Help! I Have Vulvodynia and I'm Pregnant

As women pass the hurdle of getting pregnant with having vulvodynia, many readers should know that having this condition doesn't cause infertility. It's just sometimes painful to have sex, which in turn hampers the act of getting pregnant. Vulvodynia is a condition where there is pain in the vulvar areas that is chronic. But in this article, you are already there, congratulations! Now to discuss what happens during the nine months of pregnancy.

During the pregnancy

Most women do not encounter more pain of vulvodynia during pregnancy, some even feel better. One issue that can cause complications is vaginal thrush. During pregnancy the female hormone estrogen rises since the placenta produces it. This sometimes causes an excess of normal vaginal discharge, which is white, but does not cause any itching or irritation. On the other hand, pregnant women are more prone to Candida albicans infections so if itching, irritation or discharge that looks like milk curd appears; it's best to be checked by your physician to rule out any infection. A swab culture is taken for diagnosis. Anti-yeast creams sometimes make the irritation of vulvodynia worse so obstetricians usually treat with oral medications such as nystatin or miconazole. Newer medications for yeast infections such as Diflucan and Ancobon are usually avoided because they absorb systemically.

Pre-delivery concerns

Yes, vulvodynia is painful, however it doesn't warrant a cesarean section delivery just because of vulvar pain. If other causes of concern happen, then a cesarean could be ordered, but most women with this chronic condition can deliver vaginally. Try to find an obstetrician (or certified midwife) who is knowledgeable about vulvodynia. A thing to discuss with your doctor is if they can perform an "intact delivery" that will avoid cuts or tears in the perineal tissues. Having an episiotomy can produce a scar, which will be a new area of tenderness in the future. According to Gae Rodke, M.D. in the book The Vulvodynia Survival Guide, "episiotomies should be avoided in almost all deliveries. Incisions are almost always larger than they would be if the woman tore naturally. Incisions are also more likely to cause damage to the rectal sphincter and the rectum."

Some doctors recommend perineal massage prior to delivery to prepare the vulvar tissue. Some women find this helpful, but others say that the pain of this massage is unbearable, especially women who experience vulvodynia upon touch.

It's important to discuss the type of anesthesia you will have, if you choose that route. A newer "walking" epidural anesthetic is useful where it gives pain control without losing muscle control for the first two to four hours of labor. Afterwards, a continuous infusion of local anesthetic is injected into the epidural catheter to keep the woman comfortable. There are many options for anesthesia, so it's best to discuss these treatments with your doctor during pre-delivery time.

Post-delivery issues

Whether you have vulvodynia or not, post-delivery patients will experience some discomfort during the postpartum phase. The decrease in vaginal estrogen, which causes dryness and burning, happens during lactation. In these cases, a vaginal lubricant and even small amounts of estrogen cream is soothing and helpful. Think ice when there is inflammation, a cold pack will be comforting and also help to reduce the pain. Before sexual intercourse can resume, stretching of the introital skin can be beneficial and also continuing to do pelvic floor exercises, if they were used before the pregnancy.

And of course, after your delivery make sure to consult with your doctor or midwife about after care and also ways to alleviate the uncomfortable symptoms of vulvodynia that you may have experienced before the pregnancy. There are medications and home remedies that help to make this disorder bearable.

Sources:

The Vulvodynia Survial Guide by Howard I. Glazer, Ph.D. & Goe Rodke, M.D. FACOG [New Harbinger Publications, 2002]

Vulval Pain Society "Pregnancy and Vulvar Pain"