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Dear Dr. Myrtle,
Why is my vulva so sensitive? I've been told I may have vulvodynia. What is vulvodynia? What can be done to treat it?
 There are many potential causes for pain in the vulvar region, and the term "vulvodynia" is a word that describes a variety of conditions. Vulvodyina, or chronic vulvar discomfort, is characterized by burning, stinging, irritation or rawness of the vulva. Three different sub-types have been described, and have different treatment approaches: skin disease, inflammation of the vulvar opening, and irritation of the nerves that serve the vulva. Vulvodynia is a diagnosis made after other diagnoses, such as vaginal yeast infections, neuropathies, sexually transmitted infections, and other dermatological conditions are tested for and found not to be the cause.
For skin-related vulvodynia, steroid creams are used, often successfully, for treatment. For women who experience inflammation of the vulvar opening, good attention to vaginal health (see our "Ask Dr. Myrtle" articles on vaginal health and renewal) may help. Some women find relief with alpha-interferon injections, and others choose to pursue a surgical operation (vaginal advancement).
The most severe cases of vulvodynia are those with neurologic irritation. Pain occurs wherever the nerves in the region receive too much sensation: the clitoris, vestibule (vaginal opening), urethra, perineum (skin between the vaginal and anal openings), and down the inner thighs. As in other cases of sensory neuropathies (diseases of the nerves), antidepressants and anticonvulsants may ease the pain in some cases by "resting the nerve" and allowing it to heal.
New investigations involve reducing intake of oxalate-rich foods such as chocolate, nuts, celery and spinach. This investigation is still in the experimental phases, and the outcome is unknown. It is also suggested that women with this condition not take more than 250mg of Vitamin C per day, since Vitamin C works like oxalate in the body.
Vulvodynia is a difficult condition. For many of the conditions, the cause is unknown, and the cure elusive. For some women, it's a big breakthrough to know the name of this condition, and that this is not something "in their head", or something to be ignored.
For more information, try the book The Vulvodynia Survival Guide, visit the website www.vulvodyniasupport.com, or contact the National Vulvodynia Association (online at www.nva.org and ask for a referral for a gynecologist in your area who is familiar with vulvodynia.
Take Care.
Dr. Myrtle
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