Vulvodynia Flashcards
Definition
A chronic discomfort involving the vulva in the absence of relevant visible findings or a specific clinically identifiable, neurological disorder. It is a diagnosis of exclusion.
Classification
Generalised
Localised
Generalised vulvodynia
Affecting the whole vulval area
a. provoked e.g. by touch, intercourse or tampon insertion
b. unprovoked e.g. present even without touch
c. mixed
Local vulvodynia
Affecting a specific area of the vulva including clitorodynia (where the clitoris is affected), vestibulodynia (where the vaginal vestibule is affected)
a. provoked
b. unprovoked
c. mixed
Aetiology
- Trigger causing inflammation or injury causing stimulation of pain receptors. Triggers include infections, skin conditions, allergies, trauma
- General urogenital hypersensitivity
- Disordered central pain processing
- Somatoform pain disorder
Risk factors
- Fibromyalgia
- Irritable bowel syndrome
- Chronic fatigue syndrome
- Interstitial cystitis
- Endometriosis
- History of recurrent vulvovaginal candidiasis
Description
The vulval discomfort is described as burning, stinging, irritation or rawness.
Ix
- vaginal and pelvic examination
- vaginal swab - STI
- vaginal biopsy
Ddx
- Infection - candidal vulvovaginitis, genital herpes, chlamydia, gonorrhoea, trichomoniasis, tinea
- Cystitis
- Lichen planus
- Lichen sclerosis
- Vaginismus
- Vulval atrophy
- Vulval intraepithelial neoplasia
- Psoriasis
- Contact dermatitis
General tx
Avoidance of contact irritants
Avoid use of emollient soap substitutes
Topical tx
Local anaesthetics e.g. lidocaine
Medical tx
Tricyclic antidepressants e.g. amitryptilline
Gabapentin
Physiotherapy tx
Kegel exercises
Psychological tx
CBT
Mindfulness
Surgery
Rarely used - aimed to remove hypersensitive tissue
