Let’s talk about Vulvas and Vulvodynia

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Vulvodynia and other types of Vulvar pain are high on the list of rarely discussed problems that leave women suffering silently. Despite the advances made in the last century in numerous areas, many women still experience a stigma and shame about issues concerning their genitalia. These feelings may be due to a lack of knowledge which allows misconceptions to creep in. How ignorant are we about women’s genitals? This may surprise you.

Did you know that the entire structure of the clitoris was not found until 2005? The clitoris is not just the small gland you see on the Vulva; the majority of it is on the inside. The structure of the clitoris attaches to the pubic arch and has an extensive network of tissue. 

Misinformation causes a lack of understanding of what is ‘normal’ for women’s bodies. For example, labiaplasty, an elective plastic surgery that changes the shape of inner and outer labia has increased by 217.3% over the past five years (1). This alteration of the inner and outer lips of the vagina is often done for aesthetic reasons because women and girls do not feel their vulva looks ‘normal’.  Dr. Naomi Crouch told the BBC that girls as young as nine years old were seeking the cosmetic procedure because they were distressed by the appearance of their vulva.(2)

It is worrisome that women are made to feel ashamed of their genitals. To take this idea further, recall that in our culture, it is highly offensive to call anyone ‘pussy’ or ‘cunt’, slang words that refer to a woman’s vulva. Corresponding slang about male genitals, such as ‘dick’ or ‘putz’ are not nearly as demeaning. In fact, boys and men show a great deal of pride in their penises, something you rarely see girls and women exhibit with regard to their genitals.

Psychology has a number of explanations for this phenomenon. Whether you ascribe to cultural or feminist explanations, it is worth thinking about the physiology of genitals. Men’s genitals are on the outside; much of women’s genitalia is hidden, making it less available for examination. The mystery contributes to the stories about women’s vulvas.

So it comes as no surprise that talking about your vulva is uncomfortable, and having to discuss vulvar pain or painful intercourse is even worse. To add to the frustration and reluctance, when women do summon the courage to get help, they are often misdiagnosed. Shockingly, the National Vulvodynia Association (NVA) estimates that 60% of women with Vulvodynia will see at least three different healthcare providers before finally being diagnosed. (3) 

What is Vulvodynia?

Vulvodynia is defined as chronic vulvar pain without an identifiable cause, that lasts for 3 months or longer. Common symptoms include: painful burning, itching or throbbing at the entrance to the vagina. The entire Vulva can be irritated or just a specific spot.  For some women the pain is constant, others only have pain with pressure or contact on their Vulva, such as during sexual touching, intercourse or sitting for long periods. It is also very common to have pelvic floor dysfunction along with Vulvodynia.

How common is it?

Research studies find that as many as 16 percent of women in the U.S. suffer from Vulvodynia at some point in their lives (4). Estimates vary dramatically from 200,000 to six million. A recent study at the University of Heidelberg revealed a similar percentage of around 16% of German women between the ages of 18 and 64 reporting that they have suffered from chronic vulval pain during the course of their lives (6).  Chronic pain is defined as lasting for three months or longer.

While Vulvodynia affects women of all ages and ethnic backgrounds, I’ve encountered several people who believe this problem happens more often in middle age. Other reports say that the onset of symptoms is most common among women between the ages of 18 and 25 (5). Women may go through periods of varying pain levels as well as some pain free periods, but Vulvodynia can flare off and on for many years.

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What is the cause?

The short answer is the origin is unknown. More research needs to be done on Vulvodynia to get answers and create better treatments. There are various possible causes, and it is likely that more than one factor contributes to the problem. Possible causes and/or contributing factors:

Pelvic floor dysfunction – the muscles of the pelvic floor are too tight, too weak or in spasm

Damage or irritation to the nerves of the vulva

Hormonal changes

Inflammation of the vulva

Genetic factors

Sensitivity to certain foods

Allergies or irritation caused by certain products

Remember: Vulvodynia is not an infection or a sexually transmitted disease

What treatments are available?

Elimination of substances that irritate the genitals

Antidepressants

Serotonin-Norepinephrine reuptake inhibitors

Anticonvulsant medications

Opioids

Topical medications like lidocaine and estrogen cream

Biofeedback

Botox injections in the vagina

Physical therapy for the pelvic floor muscles 

Nerve block medications

Surgery 

Complementary or alternative medicine

What is the impact on women’s lives?

Unfortunately, there are many negative ways Vulvodynia can impact a woman’s life. Living with vulvar pain may lead to feelings of hopelessness, depression and anxiety. 

Vulvodynia often has a huge impact on the quality of life for the women who suffer with it. There is a strain on intimate relationships, and sexual intercourse is often painful or impossible. Some women are too embarrassed to date. Some sufferers find sitting for long periods of time is painful and this can influence their ability to work. Vulvodynia can also limit your clothing choices. Anything tight or clothing that rubs on the vulva can intensify the discomfort, including pants and sometimes even underwear. 

Surgery

If other treatments fail, surgery, called a vestibulectomy, may be recommended. This entails surgically removing some or all of the vulva tissue that is involved. According to the NVA, the success rate of this surgery ranges from 60% to 90% (7). This surgery is sometimes recommended without the patient trying other forms of intervention, but I believe this treatment should be a last resort because it is irreversible.

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How can Chinese Medicine help?

Only a few small clinical studies on the effects of acupuncture for vulvar pain have been conducted. However, the results of those studies are promising. 

One of these results is from Lee Hullender Rubin’s study entitled, ‘The Comprehensive Treatment of Provoked, Localised Vulvodynia with Acupuncture and Associated Modalities’. Rubin, an acupuncturist, researcher and expert in the field, wrote “Acupuncture and Chinese medicine may provide significant benefit to these patients, especially when used as an adjuvant to conventional medicine. The core methods described here resulted in significant pain reductions in women with PLV in a pilot study.” (9) Hopefully, more research will be done to confirm the positive results.

Like the study above, my patients also experience relief when I treat them with regular acupuncture (before you even ask, “No needles in the genital region.”) and Chinese herbal medicine. Many women find that their painful symptoms are greatly reduced or eliminated.

Unfortunately, there is no quick fix for Vulvodynia and it takes several sessions of acupuncture to get lasting results, i.e., no pain during intercourse or at any other time. Combining other modalities, such as physical therapy, with acupuncture can be a very effective combination.

How do I help women online?

I started my practice in Chinese Medicine over 19 years ago. During that time, I’ve worked with many women suffering from Vulvodynia. Increasingly, over the years, I’ve been receiving questions from women all over the world, so in 2019 I began to offer online consultations. 

In some ways, it is similar to an office visit; in other ways, very different. When I work with women online, I take a detailed history, have them send me a photo of their tongue which is an important diagnostic tool in Chinese Medicine, and I listen carefully to their story. Once I have background information and an understanding of their symptoms, I work with the woman on an action plan. 

Each plan is different but most include numerous dietary and lifestyle recommendations and tips to help deal with the symptoms. I send all my patients a resource list and follow up notes that detail the plan. Often, I will have both internal and topical herbs sent to the patient. These are personalized and can be very helpful. 

I also discuss other treatment options such as physical therapy and acupuncture. If they are not already in treatment with someone in their area, I encourage them to get into treatment, and I make myself available if their acupuncturist would like to confer with me.

Generally, after the first consultation, there are follow ups to see how they are progressing and to change herbal formulas if needed. It has been working very smoothly and allows women access to treatment that might otherwise be unavailable. The consultations have been successful, and I am glad more women have access to treatment that might otherwise be unavailable.

Here are several suggestions you can try on your own. Some work for one woman and not another, but they are all safe and easy.

Eliminate environmental irritants like deodorant products, scented soaps, bubble baths, chlorinated water and synthetic fabrics (stick with cotton underwear). 

Eliminate spicy foods, caffeine and sugar. 

Stay away from tampons.

Soak in a lukewarm or cool bath.

Wear loose fitting clothing.

Stay out of hot tubs. 

Try a few simple yoga poses – Yoga For Vulvodynia Pain Relief

When having sex, use a lubricant that is free of all potientally irritating chemicals. One product to try is Sliquid Organics Natural Lubricating Gel.

In Conclusion

There are effective treatments out there for women suffering with Vulvodynia, but it is not one size fits all. Both the patient and their healthcare practioner need to be persistent in search of the right therapies for their particular case.

I believe Acupuncture, Chinese Medicine, and pelvic floor therapy can be very effective treatments for Vulvodynia. They can help relieve the pain associated with Vulvodynia and improve a woman’s quality of life. Lifestyle and dietary changes also contribute to pain relief. 

One of the biggest challenges at the moment is to receive the correct diagnosis of Vulvodynia. Too many patients have to see multiple doctors. In addition to that, the shame of talking about Vulvodynia and Vulvar pain also hinders patients from seeking help at an earlier stage.

Sarah’s story (names and details are altered to protect privacy)

“The first time I experienced vulvar discomfort was when I started using tampons around age 13. I didn’t think too much of it and assumed that was just normal. But I still tried to avoid using tampons as much as possible because of the pain. As I got a little older, and started to date, I realized that something must be wrong. Anytime I was touched (even a light touch) on a specific part of my vulva, I would recoil in pain. 

I couldn’t really discuss it with anyone; I was too embarrassed. One of my lowest moments was when a boy I had been dating, quickly dumped me and said “I was weird” after a make-out session which ended with me in tears. 

When I entered college, I finally decided to see a doctor. But seeing a doctor made it almost worse. He didn’t think anything was wrong with me and didn’t take me seriously, he said “I would grow out of it”, I wanted to punch him! After a while, I decided to try another doctor. The outcome, however, was similar, though I did get a prescription for lidocaine, a topical anesthetic, which helped a little. It started to interfere so much with my personal life and how I felt about myself. I was in college and wanted to be able to date like everyone else, so I did some research and finally found a doctor who specializes in vulvar conditions and she diagnosed my symptoms as provoked localized Vulvodynia. 

My doctor recommended starting pelvic floor therapy and continuing with topical anesthetics The pelvic floor therapy helped, but my then my physical therapist suggested I try acupuncture to get better results. After doing some research, I found Jenny. I started to have some relief after a few treatments, but continued regular treatments (twice a week) for about 3 months. I also continued my physical therapy. 

Jenny had several helpful suggestions and  added Chinese Herbs to my treatment plan, which I’ve been taking daily. Three months later, I felt so much better! I am able to live a normal life again and date! I still see Jenny about 4-5 times a year and I am still taking my Chinese Herbs, but I haven’t had major pain flare up in several months. – Sarah, 24, Chicago

A version of this article has been published in the Dutch Women’s Magazine Cyclus & Zo:

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Learn more about the creator of the magazine, acupuncturist Melanie Peters HERE

1.  American Society for Aesthetic Plastic Surgery https://www.surgery.org/sites/default/files/ASAPS-Stats2017.pdf

2.https://www.independent.co.uk/news/health/labiaplasty-vagina-surgery-cosmetic-procedure-plastic-study-international-society-aesthetic-plastic-a7837181.html

3. National Vulvodynia Association https://www.nva.org/what-is-vulvodynia/ 

4. Harlow 2003, Pukall 20165. https://www.nva.org/media-center/

5. Harlow 2003 https://www.nva.org/media-center/

6. https://www.omicsonline.org/germany/vulvodynia-peer-reviewed-pdf-ppt-articles/

7. NVA

8.. The Comprehensive Treatment of Provoked, Localised Vulvodynia Journal of Chinese Medicine • Number 120 •June 2019

https://www.healthywomen.org/condition/vulvodynia
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4014358/
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