Vulvodynia: integrating current knowledge into clinical practice

Abstract

Key content Vulvodynia is a chronic gynaecological condition that results in significant distress to women and management can be challenging to the clinician., The 2003 International Society for the Study of Vulvovaginal Disease ( ISSVD) defines vulvodynia as vulval discomfort that is described as burning, stinging or irritation, in the absence of relevant visible findings or specific signs of a clinically identifiable neurological condition. The condition can be localised (vestibule) or generalised and the discomfort can be spontaneous or provoked by physical contact., The diagnosis of vulvodynia is one of exclusion after inflammatory, infectious, dermatological, neoplastic, neurological and psychosexual conditions have been ruled out., A multidisciplinary approach to tackle the different components of vulvodynia is required that includes a lead clinician with clinical psychologist, physiotherapist, psychosexual medicine clinician and pain management specialist., Owing to the heterogeneity in the aetiology of the condition, multimodal therapy is recommended in most cases., Learning objectives To review the current classification and pathophysiology of vulvodynia., To review the clinical manifestation and diagnosis of a patient with generalised and localised vulvodynia., To critically appraise the currently available treatments options for vulvodynia., Ethical issues Psychosexual dysfunction related to this disorder raises the sensitive issue of open communication with the individual or couple on varying degrees of sexual and psychological counselling., Ethical issues that are realised in determining the cause of vulvodynia include sexual orientation and history of sexual abuse., How does evidence-based medicine direct health professionals in the treatment of this condition?