vulvodynia and gastrointestinal disorders, mainly attributed to irritable bowel, are often related. A study published in has amply demonstrated this PubMed in March 2020, but still little is said about it. Yet, a therapeutic approach that takes this association into account of pathologies is certainly useful for improving the quality of life of women. A key clue to address vulvodynia more broadly, multidisciplinaryincreasing the possibility of a faster and more effective recovery of vulvar pain and, at the same time, an improvement in bowel function.
What the study says about vulvodynia and gastrointestinal disorders
According to what was posted on PubMed in March 2020 (Clinical Gastroenterology and Hepatology)Inflammatory bowel disease (IBD) affects 200-400 of every 100,000 people in the United States, about half of whom are women. The study aimed to define the prevalence of vulvovaginal symptoms and the association with IBD activity in a large group of women.
A group of 1250 women from aged over 18 with IBD has completed a online survey which asked about the presence and severity of vulvar or vaginal itching, burning or irritation, vaginal discharge or dryness, and vulvovaginal pain. The survey collected information on demographic characteristics and IBD activity (classified using theindex Manitoba). The researchers evaluated the associations between IBD severity and vulvovaginal symptoms, compared by diagnosis, menopause, smoking, depression, and use of IBD medications.
Results: A total of 512 (41%) women has reported at least 1 moderate-severe vulvovaginal symptom. All vulvovaginal symptoms except vaginal dryness were more common in women with active IBD. In a multivariate model controlled for menopause, smoking, t-score from the PROMIS depression tool, and IBD medication use, women women with constant or frequent active IBD were more likely to have moderate-to-severe vulvovaginal symptoms (odds ratio, 1.68; 95% CI, 1.22-2.32) compared to women in remission. The Vulvovaginal discomfort has frequently or always decreased interest in sex (n=336; 28%) or la ability to have sex (n=207; 16%).
Conclusions: In an online survey of 1250 women, the women with more active IBD have a higher prevalence of vulvovaginal discomfortcompared to women in remission. These symptoms affect sexual health.
Questions to our experts
We talked about it with three experts on the subject. The Professor Filippo Murina, Head of the Lower Genital Tract Pathology Service and Menopause Center at V. Buzzi – University of Milan. Murina is also a founding member and scientific director of theItalian Vulvodynia Association Onlus – AIV Onlus
There Doctor Raffaela Di Pace, specialized in Obstetrics and Gynecology, with a PhD in Pathophysiology of Menopause. Di Pace is also the author of a column dedicated to gynecology on our site. We also interviewed the Doctor Carla Lertolaspecialist in nutrition science.
Study demonstrates a relationship between vulvodynia and gastrointestinal disorders: why?
«There may be a co-morbidity: alongside vulvodynia there may be disorders related, for example, to the pelvic floor, bladder and also to the intestine. Irritable bowel syndrome is most likely to occur in association with vulvar discomfort. It is an inflammatory response that can modify nerve endings and also cause vulvar pain», explains Professor Murina.
“The proportion of women suffering from vulvodynia is greater than those declared,” adds Dr. Di Pace. “The vulvovaginal pain is present in women with a chronic inflammatory disease. The one in the study is a significant group, but in the general population, women reporting pain is lower. In reality, it is known that vulvodynia is associated with a series of pathologies that have pain as their main symptom. Women with fibromyalgia, recurrent headache or chronic bowel disease also have vulvodynia in most cases. They are women who have a kind of hyper reactivity of nerve fibers that conduct pain. There is therefore a correlation between vulvodynia and irritable bowel,” explains Di Pace.
What are the causes of vulvodynia?
“One can be traced back genetic predisposition, vaginal infections or intestinal recurring, or changes in the impermeability of the intestine. Not infrequently they are women who also have some sort of gluten intolerance, lactose, or even just a hypersensitivity to gluten», explains Murina. Carla Lertola adds: «First of all we need to make a diagnosis: for example we need to understand if we are talking about typical constipation in menopause also due to estrogen deficiency, when the intestine is also aged and its functions are slower. It depends on the childbearing age or menopause. The intestine is not only the colon, but there is a whole higher part that must be considered and that often goes hand in hand with gastric disorders. The abdomen is made up of many organs and systems, and it would be useful for gynecologists and dieticians to agree. For example, in the case of candidiasis, it is one thing to be careful of simple sugars and another to be totally starchy (pasta and rice) and therefore make them eat more proteins and fats, which however are slower to digest. Carbohydrates are essential for the proper functioning of the whole body. Of course, a diet is not enough.
How useful is a multidisciplinary approach?
«In the therapeutic strategy to deal with vulvodynia it is essential to ask if the woman has these and other disorders. It takes a multidisciplinary therapeutic framework», recommends Professor Murina. It must be said that one of the causes of the disorder or triggering factors is certainly represented by recurring vaginal infections (candida) or recurring cystitis.
In both pathologies he has a an important role is played by the intestinal as well as the vaginal microbiome, which protects against infections. Those with inflammatory bowel disease are more likely to have bowel irregularity and an altered microbiome.
«Vulvodynia is characterized by hyperalgesia and allodynia of the nerve fibers that show pain, but also often hypertonicity of the pelvic floor. Hypertonicity often also affects the anal component as well as the vulvar. Pelvic rehabilitation or Tens are needed as a pain reliever and to relax the muscles of the whole area», adds the gynecologist Di Pace.
Vulvodynia and irritable bowel: what are the possible remedies?
«When the gynecologist diagnoses vulvodynia, amore accurate gastroenterological investigation it’s a verification of the correct food style.
Then there are the drugs that reduce inflammation and vulvar pain, others that have an action on the muscles, vaginal diazepam, ametriptyline in a creamy formulation which, however, can cause constipation. With physiotherapy rehabilitation we are able to achieve great improvements», recommends Professor Murina.
«Vulvodynia is a multidisciplinary pathology that requires diversified therapeutic approaches. It serves the pharmacological medical therapy either systemically (by mouth) or locally. Now there is also the CBD (cannabidiol) cream that the spot can be placed or with electroporation to make it penetrate more deeply and improve hypertone and pain», explains Dr. Di Pace.
The Decalogue of the nutritionist against vulvodynia and inflamed intestine
In order for the stomach and intestines to reduce inflammation and function properly, also improving vulvodynia, there are some good habits that are important to observe. Here are what the Doctor recommended Carla Lertolaspecialist in nutrition science.
Lots of water but watch out for tea
A good amount of non-carbonated water, at least 2 litres to drink continuously throughout the day (not all together!). Both during and away from meals. The glass of water and lemon in the morning is useless as it actually ruins the tooth enamel. Even herbal teas or tea must be chosen carefully: it is better to avoid tannic acid (green and black tea are full of it) which tends to block the gastrointestinal tract, while white and Rooibos (red tea) they have no tannic acid.
More vegetables, less fruit
Another valid help for constipation are the fibers. But be careful: it is one thing to eat lots of fruit (30/40 calories per ounce) and another lot of vegetables (12/13 calories per ounce). There vast majority of the fructose goes to the liver and is transformed into glucose which favors the glycemic peak, but also the storage of fat on the belly.
Vegetables during meals
Lots of vegetables during mealsthe. Vegetables and whole grains promote good bacterial flora. Prepackaged “junk” food, on the other hand, favors bad bacterial flora
Pasta and rice with whole grains
Pasta and rice: better if wholemeal and combined with vegetables. Ancient grains are also excellent (Senatore Cappeli or kamut wheat), basmati or Venere rice. Pasta and rice to be eaten undercooked, al dente, otherwise they will swell more. Fruit is best used as a snack, maximum 2 servings a day. Pair fresh fruit with dried nuts because it contains Omega 3 fatty acids which are excellent for health (but be careful with quantities because 600 calories per pound).
Yes, but crunchy bread
Bread: better if crunchy with little crumb because it is more digestible and with a lower glycemic index. Wholegrain has more fiber, but eaten in large quantities can cause more wind in the intestines.
Legumes at least 2/3 times a week
Legumes: they are the only protein source without cholesterol, but they must be managed with wisdom for those with intestinal swelling. In order for them to be nutritionally valid, they must be consumed at least 2/3 times a week.
Carbohydrates yes, but with vegetables
Basic to eat carbohydrates at lunch and dinner, along with vegetables and a protein source to make the meal complete.
The good fat
the evo oil, extra virgin olive oil, is a vegetable fat rich in “good” nutrients for the intestine and in the prevention of cardiovascular diseases (stroke, heart attack) and cancer.
Stop rigid diets
No to too strict diets and with too much fat reduction they do no good and increase constipation.
More movement
physical activity it is essential to improve constipation.
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