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The term vulvodynia is used to describe pain in the vulva, often severe, of unknown cause. Vestibulodynia (formerly vulvar or vulval vestibulitis) is a related term. more...

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A wide variety of possible causes and treatments for vulvodynia are currently being explored. Some possible causes include: allergy or other sensitivity to chemicals or organisms normally found in the environment, autoimmune disorder similar to lupus erythematosus, chronic tension or spasm of the muscles of the vulvar (or vulval) area.

The guidelines in Vulvovaginal health may be of some help.

Vulvodynia is the term used to describe women who experience the sensation of vulval burning and soreness in the absence of any obvious skin condition or infection. The sensation of burning and soreness of the vulva can be continuous (unprovoked vulvodynia) or on light touch eg. sexual intercourse or tampon use (provoked vulvodynia). Women who have unprovoked vulvodynia were formally know as having dysaesthetic vulvodynia where pain was felt without touch. Vestibulodynia is the term replacing vestibulitis where pain is felt on light touch. A recent change in the terminology of these conditions means that the description of women with vulvodynia can be more uniform amongst health professionals and patients. Many women have symptoms which overlap between both conditions.

Dysaesthetic vulvodynia and vestibulitis are now obsolete terms that you'll hear less and less frequently as they are phased out.

This condition is a cause of vulval burning and soreness usually as a consequence of irritation or hypersensitivity of the nerve fibres in the vulval skin. The abnormal nerve fibre signals from the skin are felt as a sensation of pain by the woman. This type of pain can occur even when the area is not touched. Another example of nerve-type (neuropathic pain) like vulvodynia is the pain some people experience with an attack of shingles. Once the rash of shingles has disappeared the area of skin where the rash was can be intensely painful and sore despite the skin appearing normal. The condition is called post-hepatic neuralgia.

The pain described by women with unprovoked vulvodynia is often of a burning, aching nature. The intensity of pain can vary from mild discomfort to a severe constant pain which can even prevent you from sitting down comfortably. The pain is usually continuous and can interfere with sleep. As with long-term pain of any cause you can have good days and bad days. Itching is not usually a feature of the condition. The pain in unprovoked vulvodynia is not always restricted to the vulval area (area of skin on the outside of the vagina) and some women get pain elsewhere. This can be around the inside of the thighs, upper legs and even around the anus (back passage) and urethra (where you pass urine). Some women also have pain when they empty their bowels. Unprovoked vulvodynia can have an affect on sexual activity and is associated with pain during foreplay and penetration. In some women with unprovoked vulvodynia the burning sensation can be generalised over the whole genital area. Alternatively it can be localised to just the clitoris (clitorodynia) or just one side of the vulva (hemi-vulvodynia).


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Psychological Factors Not Linked to Vulvodynia
From OB/GYN News, 12/1/99 by Barbara Baker

SANTA FE, N.M. -- Psychological disturbances probably do not contribute to the development or maintenance of vulvodynia, according to results of a cross-sectional study.

Psychological factors such as sexual and physical abuse, depression, and marital difficulties have been postulated to play a role in the onset and maintenance of vulvodynia for many years. But there have been few controlled studies that have examined the issue, Dr. Barbara D. Reed noted at the International Society for the Study of Vulvovaginal Disease World Congress.

Vulvodynia is a chronic pain disorder of unknown cause characterized by minimal or no physical findings at the location of the pain and tenderness at the vulva when touched with a cotton swab. Pain with sexual intercourse is common, Dr. Reed said.

She and her associates at the University of Michigan, Ann Arbor, gave lengthy questionnaires and a battery of standardized psychological inventories to new patients attending the university's gynecology clinics.

A personal history of sexual abuse was reported by 21% of 31 vulvodynia patients and 26% of 23 asymptomatic controls, a nonstatistical difference. But 63% of the 18 women with chronic pelvic pain but no vulvodynia reported such a history, Dr. Reed reported.

A history of physical abuse was also significantly more common among chronic pelvic pain patients, reported by 42% of the women in this group. In contrast, only 5% of the vulvodynia patients and none of the controls reported a history of physical abuse.

Women in all three groups reported similar levels of marital satisfaction, positive and negative feelings toward their sexual partner in the prior week, and interest in sex.

Patients with vulvodynia scored similarly to controls with respect to family history of depression, a personal history of depression, and current depression. But those with chronic pelvic pain had significantly higher rates on all three measures.

Patients with chronic pelvic pain scored significantly higher than vulvodynia patients on measures of pain disability, affective distress, and somatic preoccupation. Chronic pelvic pain patients also had significantly more physical symptoms in other parts of their body than women with vulvodynia and controls.

Physical Therapy Eases Vulvodynia Symptoms

SANTA FE, N.M. - Referral to a physical therapist who specializes in women's health may be helpful for patients with dysesthetic vulvodynia, Elizabeth H. Hartmann suggested at the International Society for the Study of Vulvovaginal Disease World Congress.

Mrs. Hartmann, a physical therapist in private practice in Naperville, Ill., treated 15 patients with vulvodynia that occurred without local pressure or intercourse using a variety of physical therapy techniques. She usually saw them once a week. The mean number of visits was 16.

The patients had their symptoms for an average of 5.2 years. Current and previous treatments included but were not limited to antidepressants, vulvar surgery, acupuncture, and calcium citrate diets.

Following physical therapy intervention, 13 of the women reported that physical therapy had significantly decreased their vulvodynia symptoms and that their sexual activity had increased. All four patients who had previously quit work because of their pain had returned to work.

A total of 19 physical therapy techniques were used. All patients received internal and external soft tissue mobilization, internal and external therapeutic exercise, and pelvic floor retraining. Biofeedback, interferential electrical stimulation to the pelvis, diet modulation, and visceral mobilization were used in 10 of the women treated. These are techniques that most physical therapists are familiar with, but "with women's health, they are utilized just a bit differently," Mrs. Hartmann noted.

COPYRIGHT 1999 International Medical News Group
COPYRIGHT 2004 Gale Group

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