Let's talk about vulvodinia

Treatment from vulvodynia is an unsolved health, social and economic problem: a path between inconvenience, false myths and effective solutions

There are still too many women, both very young and in fertile age, but also after menopause, which suffer from vulvodynia and who often do not know it.

Although about 15% of the entire female population is affected, as described in various articles and studies, Vulvodinia still remains a pathology little known by the medical class and society.

In fact, there are countless patients who, not knowing what to do, have turned hopeful to their gynecologists and gynecologists to receive, instead, answers such as "Miss, her pain does not exist, is only in her head", "lady, the lady, the Her is only a cystitis, aspects that I prescribe a cycle of antibiotics, eggs and lavenders "or some amazing remedy without any clinical rational, insisting with patients on the fact that the doctors were right.

There are too many doctors who, realizing that they do not know, do not give the answer they should give, that it is only one: “I don't know what to do to help it, it is better that he reaches a more prepared professional than me in This matter, in the meantime, I will try to fill this lack of knowledge of mine. "

Unfortunately, this admission is not very widespread.

I also happen too often, however, episodes of invalidation of pain and symptoms, diagnosis and completely incorrect therapeutic plans, lack of ability to recognize and correctly treat this gynecological problem.


Fortunately, thanks to the commitment of many activists and many professionals*, Vulvodinia is starting to finally have a concrete space in the discussions, both at parliamentary level and at a medical level but also in the population itself.

In fact, it is not possible that a patient suffering from this pathology knows more than many doctors who should, however, be able to help this person and guide it through the process of care and healing.

According to a European study conducted in 2019, between 45% and 60% of gynecologists do not know how to make a diagnosis of vulvodynia; 20% know it, but it would not be able to treat it: this percentage, in most, focuses in northern Italy. All this causes a diagnostic delay of years: some patients waiting for a few years, others who have also waited between 12 and 15 years before receiving a diagnosis.


The causes of the lack of knowledge are manifold: primarily the patriarchal and male chauvinist society for which a pain like this has been recognized in the past - and it is still, unfortunately, by multiple doctors -  As mental, therefore not organic and physical. It is no coincidence that words hysteria and the like derive from Histerëcus, which means uterus, allocating the cause of mental pathologies to women in general. But still today in Italian medicine and surgery schools, often pathologies such as vulvodynia are only mentioned, but not addressed in detail how it would be correct to do.


All this feeds an incorrect circulation of information, giving space both in the world of internet and between different professionals - who have very little professional, would be said - in buffaloes concerning both the causes of vulvodynia and i remedies.

Let's see, therefore, some of these false myths and what are the correct therapies that are proposed by serious and really prepared professionals.


Be wary of any professional who tells you that to heal from vulvodynia you need to have more sexual intercourse - in different positions and without being tense -;  that the pain derives from the fear of having relationships or that is caused by a lack of desire for one's partner; be wary of those who indicate the cause of pain in stress,  From those who recommend trying the mauve, various types of supplements and homeopathic products or even using crystals - yes, we are really talking about crystal therapy - or by those who denote your pain.

Spoiler: It is not normal to feel pain.

Also be wary of those who recommend that you get pregnant, because pregnancy solves everything: it is not so.

Or maybe to indulge in alcohol to inhibit pain.


These are just some of the answers that numerous patients have felt and still feel.

Vulvodinia does not care like this!


First of all, you have to diagnose it correctly and this is done through the Cotton Swab Test and the anamnesis performed together with the patient, listening to everything the patient feels to share and tell, investigating above all the type of pain he feels, how he feels during Sexual intercourse and outside of these, and if you also notice intestinal disorders.

There are many questions to ask for an accurate and appropriate anamnesis: a real professional will not be limited to those mentioned above, but it will do further to complete their differential diagnosis of vulvodynia.

It is then necessary to carry out an evaluation of the tone of the pelvic floor to understand the latter's state: hypertone of the pelvic floor and vulvodynia, in fact, go hand in hand. These diagnoses must follow both a therapeutic plan and the rehabilitation of the pelvic floor, which cannot be omitted in the presence of hypertone.


The care of vulvodynia is not based only on these passages made by a*gynecolog*, but a multidisciplinary approach must be adopted which also includes others*of health, such as physiotherapist*, endocrinologist*urologh*, nutritionist*, psychotherapeut*/ Psychiatr* and graduate* in motor and sports sciences: there are really many components to consider and on which you can work for a better lifestyle.


Since the causes are various and different, the therapy must be not only personalized, but also adapted to the patient's symptoms. 

To establish a healthy therapeutic relationship between doctor-patient, it is fundamental:

  • Believe the patient and listen to it;
  • avoid making her feel responsible for your pain and what she is facing;
  • avoid overestimating the secondary benefits;
  • Avoid making it passive and dependent, because the best approach is that the patient is the active protagonist of his care process;
  • Asking how pain persists instead of asking why;
  • Clearly define realistic objectives towards which to accompany the patient and adapt the style of the treatment to the latter.


And here we are finally at the heart of this article: the various treatments of the vulvodynia, which are very different from each other and through which we try to optimize pain control - in the awareness that its total disappearance may not be possible - and improve the state of psychophysical well -being and thus the quality of life.

Among the pharmacological therapies, the most effective on a systemic level are cyclical antidepressants, the anticonvulsants and selective inhibitors of the Ricapation of serotonin (SSRI) off-label who, with lower dosages, interrupt the circuits of chronic pain and the abnormal sensitivity of the nerves Causant the hill, that painful sensation that is perceived without really being damage.  If the doctor considers it appropriate to prescribe these drugs will inform the patient of possible side effects and will agree with her the methods of taking. 

At local level, topical cream anesthetics can be applied, such as lidocaine, directly in vestibular seat to transiently alleviate pain, especially before sexual intercourse.

Furthermore, there are also formulations in combination with antidepressants/anticonvulsants to improve and enhance their effectiveness on a topical level.


It is also possible to use inhibiting creams the mastocytic activity in order to avoid a hyperactivity of mastocytes. These are based on aliampides, such as adelmidrol, or chromoglietal sodium and pulidatin, elements that prevent the degranulation of mastocytes. The association of these active ingredients can be an excellent adjuvant in the control of the inflammatory response proper to the trigger, the maintenance and reactivation of the neuropathic alterations of the vulvodynia.


Physical therapy is associated with drug therapy: each therapy program, from pharmacological to manual, to the psychological one, is customized based on the results of the patient's initial evaluation.

The physiotherapist has fundamental tasks in the treatment process: in fact, in addition to the evaluation and manual rehabilitation of the specific musculature of the pelvic floor and the pelvis, it must carry out a postural evaluation and the patient breathing, because the diaphragm works in association with the muscles of the pelvic floor. This assessment must follow the correction of incorrect postural attitudes and the teaching of a good practice to which the patient must comply, such as stretching exercises and detention of the musculature involved in the hyperto.

Any muscle tensions of the basin area, then, influence the contracture of the musculature of the pelvic floor and, therefore, it will also be to be acting on these.

The manual therapies carried out with physiotherapy and physical ones, that is, through the use of machines, if performed regularly, give relief in 80% of cases. 

Physical therapy is that of electromyographic biofeedback that allows you to learn a self-rhymeing method to control muscle contractions and, consequently, pain.

The purpose of therapy is to allow the patient to learn to control the pelvic musculature, gradually reducing the hypertone that characterizes it.

Among the physical treatments, it can also be used to Tens (transcutaneous nervous electrical stimulation), a technique that consists in applying some electrodes on the affected part that emit low frequency electrical impulses capable of inhibiting the nerve afferents involved in the transmission of pain . 


A medical and pharmacological principals must then be joined by a lifestyle and behavioral style aimed at minimizing irritative stimuli, perhaps using certain intimate and non -intimate clothing or the use of products suitable for the care of intimate hygiene.

A psychotherapeutic support can be useful, in particular when elements referable to psychological trauma or physical and/or sexual abuses are highlighted in anamnesis.


When, however, this type of solutions should not be sufficient, it is possible to resort to more invasive treatments, such as infiltrations in the submucous vestibular and local anesthetic vestibulars, which, through the rapid interruption of the symptom, the anti -inflammatory action And the inhibitory effect exercised on nerve fibers make it an effective method.

Another type of infiltration is the muscle one of botulinum toxin, which acts at the level of the neuromuscular junction by inhibiting the release of acetylcholine and, therefore, causing a muscle spasm-lisure.

Surgery, usually used as the last solution, can also be a therapeutic tool to face this pathology.

There is therefore a series of different treatments of which to use and many others are still under study within several clinical trials.


One question, however, arises in the face of all this: who is to pay for all these care? Patients, of their own pocket.

It is estimated that a woman, in fact, can spend up to 50 thousand euros over the entire path of diagnosis and care of vulvodynia.

The shortcomings of the National Health Service have allowed several private specialists, self -styled "guru" propinators of totally ineffective remedies, to ask for astronomical figures for a first visit or also for a simple evaluation of the pelvic floor. The price, even if an average is made, still remains expensive: between 150 and 250 euros for gynecological visits, every month at least 300 euros of physiotherapy, between 50 and 100 euros of really effective supplements and about 50 euros of non -drugs deductible. Without taking into account the cost of psychotherapy.

And who cannot afford such an expense? Unfortunately, we know the answer.

In addition to the poor training of specialized medical personnel, Vulvodinia is not recognized even by the state: it demonstrates the fact that the disease does not appear in the essential levels of assistance (Lea), that is, it is not a disease for which services or services provided are provided by the National Health Service, but they are all paid.


The vulvodynia is and, unfortunately, remains still doubly invisible: to the doctor, who does not know and recognize it, and to the state.

The only ones to see it are the patients left to suffer their presence in their lives.

And it is time that this invisibility cloak is removed.


Lorenzo Ciol

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