Vulvodynia - Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Vulvodynia

Vulvodynia
From Wikipedia, the free encyclopedia

Vulvodynia is a chronic pain syndrome that Vulvodynia aects the vulvar area and often occurs without [1] Classication and external resources an identiable cause or visible pathology categorized in the ICD-9 group ICD-9 625.7 (http://www.icd9data.com 625specically ICD-9 625.7, which is for pain /getICD9Code.ashx?icd9=625.7) and other disorders of the female genital [2] organs. It refers to pain of the vulva [3] unexplained by vulvar or vaginal infection or skin disease. The term "vulvodynia" simply refers to "vulvar pain", and does not imply a specic [4] cause.

Contents
1 Symptoms 2 Vulvar vestibulitis 3 Possible causes 4 Diagnosis 5 Dierential diagnosis 6 Treatment and disease management 7 Mental health 8 Related disorders 9 Vulvodynia in the media 10 See also 11 References 12 External links

Symptoms
Pain is the most notable symptom of vulvodynia, and can be characterized as a burning, stinging, irritation or sharp pain that occurs in the vulva, including the labia and entrance to the vagina. It may be constant, intermittent or happen only when the vulva is touched, but vulvodynia is usually dened as lasting for years. Symptoms may occur in one place or the entire vulvar area. It can occur during or after sexual activity, when tampons are inserted, or when prolonged pressure is applied to [5] Some cases of the vulva, such as during sitting, bike riding, or horseback riding. vulvodynia are idiopathic where no particular cause can be determined.

Vulvar vestibulitis
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Main article: Vulvar vestibulitis Vulvar Vestibulitis Syndrome (VVS), vestibulodynia, or simply vulvar vestibulitis is vulvodynia localized to the vestibular region. It tends to be associated with a highly localized burning or cutting type of pain. The pain of vulvodynia may extend into the clitoris; this is referred to as clitorodynia. Vulvar Vestibulitis Syndrome (VVS) is the most common subtype of vulvodynia that aects premenopausal women the syndrome has been cited as aecting about [6] 10%15% of women seeking gynecological care.

Possible causes
A wide variety of possible causes and treatments for vulvodynia are currently being explored. Moreover, there are probably several causes of vulvodynia, and some may be individual to the patient.
[7] allergy or other Possible causes include: genetic predisposition to inammation, sensitivity (for example: oxalates in the urine), an autoimmune disorder similar to lupus erythematosus or to eczema or to lichen sclerosus, infection (e.g., yeast infections, bacterial vaginosis, HPV), injury, and neuropathyincluding an increased number of nerve endings in the vaginal area. Some cases seem to be negative outcomes of genital surgery, such as a Labioplasty. Pelvic oor dysfunction may be the underlying cause of [8] some women's pain.

Diagnosis
The condition is one of exclusion and other vulvovaginal problems should be ruled out. The diagnosis is based on the typical complaints of the patient, essentially normal physical ndings, and the absence of identiable causes per the dierential diagnosis. A cotton swab test is used to delineate the areas of pain and categorize their severity. Patients often will describe the touch of a cotton ball as extremely painful, like the scraping of a knife. Many suerers will see several doctors before a correct diagnosis is made. Many gynecologists are not familiar with this family of conditions, but awareness has spread with time. Suerers are also often hesitant to seek treatment for chronic vulvar pain, especially since many women begin experiencing symptoms around the same time they become sexually active. Moreover, the absence of any visible symptoms means that before being successfully diagnosed many patients are told that the pain is "in their head".

Dierential diagnosis
1. 2. 3. 4.
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Infections: candidiasis, herpes, HPV Inammation: lichen planus Neoplasm: Paget's disease, vulvar carcinoma Neurologic disorder: neuralgia secondary to herpes virus, spinal nerve injury
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Treatment and disease management

There is no uniform treatment approach for vulvodynia or vulvar vestibulitis. Women have shown improved symptoms from a variety of treatments. Some nd 100% relief from particular treatments, while others may experience only temporary or partial relief. Responses to the various and many treatments being tried are highly variable, with many patients often trying several treatments over the course of their diagnosis depending upon their levels of relief, the preferred method(s) of their doctor(s), and the aordability of these treatments; many treatments are still experimental and often not covered by health insurance or the particular doctor using them does not take insurance. Treatments include: 1. Over the Counter Care: Wearing cotton underwear (no synthetics); avoidance of vulvar irritants (douching, shampoos, perfumes, laundry detergents); gently wash the vaginal area and labia with cool water only using a washcloth is most eective but do not use soap; cotton menstrual pads; rinsing and patting dry the vulva after urination; using a pad when sitting to alleviate pressure. 2. Lubrication: (for intercourse or used daily to minimize irritation) If you have problems with yeast, or are worried you will, avoid lubricants with glycerine in them, which acts like a sugar and will only add to your problems. Neem oil is a good topical treatment for irritation that is also anti-fungal so very safe if you are prone to yeast, and water-based lubricant are often suggested by doctors. Vitamin E and olive oil can also create bacterial growth so avoid using them topically. 3. Diet: Following a low-oxalate diet may help those whose urine oxalate levels are high and may be causing or exacerbating irritation. The level of oxalates can be tested by taking a 24-hour urine sample. Those following a low-oxalate diet often take a calcium citrate supplement. There is no evidence that this diet helps suerers with normal oxalate levels in their urine. 4. Alternatives to Penetration: Suerers are often encouraged to explore sexual activity besides penetrative intercourse, which is often a major source of pain. Patients may seek the assistance of a sex therapist to learn specic techniques and ways to maintain a positive image of sexual intimacy and one's body. 5. Education and accurate information about Vestibulodynia: Gynaecologist-led educational seminars delivered in a group format have a signicant positive impact on psychological symptoms and sexual functioning in women who suer from [9] Provoked (caused by a stimulus such as touch or sexual activity) Vestibulodynia. 6. Medications: Patients have found variable success using topical creams and gels including estrogen and/or testosterone, often specially made through a compounding pharmacy; oral medicines including testosterone, antidepressants also used for pain disorders (e.g., nortriptyline, amitriptyline), and anti-anxiety drugs; and injectable medications including anesthetics, estrogens, tricyclic antidepressants compounded into a topical form or systemic, local steroids. 7. Biofeedback, Physical Therapy and Relaxation: Biofeedback, often done by physical therapists, involves inserting a vaginal sensor to get a sense of the strength of the muscles and help a patient get greater control of her muscles to feel the dierence between contraction and relaxation. Sessions are linked with at-home recommendations including often Kegel exercises (e.g., hold for 9 seconds, relax for 30 for 1015 sets) and relaxation (breathing deep into the gut). Other physical therapy involves direct manipulation of the muscles; the therapist may go inside [10] (One may practice the vagina and physically press on and stretch the muscles.
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stretching along with Kegel's at home using a dilation kit or series of dierent size dildos. This is a common treatment for those suering primarily from vaginismus, but may also help individuals with vaginismus that results from and worsens preexisting pain.) Other therapists encourage strengthening one's core muscles, believing that the pelvic region overcompensates for the work the core muscles should be doing, causing strain and pain. 8. Injection: This may be performed under CT, urosocopy/C-arm or ultrasound guidance where the pudendal nerve is identied in its canal (where it is commonly [11] Usually cortisone and local anaesthetic is injected and in rare compressed). cases, the nerve may be destroyed (ablated), if the pain is severe and unrelenting. In the latter instance, the trade o is permanent vulval numbness. 9. Surgery: Vestibulectomy. During a vestibulectomy, the innervated bers are excised. A vaginal extension may be performed, in which vaginal tissue is pulled forward and sewn in place of the removed skin. The success rate of a [12] to as high as 93%.[13][14] There are vestibulectomy varies from a low of 60% over 20 studies citing a success rate greater than 80%.[citation needed]

Mental health
Like many other people suering from pain disorders, those aicted with vulvodynia may often be impacted by the frustration of nding a diagnosis, subsequently confronted with an area of medicine that is still in relative infancy. The cause is still unknown and treatment success varies. Therefore, many become frustrated and [citation needed] sometimes depressed with a lower quality of life.

Related disorders Vulvodynia in the media

In Season 4, Episode 2 "The Real Me" of Sex and the City, Charlotte is diagnosed with vulvodynia and prescribed antidepressants. This episode was received with much criticism, notably from the National Vulvodynia Association, which objected to the portrayal of the condition as a eeting, minor condition. Season 1, Episode 3 ("In Which Addison Finds the Magic") of Private Practice includes a couple seeking treatment for vulvar vestibulitis and vaginismus. Susanna Kaysen, well known for her novel, Girl, Interrupted, and its lm adaptation, has also published The Camera My Mother Gave Me, a novel concerning her own experience with vulvodynia and its debilitating symptoms. Vulvodynia was featured in the TLC documentary television series Strange Sex episode "Pleasure and Pain". Vulvodynia (and female sexual dysfunction) was featured in the season 9 True Life episode "I Can't Have Sex."

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See also
Biofeedback Gabapentin Bartholinitis Endometriosis

References
1. ^ Feldhaus-Dahir (2011). "The Causes and Prevalence of Vestibulodynia: A Vulvar Pain Disorder". Urologic Nursing 31 (January/February): 5154. PMID 21542444 (//www.ncbi.nlm.nih.gov /pubmed/21542444) . 2. ^ http://www.icd9data.com /2009/Volume1/580-629/617-629 /625/default.htm 3. ^ http://medicaldictionary.thefreedictionary.com /vulvodynia 4. ^ Philip B. Mead; Wesley David Hager; Sebastian Faro (2000). Protocols for infectious diseases in obstetrics and gynecology (http://books.google.com /?id=8IoNoUHXFawC&pg=PA278) . Wiley-Blackwell. pp. 278. ISBN 978-0-632-04324-8. http://books.google.com /?id=8IoNoUHXFawC&pg=PA278. Retrieved 10 May 2010. 5. ^ National Research Center for Women and Families (October, 2007). "Vulvodynia and Genital Pain" (http://www.center4research.org/2010/03 /vulvodynia-and-genital-pain/) . http://www.center4research.org/2010/03 /vulvodynia-and-genital-pain/. Retrieved 2009-08-27. 6. ^ Bergeron S, Binik YM, Khalif S, Meana M, Berkley KJ, Pagidas K (1997). "The treatment of vulvar vestibulitis syndrome: Toward a multimodal approach" (http://www.informaworld.com /smpp/content~content=a788571576~db =all~order=page) . Sexual and Relationship Therapy 12 (4): 30511. doi:10.1080/02674659708408174 (http://dx.doi.org /10.1080%2F02674659708408174) . http://www.informaworld.com /smpp/content~content=a788571576~db =all~order=page. Bergeron S, Binik YM, Khalif S, Pagidas K (1997). "Vulvar vestibulitis syndrome: a critical review" (http://meta.wkhealth.com/pt/ptcore/template-journal/lwwgateway/media /landingpage.htm?issn=0749-8047& volume=13&issue=1&spage=27) . Clin J Pain 13 (1): 2742. doi:10.1097/00002508-199703000-00006 (http://dx.doi.org /10.1097%2F00002508-199703000-0000 6) . PMID 9084950 (//www.ncbi.nlm.nih.gov/pubmed /9084950) . http://meta.wkhealth.com /pt/pt-core/template-journal/lwwgateway /media /landingpage.htm?issn=0749-8047& volume=13&issue=1&spage=27. 7. ^ Gerber S, Bongiovanni AM, Ledger WJ, Witkin SS (March 2003). "Interleukin-1beta gene polymorphism in women with vulvar vestibulitis syndrome". Eur. J. Obstet. Gynecol. Reprod. Biol. 107 (1): 747. doi:10.1016/S0301-2115(02)00276-2 (http://dx.doi.org /10.1016%2FS0301-2115%2802%290027 6-2) . PMID 12593899 (//www.ncbi.nlm.nih.gov/pubmed /12593899) . 8. ^ Kellogg-Spadt S] (October, 2003). "Dierential Diagnosis of (http://www.medscape.org/viewarticle /465853) Pelvic Floor Dysfunction and Vulvar Pain". http://www.medscape.org /viewarticle/465853. Retrieved 2012-09-11. 9. ^ Brotto LA, Sadownik L, Thomson S (February 2010). "Impact of educational seminars on women with provoked vestibulodynia". J Obstet Gynaecol Can 32 (2): 1328. PMID 20181314 (//www.ncbi.nlm.nih.gov/pubmed /20181314) .

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10. ^ Cohen, D] (August, 2009). "For Women With Pain Disorders, Sex Can Be Excruciating Experience" (http://abcnews.go.com /2020/story?id=8261425& page=2#.UE__Q41lSZc) . http://abcnews.go.com /2020/story?id=8261425& page=2#.UE__Q41lSZc. Retrieved 2012-09-11. 11. ^ Hough DM, Wittenberg KH, Pawlina W, Maus TP, King BF, Vrtiska TJ, Farrell MA, Antolak SJ Jr. (2003). "Chronic perineal pain caused by pudendal nerve entrapment: anatomy and CT-guided perineural injection technique.". Am J Roentgenol 181 (2): 5617. PMID 12876048 (//www.ncbi.nlm.nih.gov /pubmed/12876048) . 12. ^ Stewart, Elizabeth; Paula Spencer (July 2002). The V Book: A Doctor's Guide to

Complete Vulvovaginal Health. Bantam Trade Paperback. pp. 297328. ISBN 0-553-38114-8. 13. ^ Goldstein, Andrew T.; Marino, Stanley C.; Christopher, Kurt; Johnson, Crista; Marino, SC (2006). "Surgical Treatment of Vulvar Vestibulitis Syndrome: Outcome Assessment Derived from a Postoperative Questionnaire". The Journal of Sexual Medicine 3 (5): 923931. doi:10.1111/j.1743-6109.2006.00303.x (http://dx.doi.org /10.1111%2Fj.1743-6109.2006.00303.x) . PMID 16942537 (//www.ncbi.nlm.nih.gov /pubmed/16942537) . 14. ^ "ACOG Committee Opinion: Number 345, October 2006: vulvodynia". Obstet Gynecol 108 (4): 104952. October 2006. PMID 17012483 (//www.ncbi.nlm.nih.gov /pubmed/17012483) .

http://www.jpowerpoint.com/Vulvodynia--PPT.html

External links
British Association of Dermatologists Care Guide (http://www.bad.org.uk/site/883 /Default.aspx) National Vulvodynia Association (http://www.nva.org/) Dr. Glazer's Vulvodynia Site (http://www.vulvodynia.com/index.htm) Vulvodynia and TRPV1 (IT) (http://www.ildermatologorisponde.it/vulvodinia.html) Secret Suering (http://www.instituteforwomeninpain.com/secret-suering-book) Dr. Marjorie Crandall Candida Allergy and Vulvodynia (http://www.empowher.com /yeast-infection/content/dr-marjorie-crandall-yeast-infections-candida-allergyand-vulvodynia) Low Oxalate Info (http://www.lowoxalate.info/index.html) Oxalate Content of Food list (http://www.ohf.org/docs/Oxalate2004.pdf) Clinical Management of Vulvodynia (http://www.vulvodynia.com/dia_vv_ab9.htm) Interstitial Cystitis Support Group of Manhattan (http://www.icnewyork.net) Interstitial Cystitis Network (http://www.ic-network.com) Vulvar Pain Foundation (http://www.vulvarpainfoundation.org/) http://vulvodyniasupport.forumotion.net newly created support forum for Vulvodynia suerers Psychological and medical information about vulvodynia (Polish) (http://www.vulvodynia.pl) A Support Community For Couples Struggling With Intimacy Due To Disability (http://www.whensexhurts.com/) Vulval Pain Society (UK) (http://www.vulvalpainsociety.org/) "IC woman and her trust sidekick, vulvodynia" Article about the impact on, and relationship between, the presence of both vulvodynia and the serious bladder condition, interstitial cystitis in female patients (http://icadvice.com/node/173) Vulvar Vestibulitis Support Network (http://vvssupport.wordpress.com/)
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Multidisciplinary Vulvodynia Program (http://www.mvprogram.org /Home_1378.htm/) CT sequence demonstrating a pudendal nerve block (http://www.melbourneradiology.com.au/interventional-radiology/nerveblocks.html) Vulvodynia: Dismissed and Undiagnosed (http://www.theglobeandmail.com /life/article725351.ece/) Help organisation for pudendal pain (http://www.pudendalhope.info) Retrieved from "http://en.wikipedia.org/w/index.php?title=Vulvodynia& oldid=537220171" Categories: Pain Gynaecologic disorder Neurocutaneous conditions This page was last modied on 8 February 2013 at 13:28. Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may apply. See Terms of Use for details. Wikipedia is a registered trademark of the Wikimedia Foundation, Inc., a non-prot organization.

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