General and Provoked Vulvodynia

Vulvodynia is a chronic pain condition that effects the female genital organs, specifically the vulva, labia and entrance of the vagina. This pain may be constant or intermittent and is often brought on or made worse during intercourse- making it not only painful and frustrating but often stressful on relationships.

Causes

Possible causes of vulvodynia are considered to be auto-immune, sensitivities to foods and oxalates in urine, infections and neuropathy. I have to say personally I notice many of the onset symptoms of vulvodynia seem to correlate with extended doses of Flagyl in conjunction with digestive upset and thrush. Having said that, it is very often that vulvodynia is misdiagnosed as thrush and treated with antibiotics and Canesten, so it is hard to say which came first or if thrush was even a factor.

Diagnosis

Diagnosis is one of exclusion once all other related disorders are ruled out, and can take some time as not all doctors are aware of this condition.

90% of patients I see have provoked vulodynia and display particular pain patterns in very specific areas as diagnosed by their gynecologist, most often the lower sides of the vagina, 3-4 cm internally. I do not inspect the area at all and the whole session is conducted full clothed.

Treatment

Western medical treatment is also varied and may consist of various creams, diets, lubrications and injections. One thing that frustrates me is patients that come in upset that their doctor told them it is ‘all in your head’ and to deal with it. It is true that some cases of vulvodynia may have emotional aspects and can be relieved with counselling and bio feedback, however as a statement not backed up with compassion and education, can be detrimental, harsh and unproductive.

Acupuncture & Chinese Medicine

Diagnosis in Chinese medicine varies with each patient. Within the Chinese medicine framework, I find most vulvodynia in younger women represents in the liver channel as a ‘stagnation’ in natural flow of blood and energy leading to hypersensitivity. The origin of this seems to be in my experience a state of emotional stress from work, personal life etc or hypersensitivity from food or environmental allergy/sensitivity. Having said that, chronic health conditions such as vulvodynia will also cause emotional frustration and stress but this may not be the original cause of pain.

Treatment with Chinese herbal medicine and acupuncture is effective and tailored to the individual. Treatments last for ½-1 hr at a time, and weekly sessions recommended. Symptoms may subside in 8 weeks to 4 months generally. A very general rule is that the longer you’ve had the condition the longer it takes to treat. If I gave you a ball park estimate, I would reflect on previous patients. Generally a patient that has had this condition for 6-12 months, usually takes around 8-10 treatments, patients that have had vulvodynia for 5-10 years (and this would be most of the patients I see) might take 15 – 30 treatments (basically 3-6 months).

What Happens in an Acupuncture & Chinese Medicine Treatment?

Treatments include acupuncture and herbal medicine. Acupuncture needles are single use and disposable so you can be assured 100% hygiene. Needles are NEVER placed anywhere near the genitalia. Sometimes needles are placed around the knee, so loose clothing is best worn when coming for a treatment. Often around 4-10 needles are used each time, placed below the elbows and knees. If patients are nervous about needles, we always start minimally, gently and slowly.

Studies Involving Acupuncture For Vulvodynia

An interesting study about the effect of acupuncture of vulvodynia in the Journal of the Royal Society of Medicine (LInk) shows that out of 12 patients, 2 felt completely ‘cured’ after a few sessions, 3 felt very good, 4 felt acupuncture was better than their current drug regime and 3 had no improvement at all. I find this study somewhat reflects what I find in the clinic. I do notice better results than this as I treat constitutionally rather than by protocol, however I do find that 15-20% of patients will feel amazing after just a few treatments with no recurring pain after years, 20-40% will feel very good but need ongoing treatments, another 20-40% will feel that the treatment offered them more relief than medication and around 15-20% will have no improvement at all.

I have also started a blog documenting some of the patients I’ve seen over the years that you can observe here: https://wordpress.com/view/fireinthevalley.wordpress.com  … this is anonymous and updated monthly.

For more information regarding oxalate free diet and the gut-bacteria-pain connection, read my recent blog here.