One sub-type of vulvar pain syndrome is clitorodynia, which is described as chronic pain of the clitoris. There is one school of thought that attributes most of this pain to a nerve disorder. Another believes that psychological stress is to blame. And of course, there are many other opinions, some bizarre, some interesting at the very least.
Pudendal neuralgia is pain in the groin area that is aggravated by sitting on a chair, and reduced by sitting on a toilet seat. As the region innervated by the pudendal nerve is extensive, pain and discomfort could also be experienced above the pubic region and in the lower rectal area. In fact, bladder, bowel and sexual dysfunction are common. So-called pudendal neuropathy can cause hypersensitivity to touch, a lack of sensitivity to touch, and urinary and fecal incontinence.
Clitorodynia can be caused when the branch of the pudendal nerve providing sensation to the clitoris, the Dorsal Nerve of the Clitoris, is malfunctioning.
A study published in 2009 in the journal "Obstetrical Gynecologic Survey," found that the typical patient is one who has seen multiple physicians, has no evidence of a systemic disease, and who has undergone what are deemed to be normal gynecological and colorectal evaluations. However, a history might reveal a patient who has had acute trauma to the groin area, or chronic exposure to pressure of the pudendal nerve—as due to repetitive bicycle riding or masturbation, particularly with use of vibrators.
The results of a survey published several years ago in the "Journal of Sex & Marital Therapy" found that patients with clitorodynia also suffer from vulvodynia, irritable bowel syndrome, fibromyalgia, and anxiety. The data also showed a significant drop in libido and sex drive during vulvar pain symptoms, reduced self esteem, and a negative impact on the quality of a woman's relationships.
Sadly, the researchers concluded that patients with clitorodynia did not put much faith in the health profession to help them. Which begs the next question: How to treat clitorodynia?
Treatment of clitorodynia involves the classic holistic approach that appears to work well with a variety of chronic pain syndromes:
• Cognitive behavioral therapy.
• Medications such as the anti-seizure drug gabapentin, the anti-depressant drug amitriptyline, and the fibromyalgia/neuropathy drug Lyrica.
• Physical therapy to allow internal soft tissue release and mobilization.
• Pudendal nerve block by injecting the area the nerve passes through with cortisone-like medications.
• Topical pain relievers such as lidocaine gel.
• Foregoing long bicycle rides and vibrator sessions.
One can never underestimate the healing power of understanding partners and support groups, but, hopefully, with increased awareness and sensitivity to the plight of clitorodynia and vulvodynia patients, the health care community will be accepted by patients as potential providers of relief. Patients must be willing to try some of the suggestions from health care providers; they just may have some benefit.
