Vulvodynia

Abstract

Introduction Vulvodynia is a chronic vulvar disorder which is defined by the International Society for the Study of Vulvovaginal Disease (ISSVD) as “vulvar discomfort, most often described as burning pain, occurring in the absence of relevant visible findings or a specific, clinically identifiable neurological disorder” [1]. In other words, the patient is experiencing severe discomfort in the vulvar area and yet on visual inspection the vulva looks completely normal other than the presence of focal erythema, which is often subtle and easily missed unless specifically looked for. This discrepancy in the appearance of the vulva and the symptoms experienced by the patient has often led the clinician (who may not be aware of the condition of vulvodynia) to think that the patient predominantly has a psychosomatic or psychosexual disorder. As the commonest presentation of vulvodynia is entry dyspareunia, often resulting in complete apareunia, a purely psychosexual disorder is often wrongly diagnosed. Vulvar pain was classified by the ISSVD into two main groups: pain related to a specific disorder (infections, inflammatory conditions, neoplastic and neurological disorders) pain not related to specific pathology: vulvodynia. Vulvodynia is classified as generalized or localized, and whether it is provoked, unprovoked, or mixed (Table 9.1). Provoked vestibulodynia (formerly known as “vulvar vestibulitis syndrome”) resulting in entry dyspareunia is the commonest clinical presentation of vulvodynia in young women; unprovoked generalized vulvodynia and unprovoked clitorodynia are the commonest presentations in postmenopausal women.