In some cases of PVD, there’s a history of repeated inflammation of the vagina, mostly because of yeast infections, but this is not by any means always the story. Sometimes the pain of PVD builds slowly; in others cases, it comes on suddenly. Sometimes it seems to be triggered by pregnancy.

Vulvodynia can be brought on by any number of stressful situations. A young woman in her early thirties who was referred to me had her life turned upside down over a short period of time. She left home for a new teaching position at a prestigious research center and, at the same time, broke up with her stable but dull boyfriend to begin a new, exciting relationship. The changes were welcome but, coming all at once, brought on emotional stress. She developed PVD after a two-day romantic retreat and contracted cervical HPV (Human Papillomavirus) a couple of months later. Both genital conditions were independent from each other, but added difficulty upon difficulty, and she had recurrent episodes of pain for many months until she came for treatment at my clinic.

 

Painful sex makes relationships difficult

 

One of the main problems with PVD is that it makes sexual intercourse difficult to bear.

This direct and distressing effect makes it a lot harder to treat than something like joint pain or limb injury. There is a mental and emotional aspect that absolutely must be included in any PVD treatment if it is to be effective. Otherwise, patients become trapped in a vicious cycle - anticipating pain during sex, which leads to avoidance, which in turn leads to discord between sexual partners. This, of course, produces anxiety, which results in stress, which in turn tends to trigger more emotional discomfort, added on top of the pain caused purely by the PVD.

PVD’s physical-mental intertwining can produce a tight knot to untangle. Most women have no idea why sexual contact causes genital pain. Their partners, fearing rejection or even feeling responsible, often become emotionally detached, creating an unhealthy downward spiral in the relationship. Like pretty much any problem involving sexual function, this condition must be treated in a way that includes the psychological health of the relationship involved. We’ll talk more about that below, but let’s look at the physical aspects of PVD.

First, a little history. Genital pain without an obviously recognizable cause was first referred to as “Burning Vulva” when it was formally identified by the International Society for the Study of Vulvovaginal Disease (ISSVD) in 1970. It is not an itch, and it does not bring spasms or sensations of pressure. It is a feeling of burning, as reported by all the women who experience it.

 

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