Pain Conditions

Vulvar Vestibulitis is characterized by pain limited to the vestibule, the area surrounding the opening of the vagina. The pain of Vulvar Vestibulitis is present when pressure is applied to the vestibule (sexual intercourse, tampon insertion, prolonged sitting) and is described as burning, soreness, stinging, rawness, throbbing, or itching.

Causes include:

• Chronic irritation to the vestibule from irritants such as creams, moisture, soap, etc.
  
  
• Recurrent yeast infections


• Genetic susceptibility to vulvar irritation and vulvar pain

The mainstay of treatment and future prevention is the avoidance of irritants to the vulva. This includes the discontinuation of topical creams and irritant soaps and trying to keep the vestibule water clean and dry.

Treatment may also include steroid injection of the vestibule. Refractory cases are treated by Vulvar Vestibulectomy.

During Vestibulectomy, the inflamed area of the vestibule is removed.

 

 

Bladder pain syndrome is defined as chronic pelvic pain or discomfort that is felt to be related to the urinary bladder with symptoms that include urinary urgency or frequency. Interstitial Cystitis (IC) is a specific variant of BPS.

The painful symptoms of BPS are believed to be caused by a combination of injury to the bladder lining and autoimmune factors. Bladder lining injury allows irritants found in urine to irritate the bladder wall, while autoimmune factors lead to increased sensitivity of the bladder.

Patients with BPS commonly experience an almost constant urge to void to relieve pain.

Evaluation may include urodynamics and cystoscopy.

During cystoscopy, the inside of the bladder and urethra are evaluated with a small camera for abnormalities sometimes found in the bladder of patients with BPS. This can usually be done in the office during your exam. When pelvic floor tension accompanies BPS, Physical Therapy is usually recommended.

Medications used to treat BPS include bladder analgesics, antihistamines, and Pentosan Polysulfate (Elmiron).

Treatment options also include Bladder Instillation with substances to relieve the discomfort, InterStim, and hydrodistention.

Hydrodistention is done during cystoscopy under anesthesia. Fluid is infused until pressure within the bladder is elevated. Patients who respond notice a decrease in symptoms for at least 6 months and may be candidates for repeat hydrodistention.