Madeeha Syed

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What The Burning Sensation Between Your Legs Could Be

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ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

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What Is Vulvodynia?

Introduction

Vulvodynia, also known as vulvar pain, is a chronic state of discomfort and pain in the vulva, which lasts for 3 months at least<a href="#accordion">[1]</a>.&nbsp;

Vulva is the skin surrounding the opening of the vagina. Women with vulvodynia have a vulva that appears normal but causes pain due to unspecified reasons<a href="#accordion">[2]</a>. Vulvodynia is known to affect 16% of women irrespective of their age and ethnicity<a href="#accordion">[3]</a>. It is disturbing since the quality of life of these women is negatively impacted<a href="#accordion">[4]</a>.

The pain and discomfort experienced in vulvodynia make it difficult for women to sit for long hours. Additionally, women suffering from vulvodynia have a difficult time during intercourse so much so that it reduces their sex drive. However, the cause of this chronic vulvar pain isn&#39;t clear yet.&nbsp;

Embarrassment and lack of any visible signs are the main reasons behind its underreporting. The absence of clinical signs means many women are not even aware that they have vulvodynia and those who do know usually avoid seeking help because they feel awkward discussing their symptoms with anyone else.&nbsp;

Also, a majority of women are unaware that treatment plans for vulvodynia exist and that consulting a doctor or gynecologist can help them in managing their condition along with improving their quality of life<a href="#accordion">[1]</a>. 
&nbsp;

Understanding Vulvodynia

Vulvodynia or vulvar pain isn&#39;t a condition with apparent clinical signs since the vulva appears normal in most cases; it appears swollen or slightly inflamed only in some women. However, vulvodynia symptoms that the patient may experience are as follows<a href="#accordion">[1]</a>:

<ul>
	<li>Burning pain&nbsp;</li>
	<li>Stinging sensation&nbsp;</li>
	<li>Soreness</li>
	<li>Rawness</li>
	<li>Painful intercourse (also known as dyspareunia)&nbsp;</li>
</ul>

&nbsp;

Based on the symptoms, vulvodynia can be classified into various types<a href="#accordion">[1][5]</a>:

<ul>
	<li>Provoked Vulvodynia: It is the vulvar pain that occurs upon touching the sensitive area.&nbsp;</li>
	<li>Unprovoked Vulvodynia: It is the vulvar pain that is not triggered by touch.</li>
	<li>Generalized Vulvodynia: This is vulvar pain that happens spontaneously in different areas of the vulva. This pain is constant, but there are some pain-free periods in between. Activities that exert pressure on the vulva, such as sexual intercourse or sitting for long hours, may or may not trigger this type of pain.</li>
	<li>Localized Vulvodynia: This type of vulvar pain is localized to one region in the vulva. It usually presents with a burning sensation and this type of pain often results from pressure/touch on the vulva, or due to sexual intercourse.</li>
</ul>

&nbsp;

Understanding the clinical picture of vulvodynia is important because women don&#39;t come to the clinic with complaints of pain; rather, they describe the discomfort as itching, stinging, burning, or stabbing<a href="#accordion">[3]</a>.&nbsp;

Moreover, the symptoms of vulvodynia aren&#39;t persistent as they wax and wane over time. Some women may describe that they experience pain during sexual intercourse during the initial phase of this condition. Gradually, women notice pain and discomfort without any trigger in the area of the vulvar area.&nbsp;

Also in the beginning, the pain or discomfort occurs for some days of the month, but later, it progresses to daily episodes of discomfort in the vulva<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

While the underlying cause isn&#39;t exactly known and research is underway, there are certain factors that are linked to vulvodynia. These include<a href="#accordion">[1][4]</a>:

<ul>
	<li>Past history of vaginal infections (vaginal thrush)&nbsp;&nbsp;</li>
	<li>Hormonal changes</li>
	<li><a href="https://merisehat.pk/disease/allergies">Allergies </a>or sensitive skin&nbsp;</li>
	<li>Injury or irritation to the nerves that surround the region of the vulva</li>
	<li>Spasm of the muscle or weakness of pelvic floor muscles that support the uterus, bladder, and bowel&nbsp;</li>
</ul>

Bottom line, vulvodynia is nothing to be ashamed of. It&rsquo;s a medical condition that can happen to anyone. 
&nbsp;

Vulvodynia is a chronic condition and the lifetime prevalence of this condition is estimated to be 8% among all age groups but owing to the nature of this condition, it is often underreported. Moreover, most women with vulvodynia suffer in silence and are reluctant to seek medical help. This results in a negative impact on the quality of their life, primarily because it significantly affects their psychosexual health<a href="#accordion">[3]</a>.&nbsp;

Women with vulvodynia often experience frustration, depression, chronic stress, and anxiety because of the chronic nature of pain which hampers their productivity. They are conscious and unwilling to indulge in sexual activities because of the painful intercourse that ensues. Consequently, they suffer from decreased sex drive and restricted sexual behavior in order to avoid having to mentally prepare themselves for the pain and discomfort that follows intercourse<a href="#accordion">[3]</a>.

Furthermore, most women affected with vulvodynia have to stay at home due to the nature of pain associated with this condition. Regular, chronic pain and vulvodynia symptoms makes these women homebound and socially isolated, disrupting their work-life balance<a href="#accordion">[3]</a>. 
&nbsp;

It is not uncommon for women to hide their symptoms of vulvar pain since they are hesitant to discuss their condition with a doctor. However, there&rsquo;s no need to suffer in silence when there are treatment options available to help improve your quality of life.&nbsp;

If there&rsquo;s any kind of pain or discomfort in the genital area, it is advised to immediately consult the healthcare provider or a gynecologist. Often times there is an underlying cause of vulvar pain, such as bacterial infections, yeast, herpes, genitourinary syndrome of menopause, or precancerous skin conditions. These medical problems are treatable, so there&rsquo;s no reason to waste time.

Moreover, it is advised not to use over-the-counter medications for treating yeast infections repeatedly without consulting a doctor. The right way to go about this situation is to get the symptoms evaluated by a medical practitioner who would come up with an individualized treatment plan<a href="#accordion">[1]</a>. 
&nbsp;

In order to diagnose vulvodynia, the doctor would first take a detailed history asking about symptoms and their duration as well as sexual and past surgical history to gain an insight into the patient&rsquo;s condition.&nbsp;

The doctor would then perform the following exams to diagnose vulvodynia<a href="#accordion">[6]</a>:

&nbsp;

<ul>
	<li>
	<h5>Pelvic Exam&nbsp;</h5>
	</li>
</ul>

A detailed examination of the external genitalia and vagina is required to confirm if there&rsquo;s any infection or inflammation. Usually, the vulva appears normal in vulvodynia, but the gynecologist may take a sample of cells from the vagina to test for the presence of any infection, such as bacterial vaginosis or yeast infection (candidiasis).

&nbsp;

<ul>
	<li>
	<h5>Cotton Swab Test</h5>
	</li>
</ul>

In this test, the healthcare provider will use a moistened cotton swab to check for areas of pain in the vulvar region.&nbsp; 
&nbsp;

Vulvodynia is a chronic condition and a combination of treatments can help alleviate the symptoms of vulvar pain and improve quality of life.&nbsp;

The following are the vulvodynia treatment options:

&nbsp;

<ul>
	<li>
	<h5>Vulval Gels And Lubricants&nbsp;</h5>
	</li>
</ul>

Since painful intercourse is the most frequent complaint of women affected with vulvodynia, using an anesthetic gel such as lidocaine 20 minutes before intercourse can make the activity comfortable for both partners. It&rsquo;s also advised to either wipe the gel off just before sex or to ask their partner to wear a latex-free condom during intercourse.&nbsp;

However, if the pain persists throughout the day, then it&rsquo;s usually recommended to apply lidocaine regularly during the day and also overnight to moisturize and soothe the vulva<a href="#accordion">[4]</a>.

Note: Lidocaine 5% gel is available as an over-the-counter medication in the form of gel or ointment; however, it is suggested to consult a doctor before using it.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Medications&nbsp;</h5>
	</li>
</ul>

Analgesics, like paracetamol, aren&#39;t effective in treating vulvodynia symptoms and pain. Therefore, the doctor will advise several other medications to alleviate the symptoms, including<a href="#accordion">[4]</a>:

<ol>
	<li>Antidepressants: Amitriptyline and Nortriptyline&nbsp;</li>
	<li>Anti-Epilepsy Medicines: Gabapentin and Pergabalin</li>
</ol>

The healthcare provider will start these medications on low doses and will gradually increase the doses to achieve complete remission of pain.&nbsp;For pain relief in a localized region in the vulva, injections of local anesthetics and steroids can be used to provide temporary relief to the patient.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Physiotherapy&nbsp;</h5>
	</li>
</ul>

Physiotherapy, including pelvic floor exercises, can help relax the tense muscles of the pelvic floor.&nbsp;Some physiotherapists prefer transcutaneous electrical nerve stimulation (TENS) to reduce vulvar pain. This technique uses a mild electric current that is administered to the painful region of the vulva<a href="#accordion">[4]</a>.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Behavioral Therapy And Counseling&nbsp;</h5>
	</li>
</ul>

Currently, healthcare providers are using Cognitive Behavioral Therapy (CBT) to manage the symptoms of vulvodynia by changing the thought process linked with this condition. The aim of this therapy is to focus on the problems that patients face on a daily basis because of their condition and to help them address these problems effectively<a href="#accordion">[4]</a>.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Surgery&nbsp;</h5>
	</li>
</ul>

Surgery of the painful part of the vulva is yet another treatment option for patients. However, it&rsquo;s rarely opted for, especially because the pain can recur<a href="#accordion">[4]</a>.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Treatment Of Vaginal Infections&nbsp;</h5>
	</li>
</ul>

Sometimes vulvodynia presents with itching in the vulvar region and this is mostly due to a fungal infection known as vaginal thrush which affects the region of the groin and inner thigh.&nbsp;

Treatment involves the use of antifungals. If vulvodynia is due to this underlying infection, the itching and discomfort will resolve following the completion of fungal treatment.&nbsp; 
&nbsp;

Following lifestyle changes will alleviate your vulvodynia symptoms<a href="#accordion">[4]</a>:

<ul>
	<li>Apply cool packs on the affected region of vulva to ease the pain</li>
	<li>Wear loose-fitting trousers, skirts, and cotton underwear&nbsp;</li>
	<li>Avoid using scented products, such as bubble bath, soaps, and feminine wipes&nbsp;</li>
	<li>Apply petroleum jelly before swimming to protect vulva from chlorine water in the swimming pool&nbsp;</li>
	<li>Reduce stress levels since stress aggravates vulvodynia&nbsp;</li>
	<li>Use a donut-shaped cushion to prevent vulvodynia from developing due to prolonged sitting&nbsp; 
	&nbsp;</li>
</ul>

Conclusion

Vulvodynia is vulvar pain that affects women of all ages. There is no known cause for it. Majority of women suffer silently from this condition because they are reluctant to visit and discuss their problem with a doctor. Women need to consult their healthcare professionals whenever they develop any sort of pain in their genital area since treatment is possible.&nbsp;

Key Points

<ul>
	<li>Vulvodynia is pain in the vulvar region, which is the area surrounding the opening of the vagina.</li>
	<li>Vulvodynia is pain and discomfort in the vulvar region. This can be elaborated as itching, burning pain, stinging sensation, and painful intercourse.&nbsp;</li>
	<li>This condition affects women of all ages and all ethnicities.&nbsp;</li>
	<li>This condition negatively impacts the psychosexual health of affected women and socially isolates them.</li>
	<li>The exact cause of Vulvodynia is yet to be elucidated</li>
	<li>Vulvodynia is diagnosed through history and pelvic exam and a variety of treatment options exist.&nbsp;</li>
	<li>There are multiple options for vulvodynia treatment, such as vulval gels, medications, physiotherapy, surgery, and CBT.&nbsp;</li>
</ul>

[1] Vulvodynia - Symptoms and causes. Mayo Clinic.

[2] Vulvodynia. The Royal Women’s Hospital.

[3] Sadownik L. Etiology, diagnosis, and clinical management of vulvodynia. Int J Womens Health. 2014:437. doi:10.2147/ijwh.s37660

[4] Vulvodynia (vulval pain). nhs.uk.

[5] Vulvodynia: Causes, Symptoms, and Treatments. WebMD.

[6] Vulvodynia - Diagnosis and treatment - Mayo Clinic.

Nawal Adnan

Overview

There&rsquo;s nothing quite as bad as the burning sensation down there. All of us at some point have encountered this issue. Let&rsquo;s see what could be the reason your nether regions have decided to give you a tough time: 
&nbsp;

For Women

<ul>
	<li>Yeast Infection: The medical term for this is &lsquo;candidiasis&rsquo;. It&rsquo;s also called &lsquo;thrush&rsquo; and along with a burning sensation down there you might have soreness, itching and pain as well. You can get it due to several reasons such as being on hormonal contraception, having a compromised immune system, a recent course of antibiotics or <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">diabetes</a>. In order to treat this, oral or topical antifungal treatment is used. 
	&nbsp;</li>
	<li>Bacterial Vaginosis: This happens when there is an overgrowth of certain bacteria in your vagina. Its accompanying symptoms include a white or gray discharge, strong fish-like odour, pain and itching. Antibiotics are prescribed. 
	&nbsp;</li>
	<li>Urinary Tract Infections (UTIs): These are super common and we are all too familiar with these. UTIs usually present or appear as increased frequency and urgency to urinate along with cloudy urine and burning. This can clear up in as little as five days with antibiotics. Numbing agents can also be used to eliminate the burning along your urinary tract. &nbsp; 
	&nbsp;</li>
	<li>Sexually Transmitted Infections (STIs): Such as gonorrhea, chlamydia and trichomoniasis can also lead to a burning sensation down there. Itchiness, soreness, redness, burning and foul smelling vaginal discharge are some characteristic symptoms of these. Once your doctor identifies the cause you&rsquo;ll be prescribed a course of antibiotics. 
	&nbsp;</li>
	<li>Irritation: Contact with certain substances can cause itching or stinging such as scented soaps, fabrics, perfumes, semen, feminine hygiene sprays and washes, douches and toilet paper etc. This is why it&rsquo;s important to only use lukewarm water to wash your private areas along with peeing and washing right after sex and making sure you wear breathable cotton panties. &nbsp; 
	&nbsp;</li>
	<li>Genital Herpes: This is another STI that comes with flu-like symptoms, swollen glands, itching, tingling sensation, pain while urinating, vaginal discharge as well as painful sores and blisters. The reason we mention this separately is because although these symptoms can be treated with antivirals, there is no actual cure for this. 
	&nbsp;</li>
	<li>Menopause: The gradual change in our hormonal levels as menopause develops can lead to quite a few symptoms such as night sweats, hot flushes, vaginal dryness and mood changes etc. The reason why burning happens as a result of menopause is because vaginal dryness can lead to UTIs and other infections. Similarly, vaginal atrophy means the walls of your vagina are now thin, dry and inflamed and it might get cuts and bruises. In order to manage this, Hormonal Replacement Therapy (HRT) and topical estrogen creams are used. 
	&nbsp;</li>
	<li>Yeast Infection: The medical term for this is &lsquo;candidiasis&rsquo;. It&rsquo;s also called &lsquo;thrush&rsquo; and along with a burning sensation down there you might have soreness, itching and pain as well. You can get it due to several reasons such as being on hormonal contraception, having a compromised immune system, a recent course of antibiotics or diabetes. In order to treat this, oral or topical antifungal treatment is used. 
	&nbsp;</li>
	<li>Bacterial Vaginosis: This happens when there is an overgrowth of certain bacteria in your vagina. Its accompanying symptoms include a white or gray discharge, strong fish-like odour, pain and itching. Antibiotics are prescribed. 
	&nbsp;</li>
	<li>Urinary Tract Infections (UTIs): These are super common and we are all too familiar with these. UTIs usually present or appear as increased frequency and urgency to urinate along with cloudy urine and burning. This can clear up in as little as five days with antibiotics. Numbing agents can also be used to eliminate the burning along your urinary tract. &nbsp; 
	&nbsp;</li>
	<li>Sexually Transmitted Infections (STIs): Such as gonorrhea, chlamydia and trichomoniasis can also lead to a burning sensation down there. Itchiness, soreness, redness, burning and foul smelling vaginal discharge are some characteristic symptoms of these. Once your doctor identifies the cause you&rsquo;ll be prescribed a course of antibiotics. 
	&nbsp;</li>
	<li>Irritation: Contact with certain substances can cause itching or stinging such as scented soaps, fabrics, perfumes, semen, feminine hygiene sprays and washes, douches and toilet paper etc. This is why it&rsquo;s important to only use lukewarm water to wash your private areas along with peeing and washing right after sex and making sure you wear breathable cotton panties. &nbsp; 
	&nbsp;</li>
	<li>Genital Herpes: This is another STI that comes with flu-like symptoms, swollen glands, itching, tingling sensation, pain while urinating, vaginal discharge as well as painful sores and blisters. The reason we mention this separately is because although these symptoms can be treated with antivirals, there is no actual cure for this. 
	&nbsp;</li>
	<li>Menopause: The gradual change in our hormonal levels as menopause develops can lead to quite a few symptoms such as night sweats, hot flushes, vaginal dryness and mood changes etc. The reason why burning happens as a result of menopause is because vaginal dryness can lead to UTIs and other infections. Similarly, vaginal atrophy means the walls of your vagina are now thin, dry and inflamed and it might get cuts and bruises. In order to manage this, Hormonal Replacement Therapy (HRT) and topical estrogen creams are used. 
	&nbsp;</li>
</ul>

For Men

<ul>
	<li>Urinary Tract Infection (UTI): Although less common in men than women, UTIs do happen, especially in older age. The symptoms are similar to what we observe in women and so is the treatment. 
	&nbsp;</li>
	<li>Urethritis: This is an inflammation of the urethra which is the tube that transmits urine outside the body from your bladder. This is a bacterial infection and comes with symptoms such as redness around the ureteral opening, yellow discharge, bloody urine and penile itching. A course of antibiotics can promptly fix all this. 
	&nbsp;</li>
	<li>Yeast Infection: This can happen due to unprotected sexual intercourse between partners of opposite sex if the woman has a yeast infection. The common ways it presents is itchiness and rash on the penis and a white discharge along with a burning sensation. Topical or oral antifungals are the treatment of choice. 
	&nbsp;</li>
	<li>Prostatitis: This is an inflammation of the prostate gland which is a pea-sized gland that surrounds your urethra. Leakage of bacteria from the urine can lead to prostatitis and you may have difficulty urinating, increased frequency of urination, cloudy or bloody urine as well as painful ejaculation. Antibiotics are given to fix this along with alpha blockers to help ease discomfort. 
	&nbsp;</li>
	<li>Gonorrhea: This is an STI and can be acquired through unprotected intercourse. Burning micturition, pain or swelling of the testicles and pus-like discharge can occur if you have gonorrhea and a quick course of antibiotics is advised. Other STIs such as Chlamydia are usually asymptomatic in men. &nbsp; 
	&nbsp;</li>
	<li>Penile Cancer: A rare form of penile cancer can also lead to burning down there. If you have changes in the colour of your penis, thickening of the penile skin or a sore growth on the surface then this is likely the reason. Radiation, chemotherapy and surgery are the mainstays of treatment. 
	&nbsp;</li>
</ul>