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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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Vulvodynia is important cause of vulval pain
From British Medical Journal, 6/5/99 by B Kirby

EDITOR--Although Butcher's review of female sexual problems discusses the causes of superficial vulval pain,[1] it omits to mention vulvodynia--in our experience an important cause of vulval pain and superficial dyspareunia.[2 3] The International Society for the Study of Vulvar Disease defines vulvodynia as chronic vulvar discomfort, especially that characterised by the patient's complaint of burning, stinging, irritation, or rawness.[4]

Dysaesthetic vulvodynia is thought to be an abnormal pain syndrome analogous to trigeminal neuralgia and postherpetic neuralgia.[5] Physical examination gives essentially normal results, with no evidence of vestibulitis. The most successful treatment is low dose amitryptiline, starting at 10 mg daily and increasing to a maximum of 75 mg daily in conjunction with 5% lignocaine gel.[5]

Patients with superficial vulval pain should be assessed in a specialist vulval clinic, as vulvodynia is otherwise often not recognised.

[1] Butcher J. Female sexual problems II: sexual pain and fears. BMJ 1999;318:110-2. (9 January.)

[2] Harrington CI. Vulvodynia. Dermatol in Pract 1990:June/ July:18-21.

[3] Byth J. Understanding vulvodynia. Australasian J Dermatol 1998;39:139-50.

[4] International Society for the Study of Vulvar Disease Taskforce. Burning vulvar syndrome: report of the ISSVD taskforce. J Reprod Med 1984;29:457.

[5] McKay M. Dysesthetic ("essential") vulvodynia. Treatment with amitriptyline. J Reprod Med 1993;38:9-13.

B Kirby Specialist registrar

J A Yell Consultant dermatologist Vulval Clinic, Department of Dermatology, Hope Hospital, Salford M6 8HD

COPYRIGHT 1999 British Medical Association
COPYRIGHT 2000 Gale Group

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