Vulvodynia

Chronic vulval discomfort, most often described as a burning pain, occuring in the absence of relevant visible findings or a specific, clinically identifiable, neurological disoder

Aetiology

  • Aetiology not understood, likely to be multifactoral
  • Usually requires a trigger in a vunerable individual
  • Associated with other chronic pain conditions e.g. fibromyalgia

Clinical presentation

Symptoms

  • Vulval discomfort often described as burning, stinging, irritation or rawness
  • Generalised (affecting whole vulval area) or localised (affecting a specific area)
  • Provoked (e.g. by touch, sexual intercourse, interting a tampon), unprovoked, or mixed

Signs

  • Little or nothing abnormal is apparent on inspection
  • The purpose of examination is to localise the pain and to exclude other diagnoses

Investigations

  • Diagnosis of exclusion
  • Vaginal swab may be useful to rule out infection

Management

  • Information
  • Genital skin care advice and emollients
  • Localised provoked pain - lidocaine 5% ointment, vaginal trainers, physiotherapy
  • Unprovoked pain - tricyclics, gabapentin/pregabalin
  • Psychosexual interventions