Vulvodynia
From Wikipedia, the free encyclopedia
| ICD-10 | {{ | }} | |
|---|---|---|---|
| ICD-9 | 625.9 |
Vulvodynia refers to a disorder of vulvar pain, burning, and discomfort that interferes with the quality of life. No discernible physical lesion other than perhaps some redness of the skin is present. The cause is unknown.
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[edit] Localized vulvodynia/ vulvar vestibulitis
The condition is one of exclusion and the diseases listed in the differential diagnosis need to be considered. The pain may be generalized or localized in the vulvar region. Localized vulvodynia in the vestibular region is referred to as vulvar vestibulitis and also vestibulodynia. It is unclear if these conditions are manifestations of the same disease process as the differential diagnosis is the same and the cause unknown.
[edit] Possible causes
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 area, infection, injury, and neuropathy. Dr. John Willems, head, division of obstetrics and gynecology, Scripps Clinic believes that vulvodynia is a subset of fibromyalgia.
[edit] Diagnosis
The diagnosis is based on the typical complaints of the patient, essentially normal physical findings, and the absence of identifiable causes per the differential diagnosis. A cotton “swab test” is used to delineate the areas of pain and categorize their severity.
[edit] Differential diagnosis
- Infections: candidiasis, herpes, HPV
- Inflammation: lichen planus
- Neoplasm: Paget's disease, vulvar carcinoma
- Neurologic disorder: neuralgia secondary to herpes virus, spinal nerve injury
[edit] Treatment
There is no uniform treatment approach and numerous proposed treatments are based primarily on empirical experience and opinion. Treatments include:
- Vulvar care measures: cotton underwear, no synthetics; avoidance of vulvar irritants (douching, shampoos, perfumes, detergents); water cleaning only (no soaps); cotton menstrual pads; lubrication for intercourse; rinsing and patting dry the vulva after micturition.
- Medications: topicals, oral, and injectable medication that include anesthetics, estrogens, tricyclic antidepressants compounded into a topical form or systemic, local steroids.
- Biofeedback and physical therapy.
- Surgery: vestibulectomy.
The guidelines in Vulvovaginal health may be of some help.
[edit] References
ACOG Committee on Gynecologic Practice. Committee Opinion # 345: Vulvodynia. Obstet Gynecol (2006)108;1049-52.
What Your Doctor May Not Tell You About Fibromyalgia, by R. Paul St. Amand, MD and Claudia Craig Marek, Warner Wellness, 2006.
[edit] Vulvodynia in film and television
In season 4, episode 2 "The Real Me" of Sex and the City, Charlotte is diagnosed with Vulvodynia and prescribed antidepressants.
