Hi,
Welcome back to icliniq.com.
I would like to reiterate that vulvodynia is actually a complex condition where exact etiology has not been found. Various reasons and causes have been listed depending on the presentation. It has varied presentation in different women. Many women experience vulvar pain and discomfort that affects the quality of their lives. Vulvodynia is described by most patients as burning, stinging, irritation or rawness. It is a condition in which pain is present although the vulva appears normal (other than erythema). Now the question is how long and how to treat it?
As it is not an infection, we do not need antibiotics which kill the infection completely and say it is over. This painful sensation can have varied causes right from increased urinary oxalates, genetic or immune factors, hormonal factors, inflammation, infection and neuropathic changes. Most likely, there is no single cause. Now these causes do not have a single treatment, so a multi-modality treatment is preferred. What I follow is mentioned below and in lines with ACOG (American Congress of Obstetricians and Gynecologists) guidelines. Gentle care of the vulva is advised. The following vulvar care measures can minimize vulvar irritation:
1.Wear 100% cotton underwear and no underwear at night.
2. Avoid vulvar irritants such as perfumes, dyes, shampoos, detergents and avoid douching.
3. Use mild soaps for bathing which should not get applied to the vulva.
4. Clean the vulva with water only.
5. Avoid the use of hair dryers on the vulvar area.
6. Pat the area dry after bathing, and applying a preservative-free emollient (such as vegetable oil or plain petrolatum) topically to hold moisture in the skin and improve the barrier function.
7. Switch to 100% cotton menstrual pads.
8. Use adequate lubrication for intercourse.
9. Apply cool gel packs to the vulvar area.
10. Rinse and pat dry the vulva after urination.
Treatment: No single treatment is successful in all women. Expectations for improvement need to be realistically addressed with the patient. Emotional and psychologic support is important for many patients, and sex therapy and counseling may be beneficial. Antidepressants have been found to have a 60 % response rate for various pain conditions; however, no randomized controlled studies have been published regarding the use of antidepressants for vulvodynia. Both tricyclic antidepressants and anticonvulsants take time to achieve adequate pain control, which may take up to three weeks. Patients usually develop tolerance to the side effects of these medications particularly sedation, dry mouth, and dizziness. To add there is biofeedback and physical therapy and if nothing works then vestibulectomy is done where that vulvodynic part is removed. Now the important part, the duration of treatment is not defined anywhere and varies from woman to woman. Pain can be controlled to about 80-90% in maximum number of cases with tricyclics and biofeedback and physical therapy but 100% cure is not present as pain again is a subjective feeling.
So, aim of the therapy remains that the woman should be able to lead a normal life with minimal acceptable discomfort (I hope you understand what I mean here). In my practice, I have seen three cases as of now and all three are maintained on tricyclics and general measures plus physical therapy. So, my suggestion would be to keep up the positivity and avoid taking it as a disease. Take due medications to control it and try adapting with it.