Vulvodynia

As a Private Gynaecologist I am seeing more patients who cannot access NHS GPs or experience a long waiting time for Gynaecology appointments and treatment. This is very much the case for women who suffer from the pain associated with Vulval Vestibulitis and vulvodynia.

Vulval Vestibulitis is a treatable condition. I remain disappointed by how many women still suffer from this chronic condition, and do not have swift access to treatment.

But what is Vulvar Vestibulitis? (VVS)

Vulval Vestibulitis is a characteristic pain which develops around the vulva or the vestibule-just outside the vagina. This pain causes redness and irritation of the vulval labial and perineal skin. Vulval Vestibulitis requires a face-to-face consultation with a Consultant Gynaecologist. This will allow the specialist to examine you and advise a specific treatment plan.

The Vulval Vestibulitis diagnosis is based on your history, and also the characteristic findings at examination. Most patients experience a feeling of ‘ground glass on the vulva’. They go on to explain that even using a tampon is the ‘most painful’ experience.

On examination, I often find a characteristic flare on the labia caused by touch, normally with a cotton wool bud.

Clinical Evaluation

I ensure that all my patients will have a thorough pelvic evaluation to rule out other pathology. If I am concerned about either a candidal vaginitis or bacterial vaginosis, I will assess this during the examination, and I will send swabs for analysis. There can be more than one cause for symptoms.

Histological biopsies are only be performed only if there is a vulvar abnormality or a lesion. Often the only clinical finding found is erythema or redness of the vulvar tissue. If vulvodynia is the diagnosis, pain mapping with a Q-tip test is vital.

• It can affect women at any age.

• Vulval Vestibulitis can be caused by a candidal (thrush infection).

• It is a chronic pain syndrome.

• It may be caused by neurological problems in the lower back (referred pain).

What are the benefits of the treatment?

• The medical treatments for Vestibulitis are both effective and transformative.

• The use of low dose imipramine, which is a tricyclic anti-depressant, a treatment successfully helping many women who have this condition.

• Vulval Vestibulitis is a chronic pain syndrome, and imipramine after a three month course is highly effective.

• I continue to offer the Monalisa touch laser as an effective laser treatment for Vulval Vestibulitis. These results using the Monalisa Touch are promising, and some patients only need one treatment.