vulvodynia; vulvar pain; vulvar burning; vulvar itching

Introduction

Pain of the external female genital organs including vulva, labia, clitoris, & vaginal opening

Classification

• generalized vulvodynia
• vulvar vestibulitis syndrome (pain in the vestibule)

Etiology

• idiopathic
• no evidence of infectious etiology (i.e. sexually transmitted disease)
• postulated causes include:
  • nerve injury or irritation
  • genetic factors
  • hypersensitivity
  • muscle spasms
  • hormonal changes
  • history of sexual abuse
  • chronic urinary tract infection ?
• Candida vulvovaginosis
• lichen sclerosus

Epidemiology

4% of women

Clinical manifestations

• chronic vulvar pain
• symptoms usually begin suddenly
• duration months to years
• burning, stinging, or rawness
• ching, soreness, or throbbing
• itching
• symptoms may be intermittent or constant
• symptoms may be exacerbated by activities such as exercise or may occur while at rest
• symptoms may occur in a specific area or throughout the entire vulva
• diminished quality of life
• dyspareunia 90%
• age at onset: 60% age > 30 years; 20% age < 20 years
• vulva generally appears normal, but may appear inflamed or swollen
• fibromyalgia 3-fold more common than in general population
• irritable bowel syndrome 3-fold more common than in general population

Complications

• increased referral to specialists
• physical & emotional stress

Management

• no standard satisfactory treatment
• treat urinary tract infection
• treat vulvovaginitis
• topical gabapentin 2,4 or 6% compounded by pharmacist may be of benefit
• avoid potential irritants
  • certain soaps, scented materials, douches, perfumes
  • hot tubs or pools with lots of chlorine
• rinse the vulva with cool water after urination & intercourse
• avoid foods that make urine more irritating
  • greens, beans, berries, chocolate, or nuts
• wear loose-fitting pants & skirts; don't wear pantyhose
• keep the vulva clean & dry
• use a water-soluble lubricant during sex
• avoid activities that put direct pressure on the vulva
  • bicycling & horseback riding
• sit on a foam rubber doughnut
• lukewarm or cool sitz baths
• therapy or a support group

More general terms

• pain [odyn-]

Additional terms

• vaginal pain
• vulva