LNovember 11th is celebrated International Vulvodynia Day or Vulvodynia dayestablished to support women suffering from this disease and for increase knowledge of the pathology. The disease, characterized by chronic pelvic pain, it is estimated affects 12-15% of women throughout their lives, yet for a long time vulvodynia has been underestimatedif not completely ignored from a medical point of view.
Accomplices awareness campaigns promoted in recent years, also through social media, and the testimonies of women like Giorgia Soleri who recounted his experience with the disease, today the awareness seems to have increased but many challenges still remain open.
«Today we finally begin talk about vulvodynia and patient awareness is greatly increasing – explains the doctor Raffaela Di Pace, gynecologist, PhD in Menopause Physiopathology and sexologist consultant. – Until not long ago few doctors and few patients knew about this type of pathology. Vulvodynia was interpreted more as a psychological disorder, linked to the sexual sphere, than as a physical disorder. The prevalence of the disease is still underestimated, because many women today still fail to receive a correct diagnosis».
Vulvodynia: what it is
For a long time, vulvodynia was perceived by doctors themselves as one “psychogenic” illness. But what is it actually about?
«Vulvodynia is one complex pathology because it includes different aspects – explains the gynecologist. – It definitely has a component physicsgiven by one hypersensitivity of the nerve fibers located on the vulva. The term vulvodynia actually means “pain of the vulva”. The most frequent form of the disease is vestibulodynia. The vestibule is the part of the vulva that leads to the vagina, that is, the part that is involved at the beginning of sexual intercourse. If we think that approximately 85% of vulvodynias are vestibulodynias, it is easy to understand how the disease also affects the sexual sphere to a great extent. Let’s talk about women who have therefore pain in relationships and that they are often therefore unable to have any. This problem involves a consequent psychological discomfort and therefore is associated with discomfort in sexual activity. Not to mention that from a physical point of view, in the vast majority of cases, women who suffer from vulvodynia develop hypertonicity of the pelvic floora sort of contracture of the pelvic muscles which leads to increased pain and the impossibility of having penetrative relationships».
Spontaneous vulvodynia
In a smaller percentage of women, however, the disorder appears independently of sexual activity. «That’s what it’s called spontaneous vulvodynia – Dr. Di Pace further specifies. – Women who suffer from it are bothersome sitting, riding a bicyclebut also simply a use underwear of a certain type. With a notable impact on the quality of life.”
The causes of vulvodynia
The causes of the disease have not yet been fully clarified, although some important correlations are known.
«We know that there is a correlation with others chronic pathologies that cause painand – explains the gynecologist. – The disease is more frequent in women who suffer from fibromyalgia, headache and in those women who suffer from intestinal pathologies such as irritable colon, Crohn’s disease and ulcerative colitis».
Hormonal causes
«We also know that often the cause is hormonal – continues the expert. – It is the case of women suffering from vulvodynia in menopause but also of young women taking birth control pills. Today, in fact, hormonal contraceptives are used with very low doses, which can have resulting in vaginal dryness from which vulvodynia can develop. However, it is worth underlining that when the cause is the contraceptivethe disease is absolutely reversible: just replace the pill, perhaps slightly increasing the dosage or changing the type of progestin contained, to solve the problem.”
Often vulvodynia is also the consequence of recurrent cystitis and candida. «In fact, those who suffer from vulvodynia often also have postcoital cystitis since the mechanism of action is similar» – underlines Dr. Di Pace.
Does familiarity have an impact?
Finally, there is probably also some sort of familiarity with the disease.
«Studies are underway to discover whether there is a genetically determined predisposition to infections which can then predispose to vulvodynia – explains the gynecologist. – For the moment we do not yet have certain data but it is likely that there may also be a question of familiarity».
Vulvodynia: how to treat it
Since it is a complex pathology which, as mentioned, affects various aspects, not only the physical and anatomical one, the treatment of vulvodynia must take into account its overall impact on quality of life.
«There must be therapy polymodal – confirms Dr. Di Pace – that is requires the intervention of different specialists. Only by taking into consideration every aspect of the disease can we hope to obtain a resolution of the picture. There must be the intervention of doctor prescribing drug therapywith drugs that at a topical or systemic leveldepending on the shape and gravity of the painting, go to reduce the sensitivity of nerve fibers. But the intervention of one is also necessary specialist who deals with pelvic floor rehabilitation. Through techniques that may be useful in reducing hypertonicity and help the woman to relax the muscle and therefore be less contracted.
Pelvic floor physiotherapy
«Vulvodynia is a very complex and involving picture different districts, the muscles, the ligament and tendon structures, the nerves and the vascular complex – the doctor also explains Elena Bertozzi, Pelvic floor physiotherapist – These structures are in dysfunction and to resume correct functioning they need a rehabilitation process. The objective of physiotherapy is therefore precisely that of restore the proper functioning of that district».
The rehabilitation process
«The rehabilitation process is personalized – continues Dr. Bertozzi. – Fortunately there are many strategies that can be implemented. Definitely the first step is what is called ‘awareness’what does it mean learn to know your bodyhow it works, how the muscles move and how to take control of that part.”
Kinesitherapy: what is it?
Among the rehabilitation strategies we often hear about kinesitherapy.
“It is a set of techniques that aim to rehabilitate a body area – explains the physiotherapist again. – In particular, in the case of the pelvic floor, they are meant specific exercises to raise awareness of the pelvic musclesassociated with manual techniques that are performed by the therapist on the patient». How soon can I see benefits from physiotherapy? “Usually the benefits can already be seen in a short time. These are perhaps small steps forward but they make us understand that something is changing – specifies Dr. Bertozzi. – The symptoms slowly change, perhaps the pain becomes fainter or less frequent, daily life activities become easier. In short, these changes make us understand that something is improving.”
Who to contact?
«Generally they deal with pelvic floor rehabilitation midwives and physiotherapists trained in this area but recently they are also increasing the number of specialized osteopathsi – specifies Dr. Di Pace. – In cases where the disease comes to trigger anxiety, depression and fear of sexual activity, there is a need to also involve a sexologist psychologist».
Sexuality and vulvodynia: what is important to know
“From sexuality, especially female sexuality, is unfortunately still talked about too little – he also explains Gloria Morasca, sex educator. – There is still a lot of misinformation. For this reason, my role, as a sex educator, is often that of inform women, suggesting who to contact And teaching them not to be ashamed and to become aware. I help women to don’t feel guilty when they have difficulty penetrating and rediscover a different type of sexuality. With serenity, however, without considering it a second-class sexuality. Furthermore, a sex educator can also suggest the most suitable sex toys to use».
The therapeutic role of sex toys
Although we often tend to underestimate this aspect, theUsing sex toys can be very helpful in case of vulvodynia.
«Devices like that one, for example, are useful warming – explains Gloria Morasca again. – It is a dildo that warms and reactivates circulation, aiding relaxation and lubrication. Or i dilatorsset of dildos with 5 different sizes, designed for gradually widen the part».
Lubricants
«The use of lubricants is also very important – continues the sex educator. – There are various types today: from those to waterfallto those with addition of siliconesmoother, up to those based on hyaluronic acid, useful in case of vulvodynia and more generally in menopause. Today there are also lubricants based on cannabidiolto use before intercourse or before therapy but also simply to be applied to reduce pain».
How to overcome the taboo linked to the use of sex toys
«Women who experience a certain resistance in using sex toys for vulvodynia they need to think of them as a medical device – suggests Gloria Morasca again. – Often there is fear of judgement. To break down misinformation and taboos, it is important raise awareness among gynecologists to talk about it with their patients».
The importance of raising awareness among doctors
«As we were saying, today there is more awareness but it is important also work on raising awareness among doctors – Doctor Di Pace also confirms. – Often gynecologists are more focused on other things, such as the preventive diagnosis of tumors, and do not analyze this aspect. Still Unfortunately, gynecologists deal too little with their patients’ sexuality. Too women are rarely asked how sexual activity is going and not everyone feels comfortable talking about this with their gynecologist. There is definitely something to be done information and training work on the medical profession. Why no woman suffering from vulvodynia should ever hear this again “You just need to relax”, without receiving a correct diagnosis.”
The role of the Association
In this sense it has also played an important role in recent years L’Italian Vulvodynia Association – AIV, born from the experience of some doctors and healthcare workers, e by the determination of a group of women – patients and otherwise – who have decided to commit themselves to helping other women arrive at a correct diagnosis and adequate treatment.
The Association also fights for vulvodynia to be recognised and so be it the right to treatment is guaranteed to all. In fact, we must not forget that treatments, often very expensive, are borne by the patients in most cases. A factor that unfortunately often leads even to the abandonment of the treatments themselves.
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