Chronic Pelvic Pain

sexual health

Living with chronic pelvic pain disrupts the quality of life for many patients throughout the Treasure Valley. Many practices do not take the time to identify and treat the root cause of chronic pelvic pain. Jill Gustafson, CNM, is a pelvic health specialist who diagnoses and treats conditions causing pelvic pain from her practice in Boise, Idaho.

Chronic pelvic pain describes pain anywhere below the umbilicus and between the hips that lasts for at least six months. There are many causes of chronic pelvic pain. It is important to identify the location, character, timing, and qualities associated with pelvic pain to determine the cause, diagnosis and treatment.

What conditions can cause pelvic pain?

Pelvic pain can be caused by one or more of a number of conditions, including:

  • Vulvodynia
  • Vulvar Vestibulitis
  • Vaginismus
  • Allergic Contact Vestibulitis (common culprits are soaps, laundry detergent, fabric softeners, menstrual pads, spermicides, latex condoms, or anti-yeast creams)
  • Lichen Sclerosus
  • Lichen Planus
  • Lichen Simplex Chronicus
  • Hypertonic Pelvic Floor Muscle Dysfunction
  • Endometriosis
  • Interstitial Cystitis (IC)
  • Chronic Vaginitis
  • Desquamative Inflammatory Vaginitis (DIV)
  • Vulvar Intraepithelial Neoplasia (VIN)
  • Herpes and Post-Herpetic Neuralgia
  • Pudendal Neuralgia
  • Persistent Genital Arousal Disorder (PDAG)
  • Clitorodynia (Clitoral Pain)
  • Aphthous Ulcers / Behcet's Disease
sexual health

What is vulvodynia?

"Vulva" is a word that encompasses all of the female external genitalia - mons pubis, skin and hair, labia majora, labia minora, clitoris, vestibule, urethra, and opening to the vagina. Therefore, the term vulvodynia literally means "vulvar pain." Vulvodynia is currently defined as "vulvar discomfort, most often described as burning pain, occurring in the absence of relevant visible findings or a specific, clinically identifiable disease". This definition is non-specific and can be frustrating for women who are experiencing daily pain because it does not specify the root cause of the pain (i.e., it is not an actual diagnosis).

At Quantum Women's Health, we know that vulvar pain can be caused by diagnosable and treatable disorders such as infections (yeast, trichomonas), dermatologic disorders (lichen sclerosus, lichen planus, plasma cell vulvitis), hormonal (atrophic vulvovaginitis) and neurologic disorders (pudendal neuralgia, pudendal nerve entrapment, and post-herpetic neuralgia.) While many women are referred to Quantum Women's Health with the diagnosis of "vulvodynia," we only rarely give this diagnosis because we are skilled in the diagnosis of the specific diseases that cause vulvar pain.

How common is vulvodynia?

It is estimated that 1.3% of women have vulvodynia. In 2002, a sample of women was invited to participate in a web-based survey and 94.5% responded. A history of vulvar pain was reported by 28 %, with 7.8% reporting pain within the past six months, 3 % reporting pain that lasted three or more months, and 1.7% reporting pain lasting three or more months that occurred within the past six months. The authors concluded that as many as 14 million women in the United States may experience chronic vulvar pain during their lifetime. Thus, even if only a small percentage of these women have true vulvodynia, the number of women with the problem is enormous. Unfortunately, at least 30% will suffer without seeking medical care.

What can cause vulvodynia?

The cause of vulvodynia remains elusive, but it most likely occurs from a variety of sources and represents many different disease processes.  Possible causes include abnormalities of embryological development, genetic and/or immunologic factors, hormonal factors, peripheral and central neuropathy (nerve damage), allergic reactions, tightness of the muscles of the pelvic floor, and nerve entrapment. In essence, it is likely that there are many different diseases that yield similar symptoms and cause "vulvodynia."

What does not cause vulvodynia?

  • Recent studies have shown that HPV (human papillomavirus) does not play a significant role in vulvodynia. 
  • Earlier studies hypothesized that increased urinary oxalate might be a cause of vulvodynia. This has been refuted.
  • While many women with vulvodynia report a past history of yeast infections (candidiasis), it remains uncertain whether yeast itself is a cause of vulvodynia, mainly because candidiasis is notoriously difficult to accurately self-diagnose.
  • Vulvodynia does not result from psychological or sexual dysfunction. However, the presence of chronic pain of any type can have a profound impact on quality of life and many psychosocial factors, including sex.