Some pregnant women report vulvar discomfort never felt before. Intense burning, dryness, itching, a feeling of having “cuts,” small lacerations, or pinpricks or electric shocks. They go to the doctor who, ruling out other conditions, diagnoses vulvodinia, a pain of neuropathic origin, that is, in which the nerves feel a stimulus as painful that should not be. This is often vulvar vestibulitis or provoked vestibulitis, a variant of vulvodinia in which the pain is localized at the level of the vestibule, that is, the tissues located at the entrance to the vagina. Can pregnancy trigger vulvodinia? We asked an expert
Vulvodynia and pregnancy: why it happens
“Usually pregnancy, which is a delicate period for the female body both psychologically and hormonally, reactivates a previous genetic predisposition or misrecognized or underestimated vulvar vestibulitis, or triggers hypersensitivity acquired from a history of recurrent infections or pelvic floor dysfunction. It happens more frequently in the first trimester then, usually, the pain increases as a result of changes in vaginal physiology: hormonal changes, reduced connective tissue, increased muscle tension in preparation for childbirth.” Why does it happen? Explains the specialist, “The vestibule is one of the most hormone-sensitive areas of the female body. During pregnancy, there is analteration of the immunological and neurological hormonal balance at the level of the vulva. In particular, progesterone increases, the ratio of various estrogens changes, and the expression of receptors for various estrogens varies as well. Free testosterone decreases. All this results in the vestibular epithelium becoming thinner and more vulnerable. Collagen and elastin production is altered, painful sensitivity may increase, the ecosystem of bacteria at the vaginal level changes, and susceptibility to candida irritation and microtrauma increases.”
Vulvodynia in pregnancy: how is it treated?
Symptoms are the same as in non-pregnant women, but unfortunately most medications (generally amitriptyline, gabapentin) cannot be used during pregnancy, even locally due to potential side effects on the fetus. Therefore, it is important to focus first on dietary and behavioral rules designed to reduce inflammation and keep pain under control. The multispecialty team can, in addition, indicate the safest and most suitable protocol for the specific case, which may include a pelvic floor rehabilitation program, psychotherapy sessions, and some local and/or oral therapies, depending on the case. “ Local spermidine in cream and PEA by mouth are those currently of choice in pregnancy,” Pecorari explains. “The former is a molecule derived from arginine (an essential amino acid), which is particularly effective in stimulating cell and tissue renewal. Because of its proven trophic action on female tissues when released in supramolecular complexes, it is used in the form of gels or creams to be applied topically to treat ailments such as pain, vestibular burning, and dispareunia (intercourse pain).” Palmitoylethanonolamide (PEA), on the other hand, often in combination with other active ingredients, can be an excellent adjuvant in controlling the inflammatory response peculiar to the neuropathic changes characteristic of vulvodinia. It can be taken orally, in supplement form, or applied locally
Conclusions
Is vulvodinia a dangerous condition for the mother-to-be or the baby? In itself, no, but proper diagnosis and timely and thorough medical care are essential. In fact, the scientific community reports that the occurrence of vulvodinia and vaginismus during pregnancy appears to be underestimated compared to the general population. The frequency of reported cases seems to have increased in recent decades and is associated with an increased risk of maternal and neonatal morbidity, linked in most cases to pelvic floor dysfunction reported by women and/or the difficulty of performing internal examinations during labor for fear of pain.