Surgical option for vulvodynia available

Dear Dr. Roach: My 77-year-old sister has what she and I believe is vulvodynia. She’s in horrible pain in her vaginal area and has had every test imaginable. She has been seen by her general doctor and gynecologist, but so far, no one has been able to diagnose her. She feels like she has a constant UTI, but tests come back negative. She’s used estrogen cream, and does Kegel exercises. I read that there’s some kind of surgery and would like to hear more about that. I hate that she’s in so much pain and suffering. — S.F.

Vulvodynia, pain in the vulva from unknown cause, has a significant effect on a woman’s quality of life. While it sounds like she has had some appropriate evaluation and attempts at treatment, she continues to have symptoms.

Patients with vulvodynia should see a specialist in female pelvic pain, usually a gynecologist who has special expertise in this problem. Most often, a number of interventions are begun, including: careful advice on proper hygiene, especially avoiding soaps, douches and other irritants to the vulva; wearing cotton underwear; practicing stress reduction; getting regular nonirritating exercise; and the use of warm soaks and/or ice packs. Another important resource is a pelvic floor physical therapist. Some of my patients have had an improvement in symptoms with cognitive behavioral therapy.

Although there are surgical approaches to vulvodynia, they are reserved for a subset of women with certain types of pain who continue to have pain. The literature reports 60% to 90% success rates in carefully selected patients.

There is preliminary evidence that laser-based treatments may have benefit in some women with vulvodynia.

I would strongly recommend your sister ask for a referral to an expert in female pelvic pain.