You may laugh, squirm, or blush, but for women suffering from vulvodynia, painful sex is a constant reminder of a serious and often undiagnosed problem.
"When we say vulvodynia, we're talking about pain in the genital area and the most common cause of intercourse pain in pre-menopausal women," said Dr. Candace Brown, researcher at the University of Tennessee Health Science Center. "Some people may have been married for years, and they've never consummated the marriage because intercourse is too painful."
Brown is currently conducting a study of patients with vulvodynia and possible treatments of the disorder, sponsored by the National Institutes of Health.
"What we're looking at in this study is provoked vestibulodynia, which falls under the umbrella of vulvodynia. It's pain around the vagina, provoked by something," Brown said. "It could be riding a bike. It could be wearing tight clothes. It could happen during a doctor's examination, or it could be having sex."
Studies show one in six women will experience vulvodynia in her lifetime.
"It's very common," Brown said, "but it's undertreated. These women will typically see three physicians before its ever diagnosed."
As a professor of clinical pharmacy, obstetrics, gynecology, and psychiatry, Brown's wide-ranging academic interests reflect the complex factors that come into play with vulvodynia, including, as with many chronic pain disorders, psychological and physical agents.
"Some people think it's a chronic pain disorder, which is how I'm describing it, but other people will describe it as a psychiatric disorder having to do with negative feelings about sex. In truth, it's probably a little bit of an overlap of both."
Even within these two competing theories, many questions remain.
"It could be a neuropathic condition where nerves are just firing abnormally and not uniformly, or the pain could start in the peripheral area," Brown said. "It could also be a muscular problem, because what happens with these women is the vaginal muscles will tighten up as a protective mechanism.
"And women who have vulvodynia are more likely to have a previous history of depression and anxiety," Brown continued. "They're also more likely to have been sexually abused or physically abused as children."
Brown believes a combination of approaches — sex therapy as well as pharmacological treatments — is the best course of action for patients with vulvodynia. But for this study, she is focusing on one drug: gabapentin.
Gabapentin is a medication first approved for treatment of seizure disorders. It was later approved for neuropathic pain in chronic pain conditions.
"Vulvodynia is a chronic pain disorder, so if gabapentin has been helpful in other chronic pain disorders, then it may be beneficial," Brown said. "Our study is important, because nobody has looked at it systematically over time. Nobody has really followed a woman and looked at placebo versus control within the same woman."
Participants receive gabapentin half of the time and a placebo half of the time. The four-year study is into its second year, but UT Health Science Center researchers are still looking for interested participants, who will receive study-related care at no cost and $50 per visit, or a total of $350 if all seven visits are completed.