Vulvodynia and vestibulodynia refer to a chronic discomfort of the vulva, the part of a woman’s body that protects the genitals.

It includes the external female genitalia, including the mons pubis, the labia majora and minora, the clitoris, and the perineum.

Vulval pain can happen for a number of reasons, but vulvodynia and vestibulodynia are specifically linked to a hypersensitivity of the nerve endings in the skin.

Around 16 percent of women are estimated to have experienced pain or stinging in the vulval area at some time in their life.

Treatment

Treatment aims to alleviate symptoms. As the cause is unknown, finding a solution that works may take some trial and error.

Medications to block pain may include antidepressants, anticonvulsants, or serotonin-norepinephrine reuptake inhibitors (SNRIs).

Other solutions include creams, lotions, and anesthetic gel for applying to the vulval area.

Examples include topical hormone creams containing estrogen and testosterone, topical anesthetics, such as lidocaine, and products that contain an antidepressant or anticonvulsant ingredient. These can be applied 15 to 20 minutes before sexual activity, or when needed. Some of these products are available for purchase online, including lidocaine.

A nerve block is an anesthetic drug that is injected into the nerves that transmit pain signals, in this case, from the vulva to the spine. Interrupting the pain signals in this way can provide short-term relief.

If no other method is effective, surgery to remove the painful tissue may be appropriate.

Two techniques that are currently being investigated are neurostimulation and the spinal infusion pump.

Neurostimulation involves delivering low-voltage electrical stimulation to a specific nerve. This can replace pain with a tingling sensation.

A spinal infusion pump is an implanted device that can deliver low-dose medication to the spinal cord and nerve roots. This can dull pain.

However, there is limited evidence regarding the use of these measures for vulvodynia.

Some researchers have found that physical and psychosexual therapy can help improve sexual functioning, for example, by helping to reverse a fear of touch.

Symptoms

Vulvodynia features a burning, stinging, itching, irritating, or a raw feeling in the vulvar tissue, which may or may not appear inflamed. Patients may describe a feeling of throbbing, itching, aching, soreness, and swelling.

The pain can affect a particular spot, or it may be felt in a wider area, including the clitoris, the perineum, the mons pubis, and the inner thighs. It can also affect the area around the urethra and the top of the legs and inner thighs.

The pain involved in vulvodynia is neuropathic, which means it stems from abnormal signals from the nerve fibers in the vulval area. The nerve endings are hypersensitive.

It may be constant or intermittent. A constant pain that happens when there is no touch or pressure is known as unprovoked vulvodynia.

Vestibulodynia, previously known as vestibulitis, involves a pain that is triggered by light touch, or provoked pain.

Symptoms may be worse during or after sexual intercourse, walking, sitting, or exercising. It can happen when inserting a tampon, or when prolonged pressure is applied, for example, during horseback riding.

Vulvodynia is usually defined as lasting for at least 3 months. It often starts suddenly, and it may last for months or years. It is not life-threatening, but the pain can prevent the individual from carrying out some normal activities. This can also lead to upset or depression.

Complications

Relationship problems can result, because sexual intercourse is painful. One study suggests that 60 percent of women with vulvodynia are unable to engage in sex.

Studies suggest

that women who have vulvodynia can have a normal pregnancy, and that in some cases, pain levels fall during pregnancy. However, women with the condition are more likely to have a cesarean delivery.

Home remedies

Some measures can be taken that do not involve medications.

If vulvodynia occurs, the first step is to stop using any irritants, such as perfumed soaps. A change in menstrual products might help, for example, switching from synthetic to cotton-based items.

Cool gel packs may offer immediate, short-term pain relief. A range of cool gel packs is available for purchase online.

Pelvic floor muscle exercises may help by relaxing tissues in the pelvic floor and releasing tension in muscles and joints.

Biofeedback uses technology to increase an individual’s awareness of how they might be stressing their body. This information can help people change habits that lead to harm or discomfort. For women with vulvodynia, it can help strengthen the pelvic floor muscles, and this may reduce pain.

A trigger point is a specific area of discomfort. Trigger-point therapy involves massaging a small area of tightly contracted muscle to release tension and relieve pain. An anesthetic medication applied directly, for example, as a cream, can also be used to relieve pain in a trigger point.

Since stress can play a role in vulvodynia, either as a trigger or a consequence, stress management may help ease symptoms.

Acupuncture and cognitive behavior therapy are options currently being explored.

Diet

A change in diet may help. Cutting out one food at a time may help to pinpoint a trigger.

Items that commonly trigger a reaction include:

• caffeine
• high-sugar foods
• acidic foods
• processed foods

Causes

Vulvar pain can be caused by infections, neurological problems, inflammatory conditions, and neoplasms, such as squamous cell carcinoma.

Vulvodynia is not related to an underlying condition. The exact cause is unknown. It is not caused by a sexually transmitted or other infection, skin disease, or cancer, although these can also cause pain.

Factors that may raise the risk of vulvodynia include:

• Damage to or irritation of the nerves around the vulva
• A high density of pain-sensing nerve fibers in the vulval area
• High levels of inflammatory substances in the vulval area, for example, because of inflammation
• genetic susceptibility
• pelvic floor muscles are weak or unstable
• unusual or long-term reaction to infection, trauma, or another environmental factor
• changes triggered by hormones

Other factors that increase susceptibility include:

• frequent yeast infections
• sexually transmitted infections (STIs)
• chemical irritation of the external genitals, caused by soaps, feminine hygiene products or detergents in clothing
• rashes on the genital area
• previous laser treatments or surgery on the external genitals
• nerve irritation, injury or muscle spasms in the pelvic area
• diabetes
• precancerous or cancerous conditions on the cervix

Provoked vestibulodynia could result from:

• sexual intercourse
• tampon insertion
• a gynecologic examination
• prolonged sitting
• wearing tight underclothes or pants
• activities such as cycling or horseback riding

Clitorodynia refers to pain in the clitoris.

Vulvodynia can be confused with other vulvovaginal problems, such as chronic tension or spasm of the muscles of the vulvar area called vaginismus.

Prevention

Measures that can reduce the risk of triggering pain include:

• wearing cotton underwear and loose-fitting clothes around the genital area
• avoiding scented toilet paper and perfumed creams and soaps
• avoiding friction or sitting for prolonged periods
• refraining from excessive genital washing
• not douching or using vaginal wipes
• using water-soluble lubricants during sexual intercourse
• patting the area dry after rinsing or urinating

If a vaginal infection is suspected, it is important to have it diagnosed and treated promptly and to discuss with a physician if any treatments appear to make the condition worse.

Diagnosis

Diagnosis may involve a pelvic exam, to look for skin changes and assess the pain.

A cotton swab test is used to delineate the areas of pain and categorize their severity. The physician may press with swab on different areas while asking the patient to rate the level of pain.

The patient should be ready to describe the pain, including the type of pain and its severity, say when it started, and whether it began gradually or suddenly, where it hurts, and how often.

The doctor may use a special magnifying glass, to carry out a colposcopy.

Tests may be carried out to try to find the source of the pain and to eliminate other causes.

These include:

• taking a culture for bacteria and yeast
• blood tests to assess levels of estrogen, progesterone, and testosterone
• a biopsy

In a biopsy, the doctor first numbs the genital area with a painkiller, and then a small piece of tissue is taken for examination under a microscope.

The flu is a common respiratory infection, and its symptoms can range from mild to severe. Although a rash is not a common symptom of the flu, it can sometimes occur.

There is evidence to suggest that certain types of flu may lead to a rash forming in some people. In other cases, another condition may cause a rash to develop when a person has the flu.

In this article, learn more about a flu rash, including the symptoms, diagnosis, and treatment.

Can the flu cause a rash?

The flu causes many uncomfortable symptoms, but a rash is typically not one of them. There is some evidence, however, that the flu may sometimes cause a rash.

A small 2014 case study

of school-aged children found that a rash is a possible symptom of influenza type B.

The authors indicated that other factors, aside from the flu, might have contributed to the onset of the rash, such as a measles outbreak in a nearby area.

The authors of an older article

from 2011 stated that a rash occurs in about 2% of all influenza A cases. The researchers indicated that the rash could occur among children with or without accompanying viral or bacterial infections or environmental factors.

Other symptoms

The flu has several recognizable symptoms that a person will typically experience during the infection.

In most cases, the flu will clear on its own within a few days to 2 weeks

According to the Centers for Disease Control and Prevention (CDC)

, the typical symptoms of the flu include:

• a cough
• chills
• a fever
• body aches
• a sore throat
• fatigue
• a stuffy or runny nose
• headaches
• vomiting or diarrhea

In some cases, a person may develop health complications as a result of the flu. Some of these, such as pneumonia, can be life threatening.

Other complications may include:

• worsened asthma symptoms
• swelling of heart, brain, or muscle tissues
• heart or kidney failure
• extreme inflammatory responses in the body

Other causes of a rash

Certain other viruses could potentially cause a rash. Some of these viruses may have symptoms similar to those of the flu and be easy to mistake for this illness at first.

For example, a person may develop flu-like symptoms prior to developing a measles rash.

Some common measles symptoms that may appear before the rash occurs include:

• a runny nose
• a fever
• fatigue
• a cough
• body aches and pains

Some other common viral infections that may cause a rash include:

• chickenpox
• rubella
• fifth disease
• roseola
• West Nile virus
• dengue fever
• hand, foot, and mouth disease
• mononucleosis
• Zika virus

In some cases, another condition may cause a rash in someone who already has the flu.

Diagnosis

If flu-like symptoms occur alongside a rash, it is best to speak to a doctor. During the appointment, the doctor will conduct a physical examination and ask about the person’s symptoms.

During times when the flu is widespread, the doctor may not need to test for the virus. However, when this is not the case, the doctor may test for the type of virus.

A doctor can also examine the rash and determine whether it may be due to a different condition.

Treatment

If a person has the flu, the typical treatment involves extra rest and fluids. However, people with severe infections and those at risk of developing complications may receive antiviral medications from a doctor.

These medications can help the person recover from their flu more quickly and prevent further complications. Some examples include:

• peramivir (Rapivab)
• oseltamivir (Tamiflu)
• baloxavir (Xofluza)
• zanamivir (Relenza)

If a person has the flu and a rash, a doctor may not treat the rash directly. Instead, the rash should clear when the body fights off the virus.

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When to see a doctor

Anyone can develop the flu, even otherwise healthy individuals. However, certain groups of people have a higher risk of developing complications. These individuals include:

• older people
• children under the age of 5 years
• pregnant women
• people with chronic illnesses, such as asthma, diabetes, or heart disease

Although most cases of the flu will resolve with plenty of rest and fluids, people who are at risk of complications should see a doctor.

In some cases, a person may need to seek immediate medical attention. People with the flu should seek emergency medical care if they experience any of the following:

• persistent pain or pressure in the chest or abdomen
• difficulty breathing
• seizures
• severe muscle pain
• shortness of breath
• a fever or cough that improves but then returns or worsens
• persistent confusion or dizziness
• worsening of chronic medical conditions
• lack of urination
• severe weakness or unsteadiness

Parents or caregivers should seek emergency care

for a child who has:

• bluish lips or face
• severe muscle pain
• fast breathing or trouble breathing
• seizures
• ribs pulling in with each breath
• chest pain
• a fever or cough that improves before returning or worsening
• dehydration, signs of which can include little urine, no tears, and a dry mouth
• a lack of alertness
• the inability to interact when awake
• a fever above 104°F or any fever in infants under 12 weeks old
• worsening symptoms of chronic medical conditions

Summary

A rash is a possible but uncommon symptom of the flu. If a rash appears due to the flu or another virus, it should clear when the virus is no longer active.

A person should see their doctor if they have an unexplained rash or severe flu symptoms. A doctor can also help determine whether the rash is due to the flu or another condition.

Type 1 diabetes has no cure, and although there are several treatment options available, many people find managing the condition challenging. New technology could help reduce that burden.

Many people find managing type 1 diabetes inconvenient, but new research may change this.

More than 1 million children and adults in the United States have type 1 diabetes, according to the American Diabetes Association. 

The Centers for Disease Control and Prevention (CDC) note that about 5%

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of all people who have diabetes have type 1. 

Type 1 diabetes can significantly impact a person’s life, as people need to monitor their blood sugar levels regularly to ensure they do not become dangerously high or low.

Currently, people with type 1 diabetes measure their blood sugar levels by pricking a finger several times a day or wearing a glucose monitor. Depending on the measurements, they may have to administer insulin using an injection or insulin pump.

But a new form of technology trialed recently and showcased in the New England Journal of Medicine could replace these conventional methods.

Automatic insulin

The trial looked at a particular type of artificial pancreas, or closed-loop control. These devices continuously monitor and regulate blood glucose levels. When the monitor detects that a person needs insulin, a pump releases the hormone into the body. 

The trial involved the use of the Control-IQ system — a new type of artificial pancreas that uses algorithms to adjust insulin doses automatically throughout the day.

“By making management of type 1 diabetes easier and more precise, this technology could reduce the daily burden of this disease, while also potentially reducing diabetes complications, including eye, nerve, and kidney diseases,” says Dr. Griffin P. Rodgers, director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

The 6-month trial is part of a much larger research initiative known as the International Diabetes Closed-Loop (iDCL) Study, which involves the testing of several artificial pancreas systems to determine a variety of factors, such as safety, effectiveness, and user-friendliness.

The trial recruited 168 people with type 1 diabetes and with a minimum age of 14.

The researchers assigned over 100 people to use the Control-IQ system, while 56 people formed a control group that used sensor-augmented pump (SAP) therapy. This therapy does not alter insulin doses automatically.

Researchers wanted to replicate day-to-day life, so they did not monitor the systems remotely. Participants did, however, contact researchers every few weeks to check data from the device.

24-hour control

The researchers were interested in the amount of time that blood glucose levels reached a target range of 70 to 180 milligrams per deciliter (mg/dl).

The results showed that the blood sugar levels of the people who used the Control-IQ system were in the target range for an average of 2.6 hours per day longer than previously. Those using the SAP therapy saw no notable change throughout the trial.

Vitally, the system also improved the participants’ blood glucose control overnight as well as during the day. This is a crucial advancement for people whose levels drop significantly when asleep.

None of the groups experienced severe cases of hypoglycemia ⁠— when blood sugar levels become very low.

Reducing the burden

According to Dr. Guillermo Arreaza-Rubín, the study’s program scientist and director of NIDDK’s Diabetes Technology Program, these findings indicate that this system “has the potential to improve the health of people living with type 1 diabetes, while also potentially lifting much of the burden of care from those with the disease and their caregivers.”

Boris Kovatchev, Ph.D., director of the UVA Center for Diabetes Technology, says the technology’s glucose control is “beyond what is achievable using traditional methods.”

The team has submitted the results of the trial to the U.S. Food and Drug Administration (FDA). They are waiting to find out whether the device can go to market.

Researchers believe that stress and cardiovascular health are linked in some way, but the association is not yet fully clear. A large-scale new study has recently delved into the effects of a unique kind of stress.

According to the American Heart Association (AHA), stress may affect factors that increase the risk of heart disease, including blood pressure and cholesterol level.

One major source of stress is the workplace.

In fact, a 2015 review of 27 studies that appeared in the journal Current Cardiology Reports

found an association between work stress and a “moderately elevated risk of incident coronary heart disease and stroke.”

However, one type of stress that researchers often leave out of studies is that felt by a person who needs to simultaneously balance the demands of work and family life.

Examining this in more depth may eventually help health professionals better identify and treat cardiovascular issues. This is according to the authors of the new study, which now appears in the Journal of the American Heart Association.

What is work-family conflict?

Cardiovascular diseases are currently the leading cause of death worldwide, say the World Health Organization (WHO).

Health professionals can determine people’s cardiovascular health score. Based on seven metrics including diet, blood pressure, and physical activity levels, the researchers who conducted the new study used this score to investigate how work and family stress can impact heart health.

According to the study paper, work-family conflict refers to “a form of inter-role conflict in which the role pressures from the work and family domains are mutually incompatible in some respect.”

More than 11,000 workers ages 35–74, from six state capitals in Brazil, made up the study’s sample. The participants came from a variety of educational and work backgrounds, and the study included a slightly higher number of women.

Each participant filled out a questionnaire to determine how their job affected their family life, and how their family life impacted their work.

The researchers calculated the participants’ cardiovascular health scores using a combination of clinical examinations, laboratory test results, and self-reported questionnaires.

An unequal impact

The analysis showed a distinct sex difference. Men reported less work interference with family and more time for personal care and leisure. Both sexes reported a similar amount of family interference with work.

However, women appeared to be worse off. Those who reported a number of frequent work-family conflicts had lower cardiovascular health scores.

“This was interesting because in our previous study, job stress alone affected men and women almost equally,” says senior study author Dr. Itamar Santos, a professor at the University of São Paulo in Brazil.

There could be a simple explanation as to why this is the case, and it has to do with traditional gender roles. “You feel the stress to fulfill the gender roles, and I think women still feel more of a need to have that nurturing home life,” says Dr. Gina Price Lundberg, clinical director of the Emory Women’s Heart Center in Atlanta, GA.

“Men are helping more than ever, but I think working women still feel the stress of trying to do it all.” She goes on to describe the study as “well-designed,” due to its large sample size, the diverse background of the participants, and the balance of men and women.

However, certain elements of the study relied on the participants’ own thoughts and feelings, which may have biased the results.

How to live with stress

What this study has dipped into is the need for a good work-life balance. However, this is easier said than done in many cases.

Dr. Santos hopes that the new findings will encourage workplaces to introduce stress reducing initiatives and encourage doctors to look for signs of stress when examining people.

“We’re not going to eliminate stress,” Dr. Santos says. “But we should learn how to live with it to not have so many bad consequences.”

Whether that would be through measures such as at-home meditation or employer-led strategies is yet to be determined.

Dr. Santos and team are now planning to follow the same participants for up to a decade to gain further insight.

Spotting in early pregnancy is common for many women and usually not a cause for concern. However, in some instances, it may occur as a symptom of a pregnancy complication.

About a quarter of pregnant women experience bleeding during the first trimester. Although bleeding is a possible sign of early pregnancy loss, it does not mean that this will happen. Several other conditions and factors, including normal hormonal shifts, may cause spotting in early pregnancy.

Causes

The most common causes of spotting in early pregnancy include:

Subchorionic hematoma

A subchorionic hematoma is sometimes called subchorionic hemorrhage. This happens when blood builds up near the chorion, which is the fetal membrane next to the placenta. The bleeding may also appear between the uterus and the placenta.

Subchorionic hematoma is a common pregnancy complication with various studies estimating the prevalence between 1.3% and 62% among different groups of pregnant women.

A subchorionic hematoma is not a pregnancy loss. Many pregnant women with this type of bleeding have no further complications during their pregnancy.

A 2012 meta-analysis of nine research studies concluded that there was a link between subchorionic hemorrhage and higher risk of pregnancy loss and preterm labor.

However, a 2013 observational study of 1,115 women that included 142 with a subchorionic hematoma found no significant increase in the risk of pregnancy complications.

Ectopic pregnancy

In an ectopic pregnancy, a fertilized egg implants outside of the uterus, often in the fallopian tubes. A woman may still have pregnancy symptoms or get a positive pregnancy test. The pregnancy, however, cannot survive. If it continues to grow, it can rupture and cause life threatening bleeding or a dangerous infection.

An ectopic pregnancy can cause spotting as the pregnancy grows. If the pregnancy ruptures, it can cause life threatening internal bleeding that may get progressively heavier over several hours.

Cervical irritation

The cervix, the doughnut-shaped entry to the uterus, increases its blood supply during pregnancy. This means it is more likely to bleed from irritation, such as after sex or a pelvic exam. Light spotting after any form of vaginal penetration is a possible sign of cervical bleeding.

Cervical bleeding is not dangerous and usually stops on its own within a few hours. The blood is typically red or brown, and the bleeding minimal.

Very rarely, a serious injury to the cervix, such as from an assault or trauma, might cause more severe cervical bleeding. These injuries can cause infections and other serious complications. It is important to see a doctor following any traumatic injury to the cervix or vagina.

Pregnancy loss

For many pregnant women, bleeding triggers fears of pregnancy loss. A 2010 study of 4,539 pregnant women found that 26.7% experienced bleeding at some point during their pregnancies, but only 12% had a pregnancy loss. These figures suggest that less than half of people who bleed during pregnancy have a pregnancy loss.

About two-thirds of people who do have a pregnancy loss report bleeding. As such, bleeding is a symptom that a pregnant person should not ignore. Any pregnant woman who has concerns about their pregnancy should speak to a doctor about risk factors and how to minimize them.

Hormonal shifts

Around the 7th week of pregnancy, a luteal-placental shift happens. This is when the placenta develops enough to begin producing hormones that sustain the pregnancy. Before this change, the corpus luteum — a group of cells that forms during ovulation — produces pregnancy hormones.

This hormonal change sometimes triggers a temporary drop in the hormone progesterone. This shift may cause spotting, or even bleeding as heavy as a period. As long as the placenta begins producing enough progesterone, the pregnancy can safely continue, and a woman will not have a pregnancy loss.

Diagnosis

A doctor or other healthcare provider may do numerous tests to diagnose bleeding. These may include:

Ultrasound

A doctor may order an ultrasound to help diagnose a subchorionic hematoma.

An ultrasound can diagnose a subchorionic hematoma. It can also tell a healthcare provider the location of the pregnancy, helping in the detection of an ectopic pregnancy.

After about the 6th week of pregnancy, an ultrasound can measure the viability of the pregnancy. If the embryo is growing correctly, and there is a sufficiently strong heartbeat, this suggests that the pregnancy will continue and the risk of pregnancy loss is low.

An ultrasound can also examine other pelvic organs to check for causes of bleeding. For example, an ovarian cyst may cause bleeding.

Blood tests

Blood tests can measure levels of the pregnancy hormone hCG. Low hCG may suggest that a pregnancy is not developing correctly or is in its early stages.

Some healthcare providers also check progesterone levels. Low progesterone may cause temporary bleeding, while very low progesterone may be a sign of an abnormal pregnancy.

Is it normal?

While many women who experience bleeding have healthy pregnancies, it is important never to treat bleeding as usual. Bleeding can be a critical symptom of several pregnancy-related symptoms, and prompt treatment for conditions such as ectopic pregnancy can save lives.

Implantation bleeding

Implantation happens when a fertilized egg embeds in the lining of the uterus. This marks the beginning of pregnancy. Some women notice spotting shortly after implantation. However, the body does not begin producing hCG until after implantation.

A woman is not pregnant until after implantation, and a pregnancy test cannot usually detect pregnancy until several days after implantation. So, bleeding that appears after a woman already knows she is pregnant is not implantation bleeding.

Implantation bleeding is usually brown. Some women may mistake the bleeding for their monthly period because it usually occurs around the time a woman expects her period.

The flow of implantation bleeding is often lighter and shorter than a period, so women who experience unusual bleeding after having sex should consider the possibility of pregnancy.

When to see a doctor

Speak to a doctor about any bleeding early in pregnancy. While the bleeding may be harmless, it is impossible to diagnose its cause without blood work, an ultrasound, or other diagnostic tests.

Bleeding from a ruptured ectopic pregnancy can endanger the life of the mother. While many pregnancy losses pass on their own, some require treatment to prevent excessive bleeding and infection.

Prompt medical care can be lifesaving. Even when there is no serious problem, the right care can offer peace of mind.

If a pregnant woman experiencing spotting has Rh-negative blood, a doctor may prescribe RhoGAM. This treatment can help prevent a condition known as erythroblastosis fetalis.

If a woman experiences light bleeding at any time, they should contact a midwife, doctor, or another healthcare provider.

A woman should visit an emergency room if:

• they develop a fever
• bleeding gets heavier over several hours
• bleeding is heavy, similar to a period
• there are large clots in the blood
• they have cramps
• there is severe pain in the abdomen
• they feel dizzy or light-headed

Summary

Many women panic when they bleed during pregnancy, especially if they have a previous history of miscarriage. Seeking prompt care is the fastest way to ease anxiety and get clear answers.

It is not advisable for people to try to self-diagnose bleeding or assume that bleeding means a pregnancy loss. A few quick tests can usually diagnose the cause, and prompt treatment can prevent possible complications.