Dr. Pukall, what are the current treatments for vulvodynia? Dr. Caroline Pukall is an Assistant Professor in the Department of Psychology at Queen’s University in Kingston, Ontario, Canada.
Dr. Pukall
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Todd Hartley:
Hi, you’ve tuned into the EmpowHer Network, and right now we’re joined by Dr. Caroline Pukall, an Assistant Professor at the Department of Psychology at Queen’s University in Kingston, Ontario, Canada. Doctor, let’s talk about vulvodynia. What are the current treatments?
Dr. Pukall:
There are many and they range from essentially applying topical creams to something called a vestibulectomy which is the surgical removal of the vestibule, which is the thin piece of skin that surrounds the vaginal opening. So I am going to right now talk about the more common form of vulvodynia, which is the vestibulodynia. The main complaint of women with vestibulodynia or vestibulitis is that of pain during sexual intercourse. So many people, essentially in my head, there are a few really good treatment avenues. So if you look in the literature or if you search on the web, you will find a lot of sort of treatments out there. So, I will talk about the ones that have been studied in research projects and that have been found to be successful. And so the first one I will mention is psychotherapy. Essentially, psychotherapy essentially is done by a psychologist or a counselor who is well-versed in the areas of pain management and sexuality, And typically one adopts what is called the causative behavioral perspective of this pain and works with the woman in order to try to get her to control her pain, to control her reaction to the pain and to be able to adapt to the condition that she has. And studies have shown that this particular form of therapy is quite successful for many women with vestibulitis or vestibulodynia. Of course, there is not one treatment that will solve 100% of the pain in 100% of participants in 100% of affected women. A second avenue is that of pelvic floor physical therapy. And so pelvic floor physical therapists typically work with men and women who suffer from incontinence issues, and there is a sub-set of these pelvic floor physical therapists who essentially deal with vulvar pain, and they work with the women over several sessions in order to determine if there are trigger points. These are like heightened areas of muscle tension that could lead to the pain. They help the woman to sort of learn to control her pelvic floor muscles because there is some evidence that women who have vulvar pain conditions have more tension in their pelvic floor, which of course doesn’t help the pain, it actually increases the pain and essentially work with them by giving them education, by working with biofeedback measures, all sorts of different tools. There’s a lot of manual techniques, there’s a lot of stretching that happens, and there’s homework exercises that happen afterward as well after the session, and this has been found to be quite successful for women with vulvar pain.
There is also the surgery which I mentioned. This surgery is particularly reserved for women who have vestibulodynia or vestibulitis. This surgery is not to be performed in women who have the more generalized form of vulvodynia which I have been calling generalized vulvodynia. And so the surgery, again reserved for women who have vestibulodynia, essentially is a minor day procedure and the part of that, the vulvar vestibule, essentially depending on the surgical technique is surgically removed to a depth of about 2 mm, and then usually the vaginal mucosa is advanced to cover the excised area. And this is done usually under spinal anesthesia, and there is a recovery time obviously of about four to six or six to eight weeks before the woman can resume any penetrative activity. And the surgery has been found to be quite successful for the treatment of this particular pain. So there are other studies coming out right now. One looking at sort of the long-term application of an anesthetic gel to the vulvar vestibule, and it seems to be quite effective. Of course these research studies need to be replicated. We need more studies on this, and there is also some studies looking at the effects of the some medications However, the medication seems to be a little bit more effective for women with generalized vulvodynia than with vestibulodynia. So, the jury is still out. I know that there are several projects going on looking at the effects of medications and different kinds of treatment right now, but the results are not yet in.
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For more information on Dr. Caroline Pukall visit Queen's University in Kingston, Ontario, Canada.