TOG - Vulvodynia and psychosexual medicine

Question 1

What are the lifetime and point prevalence of chronic vulval pain?

Answer 1

10-16% lifetime

4-7%

Question 2

What is the most common cause of dyspareunia in women <50?

Answer 2

Provoked localised vulvodynia 16%

Generalised vulvodynia 6-7%

Question 3

What are the medical options for treatment of vulvodynia?

Answer 3

• Topical:
  2 or 5% lidocaine topically, overnight or prior to SI
  Can use in conjunction with electromyographybiofeedback
  Some reduction with topical gabapentin
  Both 50% reduction in pain
• Intralesional:
  Botox - unclear long term effects
  Refractory - betamethasone and lidocaine
• Systemic (esp unprovoked)
  Amitryptiline up to 150mg OD
  Anticonvulsants - poor methodology

Question 4

What are the surgical options for treatment of vulvodynia?

Answer 4

• Modified vestibulectomy
• Laser ablation of vulvar epithelium

Reserved for refractory cases of provoked localised vulvodynia

Question 5

What are the alternative therapies for vulvodynia?

Answer 5

Physiotherapy, biofeedback and TENS
Neuromodulation treatment (transcranial/s.cord stimulation)
Acupuncture

Question 6

How many women attending gynae clinic have psychosexual dysfunction?

Answer 6

20%

Question 7

What are the organic causes of hypoactive sexual desire disorder?

Answer 7

Menopause
Depression
Drugs e.g SSRI, TCA
Acquired after e.g. BSO/chemo/radio

Question 8

How much does libido reduce by following BSO?

Answer 8

50% - loss of testosterone

Question 9

What are the disadvantages of testosterone patches?

Answer 9

Atopic site reaction
Acne
Hirsutism
Lower pitched voice in too-high doses