Vulvae, a young femtech shoot, has just released its app dedicated to the health of the vulva. Before that, the start-up put online, with Mia.co, a teleconsultation platform in sexology, The little illustrated guide to vulvar pathologies. While the pathologies of the vulva, still too little known by caregivers but also by women, are very often synonymous with a delay in diagnosis, this little guide is essential for all those who want to take charge of their health – more precisely that of their vulva. And who no longer want to hear themselves say: “go home ma’am, your pain is psychological”. Top Santé takes stock of vulvar pathologies with Gilbert Bou Jaoudé, sexologist doctor and medical director at Mia.co.
Top Santé: What are we talking about when we talk about vulvar pathologies?
Dr Gilbert Bou Jaoude : The term vulvar pathologiesstill little known, brings together all the difficulties and diseases that can occur in the vulva but also in the vagina, whether they are of gynecological, cutaneous, sexological, infectious origin… This is all that can disrupt the proper functioning of this area.
But who should you consult? His general practitioner, his gynecologist, his dermatologist?
In first intention, it is necessary to consult either a general practitioner, many of them practice gynecology, or a gynecologist. If they find nothing or if they realize that the problem is not within their competence, a dermatologist or a sexologist is consulted as a second intention when the problem described by the patient is a sexological problem, such as vaginismus. A urologist can also be consulted for specific urological problems, such as cystitis.
What are the most common vulvar pathologies?
The most frequent pathology, by far, is mycosis. Today, most women know this pathology – characterized by discomfort, irritation and itching, whitish secretions, a particular smell – and obtain the treatment without consultation, some being available without a prescription in pharmacies.
Also very common, genitourinary syndrome, vulvar problem linked to menopause, causing dryness in the vulva, skin and mucous membranes. The area becomes more sensitive, more painful. Urinary tract infections and inflammation are common. These two pathologies include the majority of vulvar problems.
What are the other pathologies?
Mention may be made of skin pathologies which are neither infectious nor gynecological, such as psoriasis, vulvar lichen sclerosis and, very rarely, vulvar cancer which is generally skin cancer. There are also sexological issues, such as vaginismus, pain and blockage at the time of penetration, encountered at least in the life of 10 to 12% of women.
These last pathologies are the most difficult to diagnose and are still taboo for women. Can you tell us more?
There are the vestibulodynies, causing pain in the opening of the vagina, usually sharp, and intense, like burning or tearing. The woman really has the sensation of having a lesion there and yet, no matter how many times you examine her, you almost never find anything. Unfortunately in modern medicine, when we do not find the cause of a symptom we conclude that the cause is psychological. While the problem can be neuropathic, or due to an old lesion, with obviously a psychological component. A woman who has pain, especially in the area of the vulva, and who is told again that she has nothing, there is reason to be psychologically disturbed. We can also cite the clytorodyniapain in the clitoris and vulvodyniapain that affects the entire vulva.
Is it important to consult for these pains?
Sure ! A doctor should be consulted in all cases. The genes, the pains require a first medical examination if only to check if there is an infection, an inflammation, a lesion or an injury that must be treated. Some women take time before consulting because the pain in this area is difficult to bear psychologically or even to expose to a doctor. They can do a video consultation, at least to get a first opinion. The questioning may be enough to refer the patient to a specialist in these matters.
We know that there is a long delay in diagnosis for some of these pathologies in which the doctor does not see anything during the clinical examination. How is the diagnosis made?
Vaginismus, clitoridynia, vestibulodynia, vulvodynia, these are quite difficult pathologies to diagnose. Do not hesitate to ask to be referred to a specialist. There is indeed a huge delay in diagnosis for this type of pathology, because women do not dare to consult but also because if the doctor is not a specialist and finds nothing on the clinical examination, women ‘hear that there is nothing serious: ‘let’s wait and see’. It is true that it is often necessary to see several doctors before finally being diagnosed. But, I insist, it is up to women to decide whether this discomfort is important or not, even if the clinical examination shows nothing. The feeling in these pathologies is essential. Discomfort, blockage, pain… this feeling is enough to be referred to a specialist.
How are these pathologies treated?
For infectious, skin pathologies, treatment is given. For sexo-gynecological difficulties, it is important to fully understand how the story took place. Are these pains the result of a trauma or an injury? Did they appear during a period of burnout or depression? Then, the treatment is based on three axes. The first: to make this area work well again. For this, specific exercises are carried out at home.
Second axis: it is necessary to help the person psychologically to get better. Because we observe a constant on this subject, the more one is embarrassed on the vulvar level, the more one is affected on the psychological level. And the worse we are psychologically, the more we risk having pain.
The third axis is sexological: many women almost completely interrupt their sex life, but you can have a sex life without penetration. For example, if an area remains painful because of neuropathy, it will be a question of accompanying it to find compensation techniques elsewhere.
Neuropathy? Does that mean that a neurologist can also be consulted?
A neurologist may be consulted if a neurological problem such as neuropathy is suspected. Medicines against neuropathic pain can be prescribed or also rehabilitation of the pelvis, to free the muscles and reduce neurological compression at this level. Physiotherapy or osteopathy can therefore also help in this area.
I come back to the second axis that you developed above. We necessarily find a psychological dimension in this type of vulvar pathologies?
On these pains, a psychological component is often present. It is rare that a woman who has suffered from this kind of problem for a while is completely at ease psychologically. It is a vicious circle that is set up. This is why it is essential to take into account the psychological component, even if the cause at the start is not psychological. Because this component aggravates the problem. I’ll give you an example: a scratch during sexual intercourse causes a lesion. It is thought to be cured, but the pain reappears during the next sexual intercourse. Then occurs a completely normal contraction reaction in the vagina, which is therefore the beginning of vaginismus. The next time, we are afraid that the pain will start again, we are contracted, not lubricated, so we are in pain and we are blocked. And so on. An initially benign lesion grows in size and becomes something difficult to manage. We are faced with an assemblage of causes: the pathology begins for one reason and continues for another reason. We are therefore quite far from the traditional medical field “one cause: one treatment”.
What do you want to say to these women?
The situation improves with good care. They should also know that these pathologies are very common! These are indeed complex pathologies that require multiple treatment. But we must not be discouraged in the face of this complexity because we always obtain an improvement. And just because it’s complex doesn’t mean it’s difficult!
For further, download here The little illustrated guide to vulvar pathologies and Mia.co
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