Presentation
Living with vestibulitis has certainly made my 20s very challenging, so I urge you to please remember this article the next time a woman presents with pain during intercourse. [ncbi.nlm.nih.gov]
Women with vestibulodynia have difficulty with sexual function and present with sexual distress, which has to be addressed in conjunction with pain to eliminate the disorder. Petersen CD, Giraldi A, Lundvall L, and Kristensen E. [onlinelibrary.wiley.com]
In more severe cases, the pain is present during normal daily activities, as well as during sex. Careful examination reveals redness and unusual sensitivity of the tissue at the opening of the vagina. [med.unc.edu]
Laboratory tests are used to exclude bacterial or viral infection, and a careful examination of the vulvo/vaginal area is conducted to assess whether any atrophy is present Treatment [ edit ] This section is empty. [en.wikipedia.org]
[…] such as Atarax or Vistaril, that inhibit the release of histamines that can irritate mucous membranes physical and exercise therapy to strengthen and relax the pelvic-floor muscles—called pelvic floor therapy—particularly if lower back problems are present [medical-dictionary.thefreedictionary.com]
Skin
- Skin Disease
Vulvodynia Definition Vulvodynia is chronic pain of the vulva, the external or visible region of the female genitalia, in the absence of vulvar or vaginal infection or skin disease. [medical-dictionary.thefreedictionary.com]
- Eczema
Aetiology Allergies, inflammation, autoimmune disease, eczema, infection (e.g., yeasts, bacterial vaginosis, HPV) and neuropathy. [medical-dictionary.thefreedictionary.com]
Musculoskeletal
- Muscle Spasm
Physical Therapy and Biofeedback Since vaginal muscle spasm aggravates the pain and discomfort of vulvodynia, physical therapy using biofeedback and gynecologic instruments has been successful in many patients with vaginismus (spasm of the vaginal muscle [aafp.org]
Neurologic
- Dysesthesia
Key points Vulvar vestibulitisthe leading cause of painful coitus in women under 50is distinct from pain that has a recognized cause, like cyclic candidal vulvovaginitis or lichen planus, and unprovoked generalized vulvar dysesthesia. [contemporaryobgyn.net]
Dysesthetic vulvodynia — Generalized vulvodynia; generalized vulvar dysesthesia; essential vulvodynia; chronic vulvar pain not limited to the vulva for which there is no apparent cause. [medical-dictionary.thefreedictionary.com]
The terms vulvar dysesthesia and vulvar vestibulitis are no longer used to describe vulvar pain. There is now consensus to use the term vulvodynia and subcategorize it as localized, generalized, or mixed. Box 1 classifies persistent vulvar pain. [acog.org]
- Neuralgia
Patients describe burning pain similar to that occurring in cases of postherpetic neuralgia or glossodynia (burning tongue syndrome).16 Some authors believe that pudendal neuralgia (pain along the pudendal nerve) is one of the causes of essential vulvodynia [aafp.org]
[…] a commonly identified infection (eg, candidiasis, human papillomavirus, herpes), inflammation (eg, lichen sclerosus, lichen planus, immunobullous disorder), neoplasia (eg, Paget disease, squamous cell carcinoma), or a neurologic disorder (eg, herpes neuralgia [acog.org]
- Hyperesthesia
[…] vulvodynia have less dyspareunia or point tenderness than patients with vulvar vestibulitis syndrome.16 The physical examination shows no evidence of vestibulitis or cutaneous changes.6 Urethral or rectal discomfort is often associated with vulvar pain.5 The hyperesthesia [aafp.org]
- Insomnia
Desipramine and nortriptyline are less sedating than amitriptyline; imipramine is the least sedating, and, in fact, is often taken in the morning since it can cause insomnia. If one tricyclic is not helpful, try another member of the family. [contemporaryobgyn.net]
Workup
Microbiology
- Candida
If you suspect Candida albicans or it has been a factor, suppression for 3 to 6 months with a weekly oral dose of 150 mg fluconazole is important. [contemporaryobgyn.net]
Because of the link with Candida, treatment for cyclic vulvovaginitis may include anticandidal medication even if cultures are not positive. [aafp.org]
[…] or injury to the vulvar nerves hypersensitivity of nerves in the vulvar region an abnormal response of vulvar cells to environmental factors, including infection or injury irritation from oxalate in the urine a localized hypersensitivity to the yeast Candida [medical-dictionary.thefreedictionary.com]
Treatment
S 2007 11 Effectiveness of hypnosis for the treatment of vulvar vestibulitis syndrome: a preliminary investigation. ( 17367437 ) Pukall C...Binik Y 2007 12 Human papillomavirus in vulvar vestibulitis syndrome. ( 17694965 ) Gaunt G...Gostout BS 2007 13 [malacards.org]
At the same time, it seems that many treatments bring about at least some relief in some women. [med.unc.edu]
Surgical and Laser Therapy Laser or surgical treatment should be reserved for use in cases in which all forms of medical treatment have failed. [aafp.org]
A treatment may work for some women and not for others and some treatments may cause unacceptable side effects in some women. [medical-dictionary.thefreedictionary.com]
Treatment options for vulvar vestibulitis. Contemporary Ob/Gyn Oct. 1, 2003;48:47-61. [contemporaryobgyn.net]
Prognosis
escarole, collards, and spinach celery parsley and watercress green peppers beets tomato and vegetable soups rutabaga eggplant leeks okra sweet potatoes summer squash rhubarb berries purple grapes tangerines chocolate beer, beverage mixes, and tea Prognosis [medical-dictionary.thefreedictionary.com]
Etiology
Future research should aim at evaluating a multimodal approach in the treatment of vulvodynia, along with more research on the etiologies of vulvodynia. [acog.org]
Vulvodynia is multifactorial in cause, and each subset probably has a different etiology. [aafp.org]
Epidemiology
In the 1980s, renewed interest was generated with the publication of articles by Friedrich, Lynch and McKay.2–4 Epidemiology Vulvodynia is a syndrome of unexplained vulvar pain that is frequently accompanied by physical disabilities, limitation of daily [aafp.org]
The epidemiology is unknown; preliminary data from almost 6,000 women in an ongoing NIH-funded survey of 16,000 women between ages 18 and 64 show that 16% reported a history of chronic burning, knife-like or sharp pain, or pain on contact that lasted [contemporaryobgyn.net]
Pathophysiology
Pathophysiology of R-UTIs is complex... Read more [fondazionegraziottin.org]
Greenstein A...Abramov L 2007 14 Surgical treatment for the vulvar vestibulitis syndrome. ( 16449109 ) Traas MA...Vierhout ME 2006 15 Surgical techniques: Surgery for Vulvar Vestibulitis syndrome. ( 16681483 ) Goldstein A 2006 16 A conceptual model for the pathophysiology [malacards.org]
In the absence of clear pathophysiology, as many as 26 treatments for VVS have evolved over the years.15 Data on their efficacy are limited to a few open clinical trials and small placebo-controlled studies. [contemporaryobgyn.net]
Prevention
Prevention Numerous suggestions have been made for preventing vulvodynia and for relieving symptoms and preventing further irritation, including: using soft, white or unbleached, unscented toilet tissue using 100% cotton menstrual pads and tampons avoiding [medical-dictionary.thefreedictionary.com]
According to Marinoff and Turner,26 surgery should be reserved for use in patients with pain of at least six months' duration, pain that partly or completely prevents sexual intercourse and patients who have undergone failed treatment for a specific subset [aafp.org]
[…] study of desipramine, 150 mg daily, combined with topical 5% lidocaine ointment applied five to six times daily to the vestibule showed promising results, with 71% of 53 patients completely free of symptoms.26 Frequent use of the topical anesthetic may prevent [contemporaryobgyn.net]