Chronic Pelvic Pain – Vulvodynia

Many women suffer from chronic pelvic pain. Often this starts as something minor – such as a bladder infection or thrush – but can also be the result of years of painful periods, chronic constipation or pelvic muscle tension for example.

A frequent complaint is painful sex – specifically pain with initial penetration. Often this has been treated many times as recurrent episodes of thrush and co-existing bladder symptoms as recurrent bladder infections. The sensitivity is in the same area that thrush causes itching but burning without itching is usually not thrush! Symptoms are often described as burning, paper-cuts and feeling like sandpaper with the friction of intercourse. Difficulty with penetration because ‘there is something in the way’, ‘a barrier’, ‘a wall’. The burning can linger after sex and when passing urine. An ache can continue into the next day or two. Sometimes there was always difficulty using a tampon. Often IBS and an overactive bladder co-exist. Anxiety tendencies and A-type personalities are more common in women who struggle with this which fits in with a hyper-alert nervous system.

This particular manifestation of chronic pelvic pain is known as vulvodynia, also called vulvar vestibulitis syndrome, and it is really common but frequently goes unrecognised for a long time.

The cause can be simple but the persistence becomes complex as more factors become involved: local irritants, pelvic muscle responses, overactive peripheral and central nervous systems, stress factors – physical and psychological – and others.

The treatment has to take account of all factors that help to perpetuate the problem and focusses on breaking the cycle of discomfort: pain causes guarding of the vaginal and pelvic muscles; tense muscles become achey and trigger stronger pain with attempted intercourse; painful intercourse causes an increase in muscle tension and sensitises the nervous system further which causes more pain…. and the cycle continues.

Identifying the most effective treatments requires an organised approach starting with a very comprehensive history and examination. This part cannot be rushed and is fundamental to successful treatment. A multidisciplinary team (see Cape Pelvic Pain Clinic is often needed to manage the condition effectively but a simple strategy to start with can pay huge dividends. ‘Staying with the programme’ is most important as successful management comes down to your investment in the process.

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