Vulvodynia: Diagnosis and Management
By BARBARA D. REED, M.D., M.S.P.H.
Barbara D. Reed, M.D., M.S.P.H., University of Michigan Health System, 1018 Fuller St., Ann Arbor, MI, 48109- 0708 (e-mail: firstname.lastname@example.org).
The diagnosis of vulvodynia is made after taking a careful history, ruling out infectious or dermatologic abnormalities, and eliciting pain in response to light pressure on the labia, introitus, or hymenal remnants. Several treatment options have been used, although the evidence for many of these treatments is incomplete. Treatments include oral medications that decrease nerve hypersensitivity (e.g., tricyclic antidepressants, selective serotonin reuptake inhibitors, anticonvulsants), pelvic floor biofeedback, cognitive behavioral therapy, local treatments, and (rarely) surgery. Most women experience substantial improvement when one or more treatments are used.
Vulvodynia is characterized by chronic discomfort in the vulvar region; the discomfort may range from mild to severe and debilitating. The diagnosis depends on a consistent history, lack of a documented infectious or dermatologic cause, and in most women, tenderness when gentle pressure is applied by a cotton swab to the vulva, introitus, or hymenal areas. The pain usually is present during and after intercourse, and other factors may exacerbate the pain (e.g., bicycle riding, tampon insertion, prolonged sitting, wearing tight clothes) (Table 1).1 In some women the pain is spontaneous.