Understanding changes in the brain key to treating vulvodynia.

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It is not uncommon – perhaps even normal – for sex to hurt the first time. But for about one in six women, sexual activity is unbearably painful every time, and the pain does not seem to go away.

A typical case: A woman sees her family doctor after experiencing pain with vaginal touch or penetration. The physician diagnoses a yeast infection. She is prescribed an anti-fungal cream that she uses daily, expecting the symptoms of cutting and stinging to go away. But they don’t.

She returns to her doctor, who might prescribe a stronger anti-fungal and encourage her to “wait it out.” When she returns a third time, insisting that there are cuts or tears on her vagina, her doctor examines her and declares everything normal. And then she hears those piercing words that make her already distressing pain completely intolerable: “It must be in your head.”

 

Approximately 15 per cent of women suffer from vulvodynia, a chronic pain condition that makes any type of contact with the vagina – through intercourse, other forms of sex play, a Pap smear, even the seam on a pair of skinny jeans – agonizing. And for the vast majority of these women, an examination of the vagina and vulva will show no evidence of cuts, no skin lesions, no redness and no “signs” of pain. Everything will appear entirely “normal.”

The absence of any sign of injury makes sense once one understands chronic pain: It is situated in the brain, not necessarily in the area of the body where the pain is experienced. In the past, medications applied on the vagina or taken orally were considered front-line treatment. However, randomized controlled studies found that such medications, given based on the theory of vaginal injury or tissue damage, worked not much better than a placebo.

At the same time, science was revealing that many women with vulvodynia had other co-occurring pain conditions and problems with pelvic floor tightness. This seemed to suggest that whatever was maintaining the vaginal pain might also be contributing to these other conditions, leading scientists to focus their search for answers on the brain itself.

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