From the Guidelines
Vulvodynia is a chronic condition characterized by persistent, unexplained pain in the vulva, which is the external female genital area. To diagnose vulvodynia, a thorough medical history and physical examination are necessary, as outlined in the guidelines for postmenopausal subacute or chronic pelvic pain 1.
Diagnostic Process
The diagnostic process typically involves a pelvic exam to rule out other potential causes of pain, such as infections or skin conditions. A cotton swab test may be used to assess pain in specific areas of the vulva. Imaging is primarily indicated in the context of an abnormal physical exam, with ultrasound being the initial modality of choice, and MRI may be appropriate for further characterization in select cases 1.
Causes and Associations
Vulvodynia may occur after any inflammatory condition of the vulva or vestibule, and neuropathic pain does not respond to topical corticosteroids, requiring treatment directed at this entity 1. It is essential to consider other potential causes of vulvar pain, such as lichen sclerosus, which has two peak ages of presentation, in prepubertal girls and postmenopausal women 1.
Treatment Approach
Treatment for vulvodynia often involves a multidisciplinary approach, including medications, topical creams, physical therapy, biofeedback, and cognitive-behavioral therapy. Medications such as tricyclic antidepressants like amitriptyline and gabapentin may be used to manage pain. Topical creams, such as lidocaine or estrogen creams, may be applied to the affected area to help manage pain. It's essential to work with a healthcare provider to develop a personalized treatment plan, as each woman's experience with vulvodynia is unique, and what works for one woman may not work for another.
From the Research
Definition of Vulvodynia
- Vulvodynia is a clinical syndrome characterized by unexplained vulvar pain, sexual dysfunction, and psychological disability 2
- It is a heterogeneous, chronic pain condition of unknown etiology that affects 7% to 15% of women 3
- Vulvodynia can be primary or secondary, localized or generalized, and spontaneous or provoked 3
Diagnosis of Vulvodynia
- Diagnosis should be made with a multidisciplinary approach, incorporating medical, rehabilitative, and psychological issues 2
- Clinical evaluation should stress attention to detailed "pain-mapping" and evaluation of past and present history 2
- The gynecological examination should be an overall patient evaluation, incorporating global physical impression, change in posture due to pain, and careful examination of the pelvic floor 2
- Examination of the pelvic floor is frequently omitted, leading to an incorrect diagnosis of psychogenic pain 2
- Initial evaluation and physical examination are crucial in identifying and diagnosing vulvodynia 4
Key Considerations
- Vulvodynia is a complex condition with varied clinical presentation and no widely accepted treatment protocol 5
- Treatment must be individualized based on the patient's presentation and physical examination findings 3
- A comprehensive, multidisciplinary approach is essential for proper evaluation and treatment of vulvodynia 2, 4