Vulvodynia treatment

Vulvodynia: treatment with multiple strategies

Which treatments are considered varies from individual to individual. There is no “one” therapy or combination that helps all women equally. It depends on the symptoms, but also the suspected causes of vulvodynia. You may need to try several treatments and see which ones work best for you. And you need to have a little patience – the treatments don’t always have the desired effect right away.

As a rule, several medical specialties are involved in the treatment – such as gynaecology, urology, dermatology, neurology, pain medicine, sex therapy, physiotherapy, psychology or psychiatry. The most important therapy options at a glance:

Vulvodynia: medication

Examples of locally acting medicines (cream, gel) for application to the skin: they relieve pain, have an anesthetic effect or relax the muscles.

Active ingredients used:

• Hormones, for example estrogen
• Lidocaine
• Ketamine
• Gabapentin
• Capsaicin
• Baclofen
• Amitriptyline
• Cromoglycic acid (mast cell stabilizer), as a cream (or nasal spray), also in combination with the anti-allergic cetirizine

In addition, there are other drugs (oral intake) that act not locally on the spot, but throughout the body (systemically). Examples include:

• Tricyclic antidepressants, for example amitriptyline or nortriptyline
• Serotonin-norepinephrine reuptake inhibitors (SNRIs), for example duloxetine or venlafaxine
• Neuroleptics, for example gabapentin
• Opioids – stronger painkillers

Vulvodynia: pelvic floor training and alternative therapies

• Physiotherapy: pelvic floor training is considered particularly effective for vulvodynia. You will learn to relax the often tense pelvic floor.
• Trigger point massage – it targets the trigger points (small hardened nodules) of the muscles and connective tissue sheaths (fascia). Such trigger points can be located in various places, such as the pelvis, vulva, abdomen, thighs (inner and outer) or the iliac crest and sacrum.
• Transcutaneous electrical nerve stimulation (TENS) – a therapy with stimulation current
• Biofeedback: Therapists record unconscious processes in the body and affected individuals receive feedback about them – then train them to influence and change these processes at will.
• Acupuncture
• Hypnosis

Additional Support for Treatment

Psychological support:

• Sexual counseling: You will receive information about the clinical picture as well as help and support for your partnership and sexual life.
• Psychotherapy – cognitive behavioral therapy (CBT). In doing so, you identify unfavorable thought patterns and behaviors. Subsequently, you will learn to replace them with alternatives

Vulvodynia – what you can do yourself

There are also some ways you can start yourself and do something to help improve vulvodynia.

Examples you can put into practice:

• Cold can have a pain-relieving effect. Apply cold packs for about ten minutes about every five hours.
• lukewarm or cool sitz baths, for example with Epsom salt or magnesium sulfate
• soft toilet paper without perfume to avoid unnecessary irritation of the genital area.
• dermatologically tested cosmetic and hygiene products
• 100% cotton tampons or pads
• loose pants that do not constrict and pinch
• Immediately exchange wet swimwear for dry ones
• Relaxation methods: Learn a relaxation technique to reduce stress, such as autogenic training or Jacobson progressive muscle relaxation. Some are also helped by yoga or gentle forms of exercise such as Tai Chi or Qigong.
• plenty of exercise: Endurance sports such as hiking, swimming or Nordic walking are recommended. Cycling and spinning, which are otherwise considered very healthy, are not recommended for vulvodynia due to friction. Regular walks or dancing also do many people good. Try what you enjoy and doesn’t trigger or exacerbate the discomfort.
• Make sure you get a good night’s sleep. But you should not only sleep long enough, but also relaxed. Not only the duration of sleep, but also the quality of sleep counts.

Vulvodynia - surgery and other therapies

Treatment options may be considered if other methods have not been sufficiently successful. Only experienced physicians should perform them. Also, it should be used only with caution and for selected women. The effectiveness of some methods has not yet been sufficiently proven.

Here are a few examples:

• Botulinum toxin (Botox) – a neurotoxin that paralyzes muscles. We inject it into the painful region. However, you need to repeat the treatment regularly because the body breaks down the Botox and it loses its effect.
• Laser treatment (CO2 laser) – involves the use of a laser device. These treatments can also be offered at the USZ. Since laser therapies for this indication are not yet covered by health insurance, a cost approval must be obtained in advance if required.
• Shock wave therapy – high-energy pressure waves are applied
• Vestibulectomy – a surgical procedure in which we remove painful tissue more or less extensively.