Long liquidated as an imaginary disease of purely psychosomatic origin, vulvodynia is finally recognized as a disabling disease. We talk about it with Dr. Claudio Paganotti, gynecologist and clinical sexology consultant
Maria Elena Perrero
11 mag 2022 | 09:33 – 09:33
Some, including some doctors, have called it an “imaginary pain”, but finally there vulvodynia is recognized as disabling disease in the essential levels of assistance of the National Health System with the bill filed in the last few days in Parliament. To talk about it, it also took the mobilization of Giorgia Soleri, influencer and companion of the Maneskin frontman Damiano David who has been suffering from this painful pathology for some time. “Patients have long been pointed out as complex girls, but they are not at all: it is an objective pain, confirmed by numerous studies”, he explains to him. Official Active Dr. Claudio Paganotti, gynecologist and clinical sexology consultant at the Clinical Institute of the City of Brescia (San Donato Group).
Vulvodynia: what it is and what are the symptoms
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The main symptom of the vulvodynia is a pain of the vulva, “like a burning or discomfort which can be located in an area of the vulva, such as the vestibule or the clitoris, or affect the entire organ, especially in menopausal women ”, explains Dr. Paganotti. “The Americans would call it discomfort. At the visit there is nothing altered, but then if some specific tests are performed it is evident that the pain in the vulva is present in women. So that we can properly speak of vulvodynia, this painful situation must last for at least three months “. Do not think that this pathology affects only a few women, rare cases: “It involves between 16 and 28% of women, from adolescents to those in menopause. And this is an underestimated figure, since some girls or women out of embarrassment or shame do not tell the doctor ”.
The causes of vulvodynia
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There may be several causes of vulvodynia. “Pain can arise spontaneously or as a result of some stimuli which, in the absence of this pathology, would not be painful, such as contact with clothing, sexual intercourse, crossing of the legs”, explains Dr. Paganotti. But also a common infection like candida can give rise to vulvodyniaas well as, the gynecologist tells us, “theepisiotomy, or the surgical incision of the perineum which is sometimes made to widen the vagina and facilitate the passage of the fetus during childbirth “. The pain that arises from here often does not go away: “The initial cause vanishes but the discomfort persists – warns the gynecologist -. This can happen for one excessive stimulation of mast cells, immune system cells that produce inflammatory substances. But vulvodynia can also be due to excessive stimulation of the pain nerve fibers. In this case we have a ache such that in the face of normally painless situations the patient feels pain (allodinia), or when faced with moderately painful situations the patient feels very intense pain (iperalgesia) “. Then there is a third possible cause, which is related to the pelvic floor musculature: “A hypertone pelvicor the contracture of the pelvic floor muscles, can lead to pain during penetration “, underlines Dr. Paganotti, who warns:” As you can understand, the causes are not very clear. There are several triggering, maintenance and co-responsible factors. Among the latter, it should be remembered that the diagnosis usually takes place after three to four years and in the meantime the situation worsens, partly because the therapies are often not adequate and partly because the patient in many cases does not follow the therapy, since she is long and the results are poor. For this reason it is essential that the doctor not only knows and treats the disease, but also knows how to communicate with the patient “.
How is vulvodynia treated
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Therapy for the vulvodynia it is multifactorial, and goes from drug behaviors. “Among the behaviors I remember the use of cotton underwear, preferably white, since it does not contain dyes that can be irritating. However, tight-fitting clothing should be avoided. Sanitary pads should also be pure cotton, while vaginal tampons should not be used. At night it can help to sleep without underwear, in order to avoid possible irritation from contact ”. Then there is the whole chapter concerning the intimate cleansers. “The detergent must be oily, not foaming. Rather than using aggressive detergents or with perfumes, it is better to wash only with warm water – underlines Paganotti -. And when it dries you have to dab, not rub “. There are some physical and sports activities that can cause pain: “Surely sports like horse riding or cycling, but even simply riding a bicycle can cause pain ”. Finally, with regard to the sexual intercoursethe gynecologist suggests to always have an empty bladder during intercourse and to counteract constipation, since it could alter the intestinal and vaginal pH, favoring the candida. “We also recommend lubricants or moisturizers during intercourse,” adds Dr. Paganotti.
Treatment against vulvodynia: drugs and natural treatments
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For what concern treatment of neuropathic painDr. Paganotti points out neuropathic analgesic psychotropic drugs low dose, “but also lidocaine-based gel, a local anesthetic which, however, in addition to taking away the pain, also takes away the pleasure “. To counteract local inflammation, the gynecologist suggests “anti-inflammatories in the form of gels or creams based on aliamidi o di natural extracts. Among these is the Zanthalene, solution extracted from the fruits of Zanthoxylum bungeanum, which has an anti-inflammatory and analgesic action. Creams with hibiscus or karkadè extract, with emollient properties, which avoid the dehydration produced by the anticipatory fear of pain, which reduces the natural lubrication of the vagina “.
Vulvodynia, “there are no imaginary patients”
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L’psychological aspect it is only secondary: “Patients suffering from vulvodynia are not imaginary patients. There are numerous studies showing the presence of mast cells and nerve fibers greater than the physiological. A situation that leads to ahypersensitivity of the area and, consequently, to a significant reduction in the pain tolerance threshold – underlines Paganotti -. Medicines modulate pain, local creams remove inflammation. And finally the perineal gymnastics helps to release the muscle. I refer for example to the Kegel exercises, to those with vaginal cones, to vaginal massage. At a later time I am also supporting the psychotherapy and sexual counseling, to educate patients to relieve anxiety and anticipatory fear that leads to greater contraction of the pelvic floor. But it is an objective and physical disease. Vulvodynia is cured. However, it is necessary to find a competent and sensitive doctor, and the patient must be educated to live with the therapy with the aim of not having any more pain ”.
11 maggio 2022 – 09:33
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