“If Sex Hurts, Am I Still a Woman?” The Subjective Experience of Vulvodynia in Hetero-Sexual Women (original) (raw)

Current perspectives in vulvodynia

Women's Health, 2009

Vulvodynia, or chronic vulvar pain, is a common but poorly understood condition. Although its etiology is not well understood, it appears to be multifactorial. As such, treatment options are targeted to reduce singular symptoms in a piecemeal fashion. A number of randomized, controlled trials have been conducted and at least one paper on combination therapy has been published; however, further systematic research is needed in order to more fully inform clinical practice. †

Vulvodynia: Assessment and Treatment

The Journal of Sexual Medicine, 2016

Introduction: Vulvodynia constitutes a highly prevalent form of sexual pain in women, and current information regarding its assessment and treatment is needed. Aim: To update the scientific evidence published in 2010, from the Third International Consultation on Sexual Medicine, pertaining to the assessment and treatment of women's sexual pain. Methods: An expert committee, as part of the Fourth International Consultation on Sexual Medicine, was comprised of researchers and clinicians from biological and social science disciplines for the review of the scientific evidence on the assessment and treatment of women's genital pain. Main Outcome Measures: A review of assessment and treatment strategies involved in vulvodynia. Results: We recommend the following treatments for the management of vulvodynia: psychological interventions, pelvic floor physical therapy, and vestibulectomy (for provoked vestibulodynia). We also support the use of multidisciplinary treatment approaches for the management of vulvodynia; however, more studies are needed to determine which components are most important. We recommend waiting for more empirical evidence before recommending alternative treatment options, anti-inflammatory agents, hormonal agents, and anticonvulsant medications. Although we do not recommend lidocaine, topical corticosteroids, or antidepressant medication for the management of vulvodynia, we suggest that capsaicin, botulinum toxin, and interferon be considered second-line avenues and that their recommendation be revisited once further research is conducted. Conclusion: A comprehensive assessment is needed to understand the pain experience of women presenting with vulvodynia. In addition, treatment typically progresses from less invasive to more invasive, and several treatment options are worth pursuing.

Vulvodynia Viewed From a Disease Prevention Framework: Insights From Patient Perspectives

Sexual Medicine Open Access, 2020

Introduction: Persons with vulvodynia (a chronic vulvar pain condition) suffer many barriers to diagnosis and treatment, several of which may be exacerbated by the sociocultural and geographical context in which they live. Aim: We drew on the experiences of patients with vulvodynia who were living in small urban and rural communities to learn what they perceived as the major barriers to diagnosis and treatment as well as to probe for possible solutions. Methods: For this qualitative case study, we conducted 3 focus groups with a total of 10 participants, drawn from patients seen at our academic tertiary referral center, with a goal of understanding their lived experience with vulvodynia. Main Outcome Measures: The patient dialogue was coded into themes and temporally grouped to illustrate struggles and victories in diagnosis and treatment. Results: Participants confirmed that healthcare provider knowledge and attitudes as well as system challenges (specialist and allied healthcare provider availability) are major barriers to timely diagnosis. Of novel interest are other factors that exacerbate distress and delay diagnosis such as patients’ inadequate knowledge of sexual functioning and sociocultural messages regarding “normal” sexual activity. Our work suggests that a disease prevention framework that includes comprehensive sexual education before or at the onset of sexual activity may be of benefit in reducing the burden of vulvodynia when added to strategies to increase healthcare provider knowledge and improve access to effective treatments. Conclusion: While healthcare provider knowledge and attitudes are often at the forefront of barriers to diagnosis, our study suggests that to minimize patient distress and expedite diagnosis, resources must also be directed to promoting comprehensive sexual health education.

Vulvodynia: Definition, Prevalence, Impact, and Pathophysiological Factors

The journal of sexual medicine, 2016

Vulvodynia constitutes a highly prevalent form of chronic genital pain in women, and current information regarding its definition, prevalence, impact, and pathophysiologic factors involved is needed. To update the scientific evidence published in 2010 from the Third International Consultation of Sexual Medicine pertaining to the definition, prevalence, impact, and pathophysiologic factors of women's sexual pain. An expert committee, as part of the Fourth International Consultation of Sexual Medicine, comprised of researchers and clinicians from biological and social science disciplines, reviewed the scientific evidence on the definition, prevalence, impact, and pathophysiologic factors related to chronic genital pain. A review of the definition, prevalence, impact, and pathophysiological factors involved in vulvodynia. Vulvodynia is a prevalent and highly impactful genital pain condition. Numerous factors have been implicated in its development and maintenance. What is becoming ...

Women in "Sexual" Pain: Exploring the Manifestations of Vulvodynia

This study explored the sexual and pain histories and pain presentations of women with forms of chronic vulvar pain (i.e., vulvodynia). One hundred and seventy-seven women with five subtypes of vulvodynia completed an online questionnaire. Groups were similar across several domains: participants experienced pain for many years during sexual and nonsexual activities, and pain was rated as moderate to severe. However, several differences emerged when considering pain development, number of sexual partners, and treatment seeking. This study illustrates how severe vulvodynia pain can be, regardless of subtype. However, not all vulvodynia sufferers are alike, and distinctions between research and clinical practice are highlighted.

Factors Associated With Vulvodynia Incidence

Obstetrics & Gynecology, 2014

Objective-To assess incidence rates of and risk factors for vulvodynia. Methods-We conducted a longitudinal population-based study of women in southeast Michigan (Woman to Woman Health Study) using a validated survey-based screening test for vulvodynia that was repeated at 6-month intervals over 30 months. Unadjusted incidence rates were determined using Poisson models. Demographic and symptom-related risk factors for incidence were assessed using discrete time survival analysis. Results-Women who screened negative for vulvodynia at baseline and were followed through at least one additional survey (n=1786), were assessed for onset of vulvodynia. The incidence rate was 4.2 cases per 100 person-years, and rates per 100 person-years were greater in women who were younger (7.6 cases per 100 person-years at age 20, compared with 3.3 cases per 100 personyears at age 60), Hispanic (9.5), married or living as married (4.9); had reported symptoms of vulvar pain but did not meet vulvodynia criteria on the initial survey (11.5); or had reported past symptoms suggesting a history of vulvodynia (7.5). Increased risk of new onset vulvodynia also included baseline sleep disturbance, chronic pain in general, specific comorbid pain disorders, and specific comorbid psychological disorders. Conclusions-The incidence rates of vulvodynia differ by age, ethnicity and marital status. Onset is more likely among women with previous symptoms of vulvodynia or those with intermediate symptoms not meeting criteria for vulvodynia, and among those with preexisting sleep, psychological, and comorbid pain disorders. This suggests vulvodynia is an episodic condition with a potentially identifiable prodromal phase. Vulvodynia is a vulvar pain disorder that is typically chronic, and occurs in women of all ages and ethnic groups. The pain varies from mild to excruciating, and may be provokable or spontaneous or both. Vulvodynia is known to be present in over 8% of women, and to affect women across the lifespan and across ethnic and socioeconomic groups. However, information on the onset (incidence) of vulvodynia is limited, and factors associated with this onset are not well understood. Women with vulvar pain are infrequently evaluated by

Vulvodynia: an introduction and critical review of a chronic pain condition

Pain, 2000

Vulvodynia, or chronic vulvar discomfort, has become an increasingly recognized complaint in the medical literature. However, classi-®cation, assessment, and treatment for vulvodynia have not been universally established. There is a serious need for greater understanding of this disorder since evidence suggests, although not life-threatening, vulvodynia appears to have a signi®cant impact on quality of life. This article reviews the medical and psychological literature on vulvodynia published since 1983, the ®rst year vulvodynia was recognized as a diagnosis in the medical literature. The purpose of this article is to provide a review of the literature on diagnostic issues, treatment options, and psychosocial sequelae with the aim of highlighting areas in need of future research. Finally, suggestions are made for considering vulvodynia from a multidimensional, chronic pain perspective.

Remission of Vulvar Pain Among Women With Primary Vulvodynia

Journal of Lower Genital Tract Disease, 2015

Objective-To determine whether rates of remission differed among women with primary versus secondary vulvodynia. Methods-Using a community-based observational study based in Minneapolis/St. Paul, 138 clinically-confirmed cases of vulvodynia between 18-40 years old were classified as primary (vulvar pain starting at the time of sexual debut or first tampon insertion) or secondary (vulvar pain starting after a time period of pain-free intercourse), and queried regarding their pain history to determine whether they had ever experienced any vulvar pain-free time (remission), or pain-free time lasting ≥3 months. Results-Remission prevalence was 26% (9/34) for women in the shortest quartile of duration of vulvar pain (<3.8 yrs), and 38% (13/34) for the longest quartile of duration (≥13 yrs). After adjusting for vulvar pain duration, generalized vestibular pain, medical treatment, body mass index (BMI), and history of pregnancy, women who had primary vulvodynia were 43% less likely to report remission (95% CI: 0.33-0.99) than women with later onset (secondary cases). The association was strengthened when restricting to only remissions lasting ≥3 months (adj. RR=0.43, 95% CI: 0.22-0.84). Generalized vestibulodynia and obesity also reduced the likelihood of remission. Conclusion-Our study underscores the heterogeneity of vulvodynia and provides evidence that primary vulvodynia may have a less wavering course, and as such, a potentially different underlying mechanism than that of secondary vulvodynia.

Women’s Subjective Experiences of Living with Vulvodynia: A Systematic Review and Meta-Ethnography

Archives of Sexual Behavior

Vulvodynia, the experience of an idiopathic pain in theformofburning,soreness,orthrobbinginthevulvalarea,affects around 4-16% of the population. The current review used systematic search strategies and meta-ethnography as a means of identifying, analyzing, and synthesizing the existing literature pertaining to women's subjective experiences of living with vulvodynia. Four key concepts were identified: (1) Social Constructions: Sex, Women, and Femininity: Women experienced negative consequences of social narratives around womanhood, sexuality, and femininity, including the prioritization of penetrative sex, the belief that it is the role of women to provide sex for men, and media portrayals of sex as easy and natural. (2) Seeking Help: Women experienced the healthcare system as dismissive, sometimes being prescribed treatments that exacerbated the experience of pain. (3) Psychological and Relational Impact of Vulvodynia: Women experiencedfeelingshameandguilt,whichinturnled totheexperienceof psychological distress, low mood, anxiety, and low self-esteem. Moreover, women reported feeling silenced which in turn affected their heterosexual relationships and their peer relationships by feeling social isolated. (4) A Way Forward: Women found changing narratives, as well as group and individual multidisciplinary approaches, helpful in managing vulvodynia. The findings of the review conclude that interventions at the individual level, as well as interventions aimed at equipping women to challenge social narratives, may be helpful for the psychological well-being of women with vulvodynia.