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Vulvodynia. Vulvodynia is a heterogenous, chronic pain condition of unknown etiology that affects 7% to 15% of women. It affects sexual function and quality of life. Vulvodynia can be primary or secondary, localized or generalized, and spontaneous or provoked. Contributing factors for provoked vulvodynia might include vulvovaginal infections, low estrogen states, and underlying anxiety disorder. Generalized vulvodynia likely arises from underlying connective tissue or neurological dysfunction. Vulvodynia treatment must be individualized on the basis of the patient's presentation and physical examination findings. Surgical excision of the vulvar vestibule has high success rates but other modalities showing success include pelvic floor physical therapy and cognitive-behavioral therapy.
Vulvodynia. Vulvodynia, a chronic pain disorder, affects women throughout the lifespan. Appropriate evaluation and diagnosis is necessary to enable effective management. The etiology is considered multifactorial. Therapies include self-management, nonpharmacologic, pharmacologic, and surgical. Vulvodynia can have a significant impact upon a patient's quality of life. Emotional and psychological support is invaluable. This article serves to give the primary gynecologist and practitioner a basic framework with which to identify, diagnose, and begin treatment for such patients as well as understanding for referral if necessary. The initial evaluation and physical examination will be discussed in detail.
Vulvodynia. Vulvodynia is a genital pain syndrome occurring in 7% to 8% of women. Although common, most practitioners are uncomfortable with the diagnosis and management of these women's pain, and many believe this is psychologically based. Multifactorial in origin, ubiquitous factors include pelvic floor muscle abnormalities, neuropathic pain, anxiety, and primary or secondary sexual dysfunction. Although there are many published studies on vulvodynia, quality trials that evaluate therapy are lacking. However, experience suggests that most patients are significantly improved with pelvic floor physical therapy, medication for neuropathic pain, psychological support, and attention to sexual function.