Vulvar pain is a symptom and not a diagnosis. If symptoms persist for a minimum of three months and no other pathology can be identified, consider the diagnosis of vulvodynia.
Multisocietal Definition Consensus (ISSVD, ISSWSH, and IPPS)
Symptoms may include burning, stinging, itching, and may be constant or only upon contact (provoked). When the pain is primarily localized to the vestibule, the term vestibulodynia can be used. With respect to timing, pain can be persistent or cyclical. Most cases of vulvodynia can be treated hormonally or through pelvic floor physiotherapy. In the most extreme cases of vestibulodynia, rarely a vestibulectomy may be indicated.
Treatment of generalized vulvodynia or vestibulodynia may include the following
Note: Above medications will need to be titrated, often over 3 to 4 weeks to arrive at optimal dose | Adverse effects include sedation, dry mouth, and dizziness (some patients will develop tolerance)
ACOG ASCCP Committee Opinion 673: Persistent Vulvar Pain
2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia
Descriptors of Vulvodynia: A Multisocietal Definition Consensus (International Society for the Study of Vulvovaginal Disease, the International Society for the Study of Women Sexual Health, and the International Pelvic Pain Society)
New topical treatment of vulvodynia based on the pathogenetic role of cross talk between nociceptors, immunocompetent cells, and epithelial cells
Recent advances in understanding provoked vestibulodynia
Localized provoked vestibulodynia (vulvodynia): assessment and management
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