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Unfortunately, the causes of vestibulodynia still remain unknown in spite of research being done in this area. However, certain biomedical and psychological risk factors may be associated with the development, aggravation or continuity of this problem. These are different factors targeted by treatments whether through physiotherapy (e.g., tension of the pelvic floor muscles), sex therapy (e.g., pain management, sexual and conjugal satisfaction), or medical treatments (e.g., desensitization of the mucous membranes).
Vestibulodynia affects approximately 12% of women in the general population. It is characterized by pain in the vulvar vestibule, often felt at the entrance of the vagina. The pain is described by women as being a burning sensation during sexual intercourse involving vaginal penetration, but also other activities involving pressure on the vestibule (e.g., insertion of tampons, gynecological examination). Vestibulodynia may affect teenage girls and women of all ages. It may appear from the very first sexual relation, or occur after years of non-painful sexual intercourse. This problem of gynecological pain has negative consequences on the sex and love life of women affected and their partners.
Repeatedly feeling pain during sexual intercourse with vaginal penetration leads to major repercussions on the psychological, sexual and conjugal experience of women and their partners. Psychologically, this type of problem can become a source of distress and anxiety for women affected, whereas their partners may have more depressive symptoms versus couples without this problem. Sexually, the pain felt by these women may be associated with a disturbance of their overall sexual function, which is followed by/, followed by a drop in interest, excitement and sexual satisfaction. Their partners may suffer from altered sexual function. This problem therefore deprives many couples of a major source of pleasure and intimacy. Given the considerable impact of vestibulodynia on the sex life of women and their partners, the pain may become a factor of marital discord. In the long term, it could result in sexual frustration, a feeling of being pressured into having sexual intercourse, fear of losing the partner and a feeling of powerlessness in the partner who does not know how to react. Therefore, it is best that couples find the appropriate help for genital pain so that they do not feel alone with this problem and resulting consequences.
Once the problem has been diagnosed, the doctor will recommend one of the following treatments based on what has been observed during examination. It was noted that an approach combining different treatments (including practice tips, medical treatments, physiotherapy, cognitive-behavioural therapy) and the involvement of the partner provides the best results.
Given the wide range of treatments available, only the most commonly used are described in this section. Therefore, it is possible that your doctor will recommend something else.
1. Cognitive-behavioural therapy (sexologist or psychologist with expertise in vulvar pain)
Cognitive-behavioural therapy for vestibulodynia combines sexual therapy with pain management strategies. Follow-up may be done individually, in a group or as a couple. The therapy takes into account the factors contributing to the increase or consistency of the pain (e.g., anxiety, fear of hurting the other person) as well as the psychological, sexual and relational consequences of pain. Thus, using this treatment, the woman suffering from vestibulodynia may, for example, find ways of better managing pain episodes, improving quality of life and increasing her desire and sexual satisfaction. Cognitive-behavioural therapy can also allow the partner to better understand the reality of his spouse and create a space to talk about his fears, concerns and dissatisfactions so that his partner understands his reality. Together they can work on finding a solution tailored to their situation as a couple.
The purpose of perineal and pelvic rehabilitation is to reduce or control the pain using different techniques involving body awareness, desensitization exercises for the vaginal entry and different approaches to regaining control of the pelvic floor muscles. These muscles, which are not contracting and releasing sufficiently, influence the ability of the vagina to relax, thereby making penetration impossible or difficult. Physiotherapists also use manual techniques and/or tools such as biofeedback, electrostimulation and accommodators. These exercises learned in a clinic can be practised alone or as a couple.
3. Medical treatments
a) Topical anesthetics (e.g., lidocaine): Topical anesthetics are ointments, creams or gels that are applied to a painful region. For example, applying a 5% lidocaine ointment can improve symptoms of provoked vestibulodynia. Lidocaine has been recognized as a front-line treatment that is effective for relieving the symptoms of provoked vestibulodynia. Certain women can feel a burning sensation following application, but this generally only lasts a few seconds. This treatment can be prescribed by a doctor, is easy to follow and inexpensive.
b) Vestibulectomy: If no improvement occurs in pain relief using cognitive-behavioural therapy, physiotherapy or a front-line medical treatment, a vestibulolectomy may be recommended. Vestibulectomy is a surgical intervention done in day surgery under general anesthetic. The procedure involves removing part of the hymen and vestibule in a form of a crescent at the entrance of the vagina up to a depth of 2 mm. Following the operation, the woman will generally temporarily feel discomfort in the vaginal area. The convalescence period lasts approximately 4 weeks. Sexual activities with penetration should be attempted only 12 weeks after surgery after evaluation by the doctor and physiotherapist.