How to Treat Vulvodynia
When a patient presents with < 6 months of symptoms in the absence of an obvious infectious or dermatological condition, management includes: skin care and symptom management.
Patient self-treatment with over-the-counter vaginal preparations should be strongly discouraged. Irritant dermatitis is one of the most common causes of vulvar symptoms and topical treatments aggravate this condition. Patients should be informed that they cannot “wash their symptoms away”. Women should be instructed to avoid all chemicals, including soap, and all synthetic material.
See patient handout re: General Skin Care Recommendations
Next patients should be advised as to how to relieve their discomfort. Mild discomfort associated with intercourse can be reduced with the application of topical anesthetics prior to intercourse, the use of sexual lubricants and the application of an ice pack after intercourse. Mild steroids or oral antihistamines can be used to relieve itching that leads to scratching. Topical potent steroids Class I or II should not be used to treat symptoms such as itching, burning, or dyspareunia. There is no evidence to support the use of potent Class I or II steroids (eg. Dermovate or Betamethasone) and even experts do not support its use for treating vulvodynia.
See patient handout: Symptom Control
Patients who have been suffering from vestibulodynia for greater than 6 months fit the definition of a chronic pain disorder.
- Patient education & support.
- Pain relief.
- Addressing mood and sexual concerns.
- Assessment and management of pelvic floor dysfunction.