Hormonal vulvodynia means that the pain and tenderness felt around the vulva and vestibule and/or vagina is related to something going on hormonally.
What exactly the links are between hormone levels and vulvar and vaginal pain are not well understood, but some theories exist to help our understanding.
There are many androgen and oestrogen receptors in the vestibule, with any irregularities in hormones having the potential to disrupt the healthy balance.
How can hormone disruptions cause vulvodynia?
Hormonal birth control and vulvodynia
There may be a link between hormonal birth control and vulvodynia, with an increased risk observed of women on hormonal birth control and the incidence of vulvodynia. Those who start on hormonal birth control young, and use it for longer periods of time, were more at risk.
The biggest problem products were those that were progestogenic and androgenic, but were low in oestrogenic potential.
Low-oestrogen concoctions are more common now, in a bid to have ‘low hormone’ birth control, but these products come with their own issues.
Problems can arise from low oestrogen, for example breakthrough bleeding during active pill-taking while on the oral contraceptive pill.
Women on low oestrogen hormonal contraceptives had a greater likelihood of developing vulvodynia. One case study of 50 women who developed vulvodynia after taking hormonal birth control were treated successfully with a cream containing testosterone and oestrogen, but more research is required.
Hormonal birth control and its effect on the vestibule
The vestibular mucosa is affected by hormonal birth control, with changes to tissue observed. Vestibular tissue becomes shallower and sparser with dermal papillae, which may reduce the pain threshold in that area.
The tissue becomes thinner, with that possibly making nerve endings closer to the outside world. This would increase the pressure that a nerve felt, making it painful when if the tissue was of normal depth, the pain would not have been felt or not as severely.
Oestrogen and androgen receptors in the vestibule
There may also be changes to the number of hormone receptors or how hormone receptors behave. Studies have been mixed, with some studies showing a reduction in oestrogen receptors in vestibular tissue in women using hormonal birth control, and others reporting an increase.
Fewer androgen receptors in vestibular tissue have been reported in hormonal birth control users.
Hormone levels
Circulating hormone levels are altered by hormonal birth control, with a suppression of testosterone and oestrogen production by the ovaries, and an increased level of sex hormone binding globulin (SHBG) synthesis.
This means low circulating testosterone and oestrogen, which can contribute to pain at the entrance of the vagina. Some hormonal birth control contains progestins, which are testosterone antagonists.
It has also been suggested that oestrogen and progesterone are responsible in part for our pain perception, with pain modulation less effective in those using hormonal birth control.
Hormonal vulvodynia symptoms
- Initial pain on penetration around the vaginal entrance
- Pain around the vaginal entrance
- Vaginal dryness
Testosterone in the vestibule is responsible for producing a substance called mucin, which is a part of our natural lubrication. This can mean that a lack of natural lubrication can be caused by a hormonal imbalance.
Hormone levels can be checked, however first the Q-tip test can be performed by your pelvic pain specialist practitioner to test sensitivity of your vestibule. If the entire vestibule is painful upon this test, then inflammation or a hormonal issue may be to blame. If only the posterior end of the vestibule is tender with the Q-tip, then dysfunctional pelvic floor muscles may be to blame.
What causes hormonal vulvodynia?
- Loss of certain hormones (androgens, oestrogens)
- Some medication – oral contraceptive pill, tamoxifen, spironolactone
- Disease and surgical treatments for disease – breast cancer, ovarian cancer, removal of tissue
See your specialist for advice on which type of vulvodynia you have, and be assessed for the best treatments. Remember you may need to try a few, since vulvodynia is still being researched extensively.
References
Lev-Sagie A, Witkin SS. Recent advances in understanding provoked vestibulodynia. F1000Res. 2016;5:2581. Published 2016 Oct 26. doi:10.12688/f1000research.9603.1
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