Can you please explain what vulvodynia is? And how serious it is, and how to cure it?

--A.L.

Vulvodynia is a fancy way of saying vulvar pain. It is not serious, in that it does not increase the risk of cancer and it is not life-threatening. But it can be very annoying, to say the least, affecting many aspects of a woman's life.

Vulvodynia is usually characterized by a burning or stinging sensation. Often the slightest touch will set it off. This can make intercourse painful, if not impossible, and even using pads or tampons can be difficult. Some women are so severely affected that they cannot wear underwear or pants and even have irritation while walking. Sometimes the vaginal and vulvar tissues appear red and inflamed, but in some women everything looks perfectly normal.

Vulvodynia is not completely understood. Similar symptoms may occur with infections, including yeast, chlamydia and genital warts (HPV). Allergic reactions to soaps or detergents may do the same thing, as may systemic (bodywide) conditions such as psoriasis or lupus. Interstitial cystitis, a painful bladder condition, is not infrequently found in women with vulvodynia; treatment for interstitial cystitis (usually under the direction of a urologist) may also help with vulvar pain. Trauma to nerves from childbirth, surgery or other injury may lead to this burning sensation. Too high a level of oxalates in the diet may be a cause.

The first step is to rule out various infections by careful exam and culture. If an infection is present, it is treated. Often a biopsy of the painful area is done to look for conditions such as psoriasis or HPV; if something is found, it is treated appropriately. If culture and biopsy are normal, then often treatment is a matter of trial and error. Sometimes the woman can get temporary relief by applying an ointment containing xylocaine, similar to the numbing medicine dentists use. Injections of interferon have shown promise in some studies, but interferon is very expensive and does not work for everyone. Injections into the pudendal nerve, done through the vagina, sometimes help. Amitriptyline, an antidepressant, also blocks nerve impulses to and from the pelvis and may provide relief for both vulvodynia and interstitial cystitis pain. Biofeedback works in some cases. A diet low in oxalates may help.

The most radical approach is to surgically remove all the painful tissues. This, unfortunately, does not provide relief in all cases, and occasionally the scarring that results may even make pain and burning worse. This approach is used only if all other treatments fail.

A trip to your gynecologist is the best starting place for diagnosis and treatment. In addition, several organizations are dedicated to research in vulvodynia and to providing support to afflicted women. One is the National Vulvodynia Association which offers a newsletter and support groups. Contact the National Vulvodynia Association at (301) 299-0775 or P.O. Box 4491, Silver Spring, MD 20914-4491. Another resource is the Vulvar Pain Foundation which offers The Low Oxalate Cookbook. Contact the Vulvuar Pain Foundation and/or order The Low Oxalate Cookbook online, by phoning (336) 226-0704 or writing to Vulvar Pain Foundation, Post Office Drawer 177, Graham, North Carolina 27253.