Pelvic pain: understanding vulvodynia and interstitial cystitis

Pelvic pain can vary widely and is sometimes difficult to pinpoint. Vulvodynia and interstitial cystitis are often unrecognized causes of pelvic pain—here's what you should know.

• Symptoms: Vulvodynia involves an intense burning or knifelike pain in the vulva, the fleshy area around the opening of the vagina, in response to touch or pressure.
• Statistics: Up to 16 percent of women are said to experience it during sex, whenever they insert a tampon, have a gynecological exam, or just sit down for any length of time. The actual number may be higher, since vulvodynia has no outward signs (though occasionally the area can look red and swollen). Many women are also reluctant to discuss the problem with their doctors.
• Demographic: Any woman can develop the condition at any age, though the largest group of sufferers is between ages 18 and 25.
• Cause: The condition is tough to diagnose and the causes remain unknown but are probably complex. You may develop vulvodynia as the result of a yeast infection; allergies; nerve damage; structural problems in the pelvic floor, back, and/or buttocks; or even hormonal changes like those that occur at menopause.
• Research: According to recent studies, women with vulvodynia may have as much as a tenfold increase in the number of nerve endings in the vulva—which would intensify even minor problems that can cause pain. Not surprisingly, the condition can also lead to depression.
• Treatment: Once your doctor determines the pain's cause, she can prescribe helpful treatments. There's plenty you can do to lessen the discomfort, from changes in your hygiene routine to a switch in underwear.

• Types: Because interstitial cystitis (IC) can seem so varied, most researchers suspect different forms of the disease exist.
• Nonulcerative IC: This type of IC causes the bladder to become scarred and stiffen, its walls covered with glomerulations, or pinpoint bleeding.
• Ulcerative IC: About 5 to 10 percent of cases are ulcerative IC, in which patients develop a condition called Hunner's ulcers on the lining of the bladder.
• Mimics a UTI: IC can mimic a bacterial infection, but the condition seems unrelated to bacteria and doesn't respond to antibiotics.
• Cause: Bladder or pelvic surgery, bacterial infection, or a dysfunction of the pelvic floor muscles may trigger IC.
• Research: Scientists have found a substance called antiproliferative factor, or APF, in people with IC—which appears to block the growth of normal cells on bladder walls. People with IC often have other conditions such as irritable bowel syndrome, endometriosis, and fibromyalgia, making researchers suspect that IC may be linked to a more general inflammatory condition.