Vulvodynia

Question 1

Definition of vulvodynia

Answer 1

The aetiology is unknown and the condition is best

managed as a chronic pain syndrome.

Question 2

Symptoms of vulvodynia

Answer 2

. Pain that is longstanding and unexplained.
. May be associated with urinary symptoms such as
interstitial cystitis.
. Can also be associated with irritable bowel syndrome
and fibromyalgia.

Question 3

Signs of vulvodynia

Answer 3

. The vulva appears normal.

Question 4

Complications of vulvodynia

Answer 4

. Sexual dysfunction

. Psychological morbidity.

Question 5

Investigations of vulvodynia

Answer 5

. After exclusion of other treatable causes no further
investigation is required.
. Biopsy should be performed if any suspicion of alternative diagnosis.

Question 6

Treatment of vulvodynia

Answer 6

. Use of emollient soap substitute.
. Pain modifiers – tricyclic antidepressants are well
established in chronic pain management. Few studies
have specifically examined the effect in vulvodynia;
however, amitriptyline is frequently first-line
treatment; dosage should be increased by small
increments starting at 10 mg up to 100 mg daily
according to the patient’s response. A recent randomised study has not confirmed the beneficial effect of amitriptyline.
. If unresponsive or unable to tolerate the side effects,
gabapentin or pregabalin may be used
. Topical local anaesthetic, 5% lidocaine ointment
or 2% lidocaine gel. A trial of local anaesthetic may
be considered although irritation is a common side
effect.
. Cognitive behavioural therapy and psychotherapy.
. Acupuncture.
. Physiotherapy if evidence of a weak pelvic floor