Last week I was part of a panel of experts on vulvodynia who spoke about the treatment of this confounding syndrome at Mission Hospital. Vulvodynia–literally, pain in the vulva area–can be distressing for both a woman and her partner. Basically, vulvodynia is best described as searing pain on the outer part of a woman's genitals. It can occur right at the entrance of the vagina, in the area surrounding the entrance, or onto the clitoris. Vulvodynia can make intercourse extremely difficult; women describe the friction as feeling like sandpaper being rubbed over the affected area.
Who gets vulvodynia? Women of almost any age can be afflicted with this syndrome. At one time, women who had this problem were pretty much told "it's all in your head," and in fact women in other parts of the country who may not have access to women's sexual medicine experts are often left without a diagnosis after a visit to the gynecologist.
The experts on the panel, including myself, all agreed on one thing: It takes a village to properly treat vulvodynia. A woman's treatment team must consist of a medical doctor who knows how to diagnosis and treat vulvodynia. Treatment is very individualized; what works for one woman beautifully may not work at all for another. Medical treatments include numbing creams, antidepressants (help with perception of pain), hormone balancing, and sometimes, surgery. Women also benefit from visiting a physical therapist who specializes in pelvic floor work. The PT can help relax tense muscles in the pelvic floor, which helps relieve pain.
A psychologist who has training in sex therapy is the best choice for helping a woman who has sexual pain of any kind. Again, it isn't that the pain is in a woman's head. It is that there are things that can make the perception of pain worse. When a woman is anxious, sad, or stressed (sometimes about the condition itself) it can make pain feel worse.
It goes without saying that vulvodynia affects not just the woman, but her partner. Most heterosexual couples enjoy having the closeness and intimacy of sexual intercourse, but when a woman has vulvodynia it makes intercourse impossible or nearly so. Some couples are able to be sexual in other ways, but some avoid sex altogether. Needless to say, a woman's drive may also diminish. She may feel ashamed or guilty because she is unable to function sexually for herself, for her partner, and as a normal woman in her own eyes.
It was once thought that women with vulvodynia were survivors of sexual trauma, but this is not always the case. Some women have vulvodynia because of nerve injury, abnormal response to infection, repeated infections like yeast infections, allergies to chemicals such as the scent used on feminine hygiene products or soaps, and muscle spasms. But since 25% of females are estimated to have been sexually abused, it is no wonder that there can be overlap. Having been sexually abused can also contribute to heightened perception of physical pain.
Are you or your partner suffering with sexual pain? You can start any place you wish in terms of treatment and then count on getting appropriate referrals to other team members. Some people start with a psychologist who is a sex therapist because they already know they are anxious or sad, or their relationship is in danger of collapsing because of lack of sexual activity. The Buehler Institute is a unique resource in Orange County, CA. I am a member of various organizations that specialize in sexuality and sexual pain disorders; am certified by AASECT as a sex therapist; and have a great deal of experience in treating women who have vulvodynia and similar problems. I also know how to collaborate effectively with other team members.
Have you had difficulty getting appropriate treatment? Please comment.