Vulvodynia: Is a 'depressed' vagina the reason you find sex painful?

And why aren’t we talking about it more?

(Getty Images/iStockphoto)

Upon reading this headline, millennial women everywhere will recall a certain moment of Sex & The City in which, after being diagnosed with vulvodynia, Charlotte tells her gal pals over avo toast that her vagina is “depressed.”

Naturally, symptoms of the chronically painful illness are a little more complex than not meeting a deadline or always wanting to go to Krispy Kreme, as Miss Bradshaw & co teasingly suggest.

Donuts might be glorious, but our penchant for baked goods alone certainly doesn't link us to the crippling condition that’s estimated to affect 13 million women in the US.

After the episode aired, the National Vulvodynia Association released a statement at the time, illustrating the show’s entirely inaccurate and belittling portrayal of what is a “very serious chronic pain condition” affecting 16 per cent of American women – that’s more than those with endometriosis (11 per cent) and breast cancer (12 per cent).

UK statistics have not been officially recorded due to the lack of funding for benign gynaecological disorders.

The British-based Vulval Pain Society lists five studies on its site for reference, all of which were carried out eight or more years ago (although this is not an exhaustive list of research into the condition). Research for erectile dysfunction, however (the only comparable sex-specific genital condition), is saturated, with new studies coming out all the time.

"Chronic illness of any kind already carries a stigma, but this is worsened if the condition is invisible," the Vulval Pain Society told The Independent.

"The sufferer may be disbelieved or even blamed for the problem, following which they themselves may come to internalise the feelings of blame and shame," they explained.

A 2003 study carried out by professors in Maryland titled “The Girl Who Cried Pain” demonstrated that in spite of women experiencing pain more frequently than men in their day-to-day lives, men received better treatment for their pain symptoms.

The research put this down to “gender-based biases regarding women’s pain experiences.”

For many affected women the pain is brought on by having sex, though other pressures can perpetuate it such as the insertion of a tampon or extended periods of sitting.

The pain is described on the NVA’s site as feeling akin to having acid poured on one’s skin or feeling a constant knife-like stabbing.

Although the condition is not an STD, it is often mistaken as such due to lack of public awareness, which then exacerbates its stigmatisation because vulvodynia inherits associations STDs have with promiscuity and poor hygiene, VPS explained.

"Vulvodynia still carries with it in some quarters the outdated misconception that it is psychosomatic and thus it becomes potentially associated with mental illness and the stigma which clings to that," the non-profit organisation said.

Hence the “depressed vagina” rhetoric, which actually derives from the most common form of treatment: a mild dosage of anti-depressants. Rather than bringing joy to forlorn genitalia, the medication is effective because it alters the way nerve fibres transmit pain sensations. So not quite the Krispy Kreme trips and vagina journals that fateful SATC ep would have us believe.

Although the condition does not have any psychological causes, it can still be linked to mental disorders. For some affected women the pain is so horrendous that they are forced to quit their jobs, forgo underwear and for some, it breaks up marriages. Subsequently, it's common for sufferers in severe cases to experience symptoms of depression and anxiety, as this study shows.

As with most gynaelogical disorders, vulvodynia is notoriously difficult diagnose. According to a Harvard study, only 60 per cent of affected women receive an accurate diagnosis – and that’s after visiting three different doctors.

“Sometimes there is an easy solution to the problem but unless help is sought women suffer in silence,” explains Dr Amanda Tozer, consultant gynaecologist at The London Clinic.

“Women do not like to discuss problems in having sex and can feel isolated and think they are the only one. Talking is good and the more women can talk about such issues the better so that it feels like a less taboo subject. Sometimes medical help doesn’t completely work but it may make it better and it is certainly worth trying,” she told The Independent.

Due to the lack of research, an exact cause of vulvodynia is not known.

However, recent studies have shown that contraction might come down to genetic abnormalities of the vulvar cells, localized hypersensitivity to yeast and/or a spasm in the pelvic floor muscles.

It affects women of all ages, but the majority of sufferers are between 18 and 25.

"There needs to be a much greater awareness of the condition both amongst health professionals and the general public," stressed VPS. "Doctors and nurses could be better trained to recognise and diagnose vulvodynia so as to be able to know which treatments to offer, but also crucially how to explain these to the patient so as to prevent non-compliance."

For more information on vulvodynia, visit NHS.uk or arrange a visit to a gynaecologist.