Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Vulvodynia: The Vaginal Equivalent of Fibromyalgia?

Pink is not necessarily rosy.

Lately, I have read blogs by fellow Psychology Today bloggers delineating the amazing qualities of vaginas. This genital anthropomorphism was so convincing, I was this close to suggesting that Jay Leno invite one to guest-host the Tonight Show, when I recalled that there is another fact to recount regarding that amazing structure: It, too, can contribute to chronic pain, causing the suffering of millions in this country.

Vulvodynia is often characterized by burning discomfort, itching, throbbing, or tenderness of the vulva—sometimes in the labia, sometimes around the opening of the vagina, sometimes affecting the vestibular glands—which may be experienced either as diffuse irritation or as specific painful spots.

A surprising number of women suffer from this condition of chronic, unexplainable pain in the skin of the genitals, which has only recently begun to receive public attention and validation as a legitimate complaint, much like fibromyalgia. Efforts to treat the syndrome have been frustrating for women seeking relief, as well as for caregivers who attempt to help them. Much like fibromyalgia.

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Vulvodynia was once considered an affliction of white women; however, it is now recognized as affecting as many as seven million American women of all ages and ethnic backgrounds, but there appears to be a predominance of cases in the 18 to 25 year age range. The impact of vulvodynia stretches from the bedroom to the boardroom: Marriages have ended in divorce because of it; some women are unable to work. Many women experience such constant pain that sitting or wearing pants equates to torture.

A study published in the "Journal of Reproductive Medicine" in 2008 studied 75 women suffering from chronic vulvovaginal disorders who were recruited and classified using the International Society for the Study of Vulvovaginal Disease classification criteria. The subjects completed a questionnaire to assess the impact of chronic vulvovaginal disorder on psychosocial functioning and quality of life. After adjusting for age and duration of vulvovaginal symptoms, women with vulvodynia were found to be more likely than women with other chronic vulvovaginal disorders to score significantly worse on relationship, emotion, and physical activity areas. The overall intensity of vulvar or vaginal pain correlated weakly with the degree of psychosocial impairment in the domains of relationships, emotion, and physical quality of life.

Recent studies have shown associations of early childhood victimization with fibromyalgia, chronic pelvic pain syndrome, and chronic refractory low back pain. Likewise, a study published in 2005 in the "American Journal of Epidemiology" found that women who never or only rarely received family support as children were two to three times more likely to report vulvodynia symptoms compared with women who sometimes or more often received support. In addition, women who reported feeling danger in their home, neighborhood, or school as children were also two to three times more likely to experience vulvodynia symptoms compared with women who did not report such fear.

The researchers further assessed whether the association of fear or actual physical harm with vulvodynia was related to the source of the victimization. Women who reported being afraid of, or were physically harmed by, a primary family member (such as the mother, father, sibling) were three to four times more likely to report vulvodynia than those who had no physical abuse history. Women who reported severe sexual abuse in childhood were six times more likely to report vulvodynia symptoms than women who reported no physical or sexual childhood abuse. Not surprisingly, the joint effect of severe abuse, childhood endangerment, and lack of family support was associated with a 14-fold chance of developing vulvodynia.

Despite all these data, the mechanism by which childhood abuse may influence the risk of adult-onset vulvodynia remains unclear. Still, what is perhaps more important, particularly for the sufferers of vulvodynia, is that the health care establishment now appreciate the necessity of assessing early-life exposure for women at risk of this debilitating chronic pain condition. Psychotherapeutic intervention, coupled with judicious use of some of the medications used to treat fibromyalgia (e.g., Cymbalta and Lyrica), may contribute to the walk down what for many patients is a long road to recovery.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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