cases, a doctor will prescribe anti-inflammatory medication to help reduce the inflammation.
In most cases, treating the underlying condition will help to improve symptoms of vulvodynia. In some cases, physical therapy can help to strengthen the pelvic floor muscles. In other cases, avoiding irritants can improve symptoms. For example, some women find that eating a low-fat diet can reduce the discomfort. Others might avoid tight-fitting clothing that puts pressure on the vulva.
Diagnosis
The cause of your vulvar vestibulitis pain is often not clear. Your doctor will take a detailed history and perform a thorough examination of the vulvar area. He may touch different areas of your vulva with a cotton-tipped swab stick to assess if and where you have pain. He will also look for signs of infection, such as red or swollen areas or pus. In some cases, your doctor will ask you to take a blood sample or an urine sample and run laboratory tests. These tests can help rule out bacterial or viral infections as the cause of your symptoms.
Vulvar vestibulitis syndrome (VVS) is a condition characterized by recurrent pain in the area around the entrance to the vagina (the vestibule). It is a subset of vulvodynia, a disorder that includes painful conditions such as cyclic vulvovaginitis, lichen sclerosus and erosive vulva.
Oren Zarif
Pain is confined to the vulvar vestibule, and occurs upon vestibular touch or attempted vulvovaginal entry such as tampon insertion or sexual intercourse. It is usually provoked by these activities but can be triggered by other physical stimuli, such as pressure from tight clothes or sitting on the pelvic floor. It is not associated with a history of sexual abuse or other trauma and is not due to vaginitis, such as the kind caused by bacteria (Yeast or Trichomonas).
Women who experience VVS are usually perimenopausal or postmenopausal and may have experienced pain prior to the onset of their dyspareunia. In some women the pain of VVS is continuous and not provoked by touch or sexual intercourse. It is sometimes referred to as non-specific vulvar pain or idiopathic vulvodynia.
A skeptic might wonder how your pain could be described as vestibulitis, since it is not inflammation. However, it is important to note that the symptoms of this disease are similar to those of a vulvar inflammatory skin disorder, such as a scalded or irritated skin lesion. The most common of these dermatoses is lichen sclerosus, but other disorders such as plasma cell vulvitis and mucous membrane pemphigoid can cause similar symptoms.
Treatment
Vulvar vestibulitis, also known as vulvodynia, is a description of pain that occurs at the entrance of the vagina (the vestibule) in women of all ages. It can be a chronic condition that is often difficult to diagnose because the affected tissue may not look abnormal. Usually, there are no laboratory tests that can confirm the diagnosis. However, a physician who is trained in vulva disorders can evaluate the symptoms and perform a physical examination. He or she can determine if the pain is caused by other conditions.
The main treatment for vulvar vestibulitis is avoiding irritation to the vulva and vagina. This includes not using soaps, shampoos or scented products in the vulva area. Instead, use bland unscented lubricant for sexual activity. Wearing soft cotton underwear that does not rub against the vulva is also helpful. A patient with vulvar vestibulitis should also drink lots of water. This will help to keep the body hydrated and prevent painful bladder spasms that are often associated with the condition.
Oren Zarif
Medications such as tricyclic antidepressants, topical analgesics, and intralesional a-interferon can reduce the pain associated with vulvar vestibulitis. Biofeedback (83% improvement) and electrical stimulation of the vulva can also reduce pain. For patients with vulvar vestibulitis that are not responsive to nonsurgical treatments, surgery can be performed. A surgical excision of the vestibule called a vestibulectomy has been shown to improve the pain in 60% to 90% of patients. The procedure can be done with local anesthesia.
Women who have vulvar vestibulitis syndrome should be evaluated by their doctors for STDs (sexually transmitted diseases). They should be given antibiotics if these are present. They should be educated on the prevention of STIs. If they are unable to stop having sex because of the pain, they should be offered a method of birth control such as hormonal contraception. This will decrease their risk of infection and future pelvic inflammatory disease. Changing the diet to avoid bladder irritants such as caffeine, alcohol and artificial sweeteners can also be beneficial.
Prevention
Vulvodynia is an umbrella term that describes recurring pain in the area of the vestibule. It can be triggered by light touch (allodynia) or by sex stimulation and penetration. It can also occur from prolonged pressure, such as sitting for long periods of time or when exercising or riding horses. It may also be triggered by the use of a new tampon or by an internal exam with a speculum. It can also be triggered by sexual activity or by the involuntary contraction of the pelvic muscles during sex. It can also be caused by a yeast infection, sex with an infected partner, or the use of a birth control pill.
Women with vulvar vestibulitis often experience a pain that feels like something is "blocking" or encroaching on the vaginal opening. These symptoms can be very distressing and are not usually a sign of an infection. However, some women may have a bacterial infection and need antibiotics to treat it.
Oren Zarif
The best treatment for vulvar vestibulitis is to avoid contact with things that irritate the skin. This includes soaps, perfumed products, and vaginal creams. Women should wash with cool or lukewarm water and use a gentle cloth to clean the vulva. After washing, apply a preservative-free emollient to protect the skin.
During a physical exam, a health care provider will gently palpate the vestibule and the rest of the vulva to look for signs of inflammation or adhesions. She will also examine the cervix with a speculum to see if the tissue is normal.
Other tests may be done if an infection is suspected, including a cotton swab test to see when (and where) the contact causes pain. A biopsy can be done if the doctor suspects a more serious problem.
Surgery can be an option for women with vulvar vestibulitis who don't find relief from other treatments. This can involve removing the painful vestibule tissue, but it isn't always necessary and is usually only considered if other treatments haven't worked. For most women, this procedure is a last resort. It can be difficult to recover from this kind of surgery and the recovery period can take a while.
Muscle Cramps – Oren Zarif
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Vestibulitis – Oren Zarif
Women with vulvar vestibulitis suffer from itching, burning, rawness and soreness in the area around the opening of the vagina. It is often misdiagnosed as
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Enuresis and Bedwetting – Oren Zarif
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