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vulvodynia; vulvar pain; vulvar burning; vulvar itching

Pain of the external female genital organs including vulva, labia, clitoris, & vaginal opening Classification: 1) generalized vulvodynia 2) vulvar vestibulitis syndrome (pain in the vestibule) Etiology: 1) idiopathic [3] 2) no evidence of infectious etiology (i.e. sexually transmitted disease) 3) postulated causes include: a) nerve injury or irritation b) genetic factors c) hypersensitivity d) muscle spasms e) hormonal changes f) history of sexual abuse g) chronic urinary tract infection ? [3] 4) Candida vulvovaginosis 5) lichen sclerosus Epidemiology: 4% of women Clinical manifestations: 1) chronic vulvar pain 2) symptoms usually begin suddenly 3) duration months to years 4) burning, stinging, or rawness 5) ching, soreness, or throbbing 6) itching 6) symptoms may be intermittent or constant 7) symptoms may be exacerbated by activities such as exercise or may occur while at rest 8) symptoms may occur in a specific area or throughout the entire vulva 9) diminished quality of life 10) dyspareunia 90% 11) age at onset: 60% age > 30 years; 20% age < 20 years 12) vulva generally appears normal, but may appear inflamed or swollen 13) fibromyalgia 3-fold more common than in general population 14) irritable bowel syndrome 3-fold more common than in general population Complications: 1) increased referral to specialists 2) physical & emotional stress Management: 1) no standard satisfactory treatment [3] 2) treat urinary tract infection 2) treat vulvovaginitis 3) topical gabapentin 2,4 or 6% compounded by pharmacist may be of benefit [3] 4) avoid potential irritants [4] a) certain soaps, scented materials, douches, perfumes b) hot tubs or pools with lots of chlorine 5) rinse the vulva with cool water after urination & intercourse 6) avoid foods that make urine more irritating - greens, beans, berries, chocolate, or nuts 7) wear loose-fitting pants & skirts; don't wear pantyhose [4] 8) keep the vulva clean & dry 9) use a water-soluble lubricant during sex 10) avoid activities that put direct pressure on the vulva - bicycling & horseback riding 11) sit on a foam rubber doughnut 12) lukewarm or cool sitz baths [4] 13) therapy or a support group

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vaginal pain vulva

General

pain [odyn-]

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 398-99
  2. Arnold LD, Bachmann GA, Rosen R, Kelly S, Rhoads GG. Vulvodynia: Characteristics and Associations With Comorbidities and Quality of Life. Obstet Gynecol. 2006 Mar;107(3):617-624. PMID: 16507933
  3. Boardman LA et al. Topical gabapentin in the treatment of localized and generalized vulvodynia. Obstet Gynecol 2008 Sep; 112:579. PMID: 18757655
  4. WebMD: Vulvodynia: Causes, Symptoms, and Treatments http://women.webmd.com/vulvodynia
  5. Mayo Clinic: vulvodynia http://www.mayoclinic.com/health/vulvodynia/DS00159/DSECTION=symptoms
  6. Haefner HK, Collins ME, Davis GD et al The vulvodynia guideline. J Low Genit Tract Dis. 2005 Jan;9(1):40-51. Review. PMID: 15870521