OBGYN.net: The Universe of Women's Health

**3. CAN IT GET WORSE?**

Some women experience a constant and unchanging level of pain for years. Others describe their pain as occurring in cycles, with partial or complete remissions, followed by flare-ups. Many women with vulvodynia say that their pain began with vestibulitis and gradually spread in area; however, it is equally clear that not all vestibulitis will turn into vulvodynia. Then, too, there are women with vulvodynia who do NOT have vestibulitis.

Many women have reported worsening after being on birth control pills, using antifungal creams, or being on antibiotics. In most, but not all, cases, the additional pain seems to eventually recede when these things are discontinued.

Inexpertly performed laser surgery may be the biggest risk factor for long-term worsening of the pain!

**4. CAN IT GET BETTER?**

YES. There are women whose symptoms have disappeared! Many women have been able to lessen their pain through following the suggestions others have provided. You are not doomed to spend the rest of your life at your current pain level; there ARE options you can try.

One suggestion is that you keep a pain diary, in which you keep a daily record of what treatment(s) you're trying, what the pain feels like (burning, itching?) and a note of your total pain level on a numeric scale (i.e., 1-10). It can also be useful to note where you are in your menstrual cycle. This information can be tremendously helpful to review -- or to graph -- and can give you some insights into what, for you, works and what doesn't.

**5. WHAT CAUSES VULVODYNIA AND VULVAR VESTIBULITIS?**

We'd love to know this one! It's VERY important to remember that there are likely to be multiple causes of vulvar pain. After all, we don't expect that everyone gets headaches for exactly the same reasons! And, just as in headaches, your body may be able to tolerate ONE cause, but the pain results when you have a COMBINATION of causes acting all at once. Below are listed some of the possible causes we've discussed. Because some treatments may be appropriate for more than one suspected cause, they are listed separately (alphabetically) in section 6.

_5.1 Allergies_

Unfortunately, allergies can also be to the building blocks of food (i.e., certain acids) which can make it difficult to figure out which foods might be causing the trouble. Rather than try to self-diagnose, you may want to try to talk to an allergist knowledgeable about vv -- or, if you can't find one, ask your gynecologist to consult with a specialist in allergic vaginitis. Most allergy tests are done by examining samples of your blood for the presence of specific antibodies, or by injecting small amounts of typical allergens and looking for skin reactions. While frustrations with the inability and apparent lack of interest of "Western medicine" to address our problems is perfectly understandable, please be especially careful about trusting "alternative" medicine in this arena: many, many ways are touted for determining allergies -- from noting reactions to spoken lists of foods, to impressive-looking but useless "computers", and most are expensive and scientifically worthless. Once your allergies are identified you can undergo a course of injections, or "Enzyme Potentiated Desensitization" (EPD), in order to curb the inflammatory response to the allergen.