Management of vulvodynia

Vulvodynia is the term assigned when a woman has a chronic condition of pain in the inner or outer vulva that has lasted longer than 6 months and cannot be explained by a chronic skin condition or infection. The general diagnostic term vulvodynia is used to describe two subtypes of vulvar pain. One is localized to the vestibule of the vulva, generally is painful only when touched, and is the most common explanation for repeated pain at initial vaginal penetration. It is the most common form of vulvodynia, termed localized provoked vulvodynia (LPV). The second form of vulvodynia causes a constant burning sensation in areas of the outer vulva, whether touched or not, and is less common. Vestibular vulvodynia is often associated with tight pelvic floor muscles and was initially described in 1861 by Marion Sims and named vaginismus. Localized provoked vulvodynia has characteristic histologic findings of nerve hyperplasia and an infiltrate of lymphocytes and mast cells. A multitude of therapies has been tried for both types of vulvodynia, but careful comparative studies have been few. Because of the significant associated problem of dyspareunia, this condition has very deleterious effects on intimacy, development of relationships, and self-image. Therapeutic efforts should be multidisciplinary, including gynecologic assessment and treatment of local skin pain, physical therapy to retrain tight pelvic floor muscles, and skilled mental health counseling for emotional difficulties.