Materiały źródłowe

• #1 Vulvodynia: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0401/p1231.html

  The diagnosis of vulvodynia is made after taking a careful history, ruling out infectious or dermatologic abnormalities, and eliciting pain in response to light pressure on the labia, introitus, or hymenal remnants. […] The diagnosis depends on a consistent history, lack of a documented infectious or dermatologic cause, and in most women, tenderness when gentle pressure is applied by a cotton swab to the vulva, introitus, or hymenal areas. […] The diagnosis of vulvodynia depends on a careful history, followed by a confirmatory physical examination. […] The physical examination is an important part of the diagnostic process. […] Confirmation during the examination often will clarify this issue. […] A cotton swab is used to gently indent (approximately 5 mm) several locations on the labia, introitus, and hymenal remnants. This pressure will elicit discomfort in almost all women with vulvodynia; the posterior introitus and the posterior hymenal remnants are the most common sites of increased sensitivity.

• #2 How do health care providers diagnose vulvodynia? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  http://www.nichd.nih.gov/health/topics/vulvodynia/conditioninfo/diagnosed

  Vulvodynia tends to be diagnosed only when other causes of vulvar pain, such as infection or skin diseases, have been ruled out. […] To diagnose vulvodynia, a health care provider will take a detailed medical history, including pain characteristics and any accompanying bowel, bladder, or sexual problems. […] The provider may also perform a cotton swab test, applying gentle pressure to various vulvar sites and asking the patient to rate the severity of the pain. […] Because vulvodynia is often a diagnosis of exclusion, it can be difficult and time-consuming to arrive at an actual diagnosis. […] The diagnostic process can be especially problematic for women who lack health insurance because they may not have the resources to continue seeking care to exclude the many possible causes of pain. […] Moreover, some women may be reluctant to discuss their pain or seek treatment.

• #3 Vulvodynia: Causes, Symptoms, Management & Treatment

  https://my.clevelandclinic.org/health/diseases/17878-vulvodynia

  Vulvodynia is pain in your vulva that lasts longer than three months. Unlike vulvar pain that results from a condition, vulvodynia doesnt have a clear cause. […] Vulvodynia is different. Vulvodynia is pain lasting three or more months that isnt an obvious symptom of a specific condition. […] Vulvodynia is the most common cause of painful intercourse (dyspareunia) and chronic pelvic pain among people in their reproductive years (people who menstruate). […] Many people with vulvodynia likely dont seek treatment. Also, it isnt easy to diagnose vulvodynia because researchers dont know its exact cause. […] Your healthcare provider will diagnose vulvodynia by ruling out other conditions that may be causing your pain. […] Tests and procedures used to diagnose vulvodynia may include: Physical exam. Your provider will inspect your vulva and perform a pelvic exam with a speculum to assess your vagina and cervix.

• #4 Localised provoked vestibulodynia (vulvodynia): assessment and management

  https://www.racgp.org.au/afp/2015/july/localised-provoked-vestibulodynia-vulvodynia-asses

  Vulvodynia is a chronic vulvar pain condition. Localised provoked vestibulodynia (LPV) is the most common subset of vulvodynia, the hallmark symptom being pain on vaginal penetration. […] Diagnosis is based on history. Examination is used to support the diagnosis. […] There are no specific tests. Diagnosis is made on the basis of a typical history, supported by examination findings and exclusion of other painful vulvar conditions. […] Vulvodynia can co-exist with other vulvar conditions but become evident only when other conditions have been managed and pain persists. […] The location and nature of pain are the keys to diagnosis. […] Sensitively explore the effect of pain on sexual relationships and intimacy. […] The goal of treatment is to reduce pain and to improve quality of life and sexual function.

• #5 Vulvodynia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vulvodynia/diagnosis-treatment/drc-20353427

  During a pelvic exam, a doctor inserts one or two gloved fingers inside the vagina. Pressing down on the abdomen at the same time, the doctor can check the uterus, ovaries and other organs. […] With vulvodynia, your gynecologist or another member of your care team likely will ask you questions about your medical and sexual history. You’ll also be asked if you’ve had any surgeries. […] Your outer genitals and vagina are checked for signs of an infection or other causes of your symptoms. A sample of cells from your vagina might be taken to test for an infection caused by yeast or bacteria. Your health care professional also might insert a gloved finger into your vagina to check the pelvic floor muscles for tenderness. […] A moistened cotton swab is used to gently check for specific areas of pain in your vulva. If a painful area is found, you’ll likely be asked what it feels like and how much it hurts.

• #6 Vulvodynia: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0401/p1231.html

  The diagnosis of vulvodynia is made after taking a careful history, ruling out infectious or dermatologic abnormalities, and eliciting pain in response to light pressure on the labia, introitus, or hymenal remnants. […] The diagnosis depends on a consistent history, lack of a documented infectious or dermatologic cause, and in most women, tenderness when gentle pressure is applied by a cotton swab to the vulva, introitus, or hymenal areas. […] The diagnosis of vulvodynia depends on a careful history, followed by a confirmatory physical examination. […] The physical examination is an important part of the diagnostic process. […] Confirmation during the examination often will clarify this issue. […] A cotton swab is used to gently indent (approximately 5 mm) several locations on the labia, introitus, and hymenal remnants. This pressure will elicit discomfort in almost all women with vulvodynia; the posterior introitus and the posterior hymenal remnants are the most common sites of increased sensitivity.

• #7 Provoked vulvodynia: diagnosis of perplexing pain condition – Pelviperineology A Multidisciplinary Pelvic Floor Journal

  https://doi.org/10.34057/PPj.2020.39.04.003

  Provoked vulvodynia typically presents with pain during intercourse. The etiology of this condition has not been elucidated, and the diagnostic procedures are unfamiliar to many health care providers. […] The present paper is the first to present a contemporary approach to the diagnosis of vulvodynia based on medical history, physical examination, and the use of specific instruments and tests, based on a recent consensus terminology of vulvodynia. […] Vulvodynia is currently defined as a vulvar pain of at least three months, without a clear identifiable cause, which may have potential associated factors. […] The most common presentation of vulvodynia is PV, with severe entry dyspareunia, sometimes preventing the possibility to have intercourse. […] The approach to diagnosis has also been amended by the introduction of the consensus terminology.

• #8 Vulvodynia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vulvodynia/diagnosis-treatment/drc-20353427

  If the skin of the vulva looks different than usual, your doctor or gynecologist might remove a small sample of tissue for a lab to check. […] This may be done to check your levels of hormones such as estrogen, progesterone and testosterone. […] For vulvodynia, questions to ask your care team include: What tests do you recommend? […] What treatments are most likely to improve my symptoms? […] When might I expect to get relief? […] You may be asked several questions, such as: How bad is your pain, and how long does it last? How would you describe it? […] Is your pain often triggered by a specific event, such as sex, exercise or going to the bathroom? […] Does anything make your pain better or worse? […] Have you been treated for urinary tract or vaginal infections?

• #9 Vulvodynia: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0401/p1231.html

  The diagnosis of vulvodynia is made after taking a careful history, ruling out infectious or dermatologic abnormalities, and eliciting pain in response to light pressure on the labia, introitus, or hymenal remnants. […] The diagnosis depends on a consistent history, lack of a documented infectious or dermatologic cause, and in most women, tenderness when gentle pressure is applied by a cotton swab to the vulva, introitus, or hymenal areas. […] The diagnosis of vulvodynia depends on a careful history, followed by a confirmatory physical examination. […] The physical examination is an important part of the diagnostic process. […] Confirmation during the examination often will clarify this issue. […] A cotton swab is used to gently indent (approximately 5 mm) several locations on the labia, introitus, and hymenal remnants. This pressure will elicit discomfort in almost all women with vulvodynia; the posterior introitus and the posterior hymenal remnants are the most common sites of increased sensitivity.

• #10 Diagnosis – The National Vulvodynia Association

  https://www.nva.org/learnpatient/diagnosis/

  Upon examination, the vulvar tissue may either appear red and swollen, or perfectly normal. By comparing the vestibular tissue, you can see that the vestibule on the top is very red. Even though the vestibule in the bottom photo shows very little redness, this woman had severe pain that made sexual intercourse and inserting a tampon impossible. Thus, the severity of a woman’s pain doesn’t necessarily correlate with the degree of visible redness. […] Prior to your appointment, you should consider downloading and completing the International Pelvic Pain Society’s thorough pelvic pain questionnaire. You can either fax the form to your provider prior to your appointment or bring it with you. In addition, you should bring your pain diary. […] Some women with vulvodynia also suffer from other disorders, such as interstitial cystitis (painful bladder syndrome), irritable bowel syndrome, fibromyalgia, temporomandibular joint and muscle disorders, endometriosis and/or chronic fatigue syndrome. When you are seeking care and treatment, it is important to discuss all of your symptoms/conditions with your health care provider, even if you don’t think they are related. […] The NVA and five other non-profit organizations formed the Chronic Pain Research Alliance to advocate for those who suffer from more than one of the above disorders. Additional information on these conditions can be viewed at http://www.chronicpainresearch.org.

• #11 Aetiology, diagnosis, and clinical management of vulvodynia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7258372/

  Chronic vulvar pain or discomfort for which no obvious aetiology can be found, i.e. vulvodynia, can affect up to 16% of women, and it may be found in girls and women across all age groups and ethnicities. […] Vulvodynia is a diagnosis of exclusion with unknown aetiology. […] The diagnosis of vulvodynia is made based on the principle of exclusion. In fact, the exclusion of all other treatable causes before making a diagnosis of vulvodynia is obligatory. […] A good knowledge of vulvar anatomy is of exceptional significance for making of the diagnosis. […] Typical physical finding upon the examination is erythema of vestibule. Since the diagnosis of vulvodynia is made based on the absence of any other cause of the condition, in the presence of erythema, vulvovaginal infection or other specific disease of the vulva is to be ruled out.

• #12 Vulvodynia: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0401/p1231.html

  The diagnosis of vulvodynia is made after taking a careful history, ruling out infectious or dermatologic abnormalities, and eliciting pain in response to light pressure on the labia, introitus, or hymenal remnants. […] The diagnosis depends on a consistent history, lack of a documented infectious or dermatologic cause, and in most women, tenderness when gentle pressure is applied by a cotton swab to the vulva, introitus, or hymenal areas. […] The diagnosis of vulvodynia depends on a careful history, followed by a confirmatory physical examination. […] The physical examination is an important part of the diagnostic process. […] Confirmation during the examination often will clarify this issue. […] A cotton swab is used to gently indent (approximately 5 mm) several locations on the labia, introitus, and hymenal remnants. This pressure will elicit discomfort in almost all women with vulvodynia; the posterior introitus and the posterior hymenal remnants are the most common sites of increased sensitivity.

• #13 Vulvodynia: Causes, Symptoms, Management & Treatment

  https://my.clevelandclinic.org/health/diseases/17878-vulvodynia

  Cotton swab test (point-pressure testing). Your provider will brush a cotton swab gently over parts of your vulva and ask when (and where) the contact feels painful. […] In rare instances, your provider may order a colposcopy or a biopsy of your vulva to rule out conditions unrelated to vulvodynia that may be causing your pain. […] Vulvodynia treatment takes time. Finding the treatment or combination of treatments that bring you pain relief involves trial and error. […] Treatments may include: Topical medications: You can apply creams and ointments that numb your vulva (anesthetics) or stabilize your nerves. […] Oral medication: Antidepressants and anticonvulsants that you can take by mouth can reduce nerve pain. […] A nerve block: Your provider may recommend an injection that prevents pain signals from traveling from your nerves to your brain.

• #14 Vulvar Pain: How Do You Diagnose Vulvodynia?

  https://www.vuvatech.com/blogs/care/vulvar-pain-how-do-you-diagnose-vulvodynia?srsltid=AfmBOorb4a4iHEoK51A7-QFCO7sEQQZ6DfatdzPzNvq32ZnWrotiYrVe

  Vulvodynia is the vulvar pain condition characterized by feelings of chronic pain and discomfort in the vulvar, introitus or hymenal areas. To diagnose vulvodynia it is necessary to move through a process of different assessments and tests. The condition is notoriously difficult to diagnose, so some patience may be required. […] If you wish to diagnose vulvodynia, you will need to be prepared for an examination of your personal history be sure that your pain is not rooted in any potential infectious or dermatologic causes. […] When your healthcare practitioner is trying to diagnose vulvodynia, they will assess your medical history carefully, as well as your sexual and surgical history. Once all other pain-causing abnormalities are ruled out, it may be possible to pinpoint nerve damage or misinterpretations of pressure by the nervous system, which are the most probable causes of vulvodynia.

• #15 Localised provoked vestibulodynia (vulvodynia): assessment and management

  https://www.racgp.org.au/afp/2015/july/localised-provoked-vestibulodynia-vulvodynia-asses

  Most women do improve with treatment. […] It is important to emphasise that pain does not signify damage. Reassure that this is a recognised condition with recommended treatments and that most women gain significant improvement over time. […] Examination typically shows a very normal looking vulva. […] With LPV, there is marked tenderness to light pressure in the inner vestibule. […] The place of surgery as a treatment is uncertain and controversial. […] In a small number of selected women with very localised vestibular pain, surgical excision of the painful area has been successful.

• #16 Provoked vulvodynia: diagnosis of perplexing pain condition – Pelviperineology A Multidisciplinary Pelvic Floor Journal

  https://doi.org/10.34057/PPj.2020.39.04.003

  Women with vulvar pain usually go through years of endless visits to health care providers without achieving any significant improvement. […] Therefore, the approach should be very empathic. […] We suggest using a structured questionnaire to obtain the relevant history. […] The cotton-swab test, also known as the Q-tip test, is an easy-to-use test for diagnosing PV. […] At this time, a biopsy is not required to make a diagnosis of vulvodynia. […] The patient usually requests to get an opinion on the severity of her PV. […] However, the severity is determined by the subjective level of pain at vaginal intercourse by using the Marinoff’s criteria. […] The first part of the consensus terminology contains a list of recognized causes of vulvar pain, including Candida and bacteriologic vaginal infections, dermatoses, deformities, birth lacerations, and past trauma.

• #17 Provoked vulvodynia: diagnosis of perplexing pain condition – Pelviperineology A Multidisciplinary Pelvic Floor Journal

  https://pelviperineology.org/articles/provoked-vulvodynia-diagnosis-of-perplexing-pain-condition/doi/PPj.2020.39.04.003

  The cotton-swab test, also known as the Q-tip test, is an easy-to-use test for diagnosing PV. At this time, a biopsy is not required to make a diagnosis of vulvodynia. […] The patient usually requests to get an opinion on the severity of her PV. However, the severity is determined by the subjective level of pain at vaginal intercourse by using the Marinoff’s criteria. […] The first part of the consensus terminology contains a list of recognized causes of vulvar pain, including Candida and bacteriologic vaginal infections, dermatoses, deformities, birth lacerations, and past trauma. These should be excluded before a diagnosis of vulvodynia can be made. […] In most cases, vestibular examination is sufficient, and no other test is required to diagnose PV. However, additional testing may be necessary in the following women: In women with associated deep dyspareunia or deep pelvic pain, vaginal ultrasound examination and possibly magnetic resonance imaging studies should be carried out to diagnose endometriosis. […] Diagnosing PV should be conducted according to a structured plan. Diagnosis is based on the understanding of the associated factors of PV as described in the consensus terminology.

• #18 Vulvodynia: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0401/p1231.html

  The diagnosis of vulvodynia is made after taking a careful history, ruling out infectious or dermatologic abnormalities, and eliciting pain in response to light pressure on the labia, introitus, or hymenal remnants. […] The diagnosis depends on a consistent history, lack of a documented infectious or dermatologic cause, and in most women, tenderness when gentle pressure is applied by a cotton swab to the vulva, introitus, or hymenal areas. […] The diagnosis of vulvodynia depends on a careful history, followed by a confirmatory physical examination. […] The physical examination is an important part of the diagnostic process. […] Confirmation during the examination often will clarify this issue. […] A cotton swab is used to gently indent (approximately 5 mm) several locations on the labia, introitus, and hymenal remnants. This pressure will elicit discomfort in almost all women with vulvodynia; the posterior introitus and the posterior hymenal remnants are the most common sites of increased sensitivity.

• #19 Persistent Vulvar Pain | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/09/persistent-vulvar-pain

  The vulva and vagina should be examined, and infection ruled out when indicated using tests, including wet mount, vaginal pH, fungal culture, and Gram stain, or other available point-of-care testing or polymerase chain reaction testing. […] A musculoskeletal evaluation would help rule out musculoskeletal factors associated with vulvodynia, such as pelvic muscle overactivity and myofascial or other biomechanical disorders. […] Medications used to treat vulvar pain include topical, oral, and intralesional medicinal substances, as well as pudendal nerve blocks and botulinum toxin. Tricyclic antidepressants and anticonvulsants also can be used for vulvodynia pain control. […] Women with vulvodynia should be assessed for pelvic floor dysfunction. Biofeedback and physical therapy, including pelvic floor physical therapy, can be used to treat localized and generalized vulvar pain.

• #20 Vulvodynia | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688787/all/Vulvodynia?q=Pain+Pelvic

  Vulvar pain 3 months duration, without visible findings, lab abnormalities, or an identifiable neurologic disorder. […] Provoked vulvodynia is often described as the sensation that something is blocking the vagina or the vagina is too small for penetration. […] Unprovoked vulvodynia is described as constant burning or stinging in the absence of any sexual activity. […] Annual rate of new onset vulvodynia is 1.8%. […] Lifetime incidence approaches 15%, suggesting nearly 14 million U.S. women will experience vulvar discomfort at some point in their lives. […] Provoked vulvodynia is the most common cause of sexual pain in women 30 years old. […] Recurrent vulvovaginal infections, specifically candidiasis. […] Hormonal factors: Pain onset or increased severity may be associated with perimenopause/menopause. […] Pelvic floor dysfunction. […] Interstitial cystitis/painful bladder syndrome. […] Childhood physical or sexual abuse. […] Depression and anxiety. […] Other neuropathic and chronic pain disorders, including regional pain syndrome.

• #21 Vulvodynia: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0401/p1231.html

  Vaginal secretions should be evaluated for the presence of an active candidal vulvovaginal infection. If an infection is diagnosed, treatment with antifungal medication should precede treatment for vulvodynia. […] The diagnosis of vulvodynia depends on a careful history, followed by a confirmatory physical examination.

• #22 Vulvodynia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vulvodynia/diagnosis-treatment/drc-20353427

  During a pelvic exam, a doctor inserts one or two gloved fingers inside the vagina. Pressing down on the abdomen at the same time, the doctor can check the uterus, ovaries and other organs. […] With vulvodynia, your gynecologist or another member of your care team likely will ask you questions about your medical and sexual history. You’ll also be asked if you’ve had any surgeries. […] Your outer genitals and vagina are checked for signs of an infection or other causes of your symptoms. A sample of cells from your vagina might be taken to test for an infection caused by yeast or bacteria. Your health care professional also might insert a gloved finger into your vagina to check the pelvic floor muscles for tenderness. […] A moistened cotton swab is used to gently check for specific areas of pain in your vulva. If a painful area is found, you’ll likely be asked what it feels like and how much it hurts.

• #23 Persistent Vulvar Pain | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/09/persistent-vulvar-pain

  The vulva and vagina should be examined, and infection ruled out when indicated using tests, including wet mount, vaginal pH, fungal culture, and Gram stain, or other available point-of-care testing or polymerase chain reaction testing. […] A musculoskeletal evaluation would help rule out musculoskeletal factors associated with vulvodynia, such as pelvic muscle overactivity and myofascial or other biomechanical disorders. […] Medications used to treat vulvar pain include topical, oral, and intralesional medicinal substances, as well as pudendal nerve blocks and botulinum toxin. Tricyclic antidepressants and anticonvulsants also can be used for vulvodynia pain control. […] Women with vulvodynia should be assessed for pelvic floor dysfunction. Biofeedback and physical therapy, including pelvic floor physical therapy, can be used to treat localized and generalized vulvar pain.

• #24 Vulvodynia FAQ’s

  https://www.contemporaryobgyn.net/view/vulvodynia-faqs

  A good doctor will also test your vaginal pH (which will tell you whether your bacterial levels are normal), culture for yeast and for as many sexually-transmitted diseases as possible, do a thorough visual inspection for molluscum contagiosum (be sure to point out to them the areas in which you feel bumps), and do a hormone panel. […] If the colposcopy shows damaged areas, your doctor may want to do a biopsy. […] A biopsy that finds evidence of HPV only through looking at skin inflammation and not DNA-typing may in reality simply tell you that you have skin inflammation — which you already knew, of course! […] If you do have a bacterial or viral infection, it is possible that the Bartholin glands located in the vulvar vestibule, as well as other vulvar glands, may have been blocked or otherwise damaged from past infection.

• #25 Vulvodynia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vulvodynia/diagnosis-treatment/drc-20353427

  If the skin of the vulva looks different than usual, your doctor or gynecologist might remove a small sample of tissue for a lab to check. […] This may be done to check your levels of hormones such as estrogen, progesterone and testosterone. […] For vulvodynia, questions to ask your care team include: What tests do you recommend? […] What treatments are most likely to improve my symptoms? […] When might I expect to get relief? […] You may be asked several questions, such as: How bad is your pain, and how long does it last? How would you describe it? […] Is your pain often triggered by a specific event, such as sex, exercise or going to the bathroom? […] Does anything make your pain better or worse? […] Have you been treated for urinary tract or vaginal infections?

• #26 Vulvodynia: Causes, Symptoms, Management & Treatment

  https://my.clevelandclinic.org/health/diseases/17878-vulvodynia

  Cotton swab test (point-pressure testing). Your provider will brush a cotton swab gently over parts of your vulva and ask when (and where) the contact feels painful. […] In rare instances, your provider may order a colposcopy or a biopsy of your vulva to rule out conditions unrelated to vulvodynia that may be causing your pain. […] Vulvodynia treatment takes time. Finding the treatment or combination of treatments that bring you pain relief involves trial and error. […] Treatments may include: Topical medications: You can apply creams and ointments that numb your vulva (anesthetics) or stabilize your nerves. […] Oral medication: Antidepressants and anticonvulsants that you can take by mouth can reduce nerve pain. […] A nerve block: Your provider may recommend an injection that prevents pain signals from traveling from your nerves to your brain.

• #27 Diagnosis – The National Vulvodynia Association

  https://www.nva.org/learnpatient/diagnosis/

  Diagnosis […] Since vulvodynia is both a pain condition and affects the vulva, health care professionals from multiple disciplines may be involved in its treatment at different points in time. A gynecologist, urogynecologist or other provider knowledgeable about vulvodynia should perform your first examination to rule out conditions that mimic the symptoms of vulvodynia. Then, based on your symptoms, you may be referred to other specialists for continued care. […] After taking a thorough medical history and asking questions about your symptoms, your provider should carefully examine the vulva, vagina and vaginal secretions to rule out an active infection or skin disorder. Routine cultures for yeast and bacterial infections should be performed. Your provider may also recommend that you have blood drawn to assess levels of estrogen, progesterone and testosterone. He/she will likely perform a cotton-swab test. During the test, gentle pressure is applied to various vulvar sites and you’re asked to rate the severity of the pain. If any areas of skin appear suspicious, your provider may examine them with a magnifying instrument or take a biopsy of the area.

• #28 Vulvodynia | LifeBridge Health

  https://www.lifebridgehealth.org/conditions/vulvodynia

  Vulvodynia is chronic pain and discomfort of the vulva that is not caused by an infection, skin disease or cancer. […] Two types of vulvodynia are recognized: generalized vulvodynia and localized vulvodynia. […] In VVS, the pain is felt only in the vestibule (the area around the opening of the vagina), usually in response to touch or pressure. […] We will try to rule out other known causes of pain first. […] We will examine the vulva and vagina carefully. […] A swab test may be done to find out whether the pain is generalized or localized. […] The goal is to find where the pain is and whether it is mild, moderate or severe.

• #29 Vulvodynia treatment guidelines – Melbourne Sexual Health Centre (MSHC)

  https://www.mshc.org.au/health-professionals/treatment-guidelines/vulvodynia-treatment-guidelines

  Vulvodynia is a well-recognised chronic pain condition. […] The International Society for the Study of Vulvovaginal Disease (ISSVD) defines vulvodynia as vulvar pain of at least 3 months duration, without a clear, identifiable cause and which may have potential associated factors. […] A diagnosis of vulvodynia is largely based on history. […] Examination and investigations are necessary to exclude other conditions and treat associated conditions. […] Biopsy is not recommended routinely, even when the area looks red. Biopsy findings in women with symptoms have often been similar to women without symptoms.

• #30 Vulvodynia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vulvodynia/diagnosis-treatment/drc-20353427

  If the skin of the vulva looks different than usual, your doctor or gynecologist might remove a small sample of tissue for a lab to check. […] This may be done to check your levels of hormones such as estrogen, progesterone and testosterone. […] For vulvodynia, questions to ask your care team include: What tests do you recommend? […] What treatments are most likely to improve my symptoms? […] When might I expect to get relief? […] You may be asked several questions, such as: How bad is your pain, and how long does it last? How would you describe it? […] Is your pain often triggered by a specific event, such as sex, exercise or going to the bathroom? […] Does anything make your pain better or worse? […] Have you been treated for urinary tract or vaginal infections?

• #31 Aetiology, diagnosis, and clinical management of vulvodynia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7258372/

  The role of biopsy in making the diagnosis remains uncertain. […] The vulvar pain may also be reflected pain from other parts of the body, such as the back or flanks, so musculoskeletal evaluation should be considered. […] Vulvodynia is a complex disorder that can be difficult to treat. […] The lack of data about the effectiveness of various treatment options for vulvodynia, and many of the commonly recommended treatments have not been systematically studied in randomised, controlled trials. […] The overall success of self-diagnosis and treatment remains unclear. […] Vulvodynia is a disease that is not well known in the circles of health care providers. The lack of clarity in its aetiology results in the presence of multiple methods for treatment, with various durations and levels of success. None of them can be effective in all cases. This requires use of a strictly individual approach to every single patient.

• #32 Vulvodynia fact sheet – Melbourne Sexual Health Centre (MSHC)

  https://www.mshc.org.au/sexual-health/sexual-health-fact-sheets/vulvodynia

  Vulvodynia or vulval pain is the term used to describe pain or discomfort at or around the vaginal opening. This pain happens without an obvious ongoing cause. […] Vulvodynia means vulval pain. There are two types of vulvodynia, which can overlap. […] A diagnosis of vulvodynia is made by your doctor carefully detailing your symptoms and a physical examination. Skin disease and infection are excluded. A swab may be taken to exclude thrush. A cotton wool bud is used to map out the area of discomfort. Pelvic floor muscle function and tenderness will be assessed during a gentle examination. In almost all cases the skin and vulva look normal but sometimes there can be a degree of redness that is not an infection or skin problem. […] Biopsy is not routinely recommended, even when the area looks red. Biopsy findings in women with symptoms have often been similar to women without symptoms.

• #33 Provoked vulvodynia: diagnosis of perplexing pain condition – Pelviperineology A Multidisciplinary Pelvic Floor Journal

  https://doi.org/10.34057/PPj.2020.39.04.003

  Experts of vulvar disease differ in opinions as to whether colposcopic examination of the vulva, commonly referred to as “vulvoscopy”, should be a part of vulvar examination. […] Performing a speculum examination of the vagina and cervix is often difficult or impossible because of entry sensitivity. […] Pelvic manual examination is essential for initial evaluation because it may help to determine which associated factor is present and needs attention. […] A biopsy is not required for the diagnosis of vestibulodynia; however, the four pathological features typical for vestibulodynia in biopsy are as follows: Stromal hyperinnervation, intraepithelial innervation, stromal inflammation localized around the minor vestibular minor glands, and increased number of stromal mast cells. […] In most cases, vestibular examination is sufficient, and no other test is required to diagnose PV.

• #34 Persistent Vulvar Pain | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/09/persistent-vulvar-pain

  Persistent vulvar pain is a complex disorder that frequently is frustrating to the patient and the clinician. […] Vulvar pain can be caused by a specific disorder or it can be idiopathic. Idiopathic vulvar pain is classified as vulvodynia. […] The classification of vulvodynia is based on the site of the pain; whether it is generalized, localized, or mixed; whether it is provoked, spontaneous, or mixed; whether the onset is primary or secondary; and the temporal pattern (whether the pain is intermittent, persistent, constant, immediate, or delayed). […] A thorough history should identify the patients duration of pain, medical and surgical history, sexual history, allergies, and previous treatments. […] Cotton swab testing is used to identify the areas of pain (classifying each area of pain as mild, moderate, or severe) and to differentiate between generalized and localized pain.

• #35 Etiology, diagnosis, and clinical management of vulvodynia | IJWH

  https://www.dovepress.com/etiology-diagnosis-and-clinical-management-of-vulvodynia-peer-reviewed-fulltext-article-IJWH

  Chronic vulvar pain or discomfort for which no obvious etiology can be found, ie, vulvodynia, can affect up to 16% of women. […] An approach to the diagnosis and management of a woman presenting with chronic vulvar pain should address the biological, psychological, and social/interpersonal factors that contribute to her illness. […] The gynecologist has a key role in excluding other causes for vulvar pain, screening for psychosexual and pelvic floor dysfunction, and collaborating with other health care providers to manage a woman’s pain. […] Vulvodynia is a diagnosis of exclusion. […] The classification of vulvodynia is currently based on a description of the pain. […] The pain may be provoked (caused by direct touch, inserting a tampon, or sexual touch), unprovoked (present without touch), or have a mixed pattern.

• #36 Vulvodynia | LifeBridge Health

  https://www.lifebridgehealth.org/conditions/vulvodynia

  Vulvodynia is chronic pain and discomfort of the vulva that is not caused by an infection, skin disease or cancer. […] Two types of vulvodynia are recognized: generalized vulvodynia and localized vulvodynia. […] In VVS, the pain is felt only in the vestibule (the area around the opening of the vagina), usually in response to touch or pressure. […] We will try to rule out other known causes of pain first. […] We will examine the vulva and vagina carefully. […] A swab test may be done to find out whether the pain is generalized or localized. […] The goal is to find where the pain is and whether it is mild, moderate or severe.

• #37 What is Vulvodynia?

  https://www.nva.org/what-is-vulvodynia/

  Vulvodynia, simply put, is chronic vulvar pain without an identifiable cause. […] The majority of women with localized vulvodynia have Provoked Vestibulodynia (PVD), in which pain occurs during or after pressure is applied to the vestibule, e.g., with: sexual intercourse, tampon insertion, a gynecologic examination, prolonged sitting, and/or wearing fitted pants. […] PVD is further classified as primary or secondary. […] Women with primary PVD have experienced vestibular pain since the first attempt at vaginal penetration. […] Women with secondary PVD have experienced pain-free sexual intercourse prior to the development of vulvar pain. […] For women with generalized vulvodynia (GV), pain occurs spontaneously and is relatively constant, but there can be some periods of symptom relief.

• #38 Persistent Vulvar Pain | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/09/persistent-vulvar-pain

  Persistent vulvar pain is a complex disorder that frequently is frustrating to the patient and the clinician. […] Vulvar pain can be caused by a specific disorder or it can be idiopathic. Idiopathic vulvar pain is classified as vulvodynia. […] The classification of vulvodynia is based on the site of the pain; whether it is generalized, localized, or mixed; whether it is provoked, spontaneous, or mixed; whether the onset is primary or secondary; and the temporal pattern (whether the pain is intermittent, persistent, constant, immediate, or delayed). […] A thorough history should identify the patients duration of pain, medical and surgical history, sexual history, allergies, and previous treatments. […] Cotton swab testing is used to identify the areas of pain (classifying each area of pain as mild, moderate, or severe) and to differentiate between generalized and localized pain.

• #39 Localised provoked vestibulodynia (vulvodynia): assessment and management

  https://www.racgp.org.au/afp/2015/july/localised-provoked-vestibulodynia-vulvodynia-asses

  Vulvodynia is a chronic vulvar pain condition. Localised provoked vestibulodynia (LPV) is the most common subset of vulvodynia, the hallmark symptom being pain on vaginal penetration. […] Diagnosis is based on history. Examination is used to support the diagnosis. […] There are no specific tests. Diagnosis is made on the basis of a typical history, supported by examination findings and exclusion of other painful vulvar conditions. […] Vulvodynia can co-exist with other vulvar conditions but become evident only when other conditions have been managed and pain persists. […] The location and nature of pain are the keys to diagnosis. […] Sensitively explore the effect of pain on sexual relationships and intimacy. […] The goal of treatment is to reduce pain and to improve quality of life and sexual function.

• #40 Generalised vulvodynia

  https://dermnetnz.org/topics/generalised-vulvodynia

  Generalised vulvodynia is one of the most common types of vulvodynia or vulval pain of unknown cause. […] Vulvodynia is defined by the International Society for the Study of Vulvovaginal Diseases (ISSVD) as vulvar pain of at least 3 months duration, without a clearly identifiable cause. […] Generalised vulvodynia describes widespread pain throughout the vulvar region where there is no physical explanation for it. […] Pain may be constant or unprovoked by touch or pressure to the vulva. […] Patients with generalised vulvodynia may describe intermittent or continuous symptoms, including widespread, generalised vulvar discomfort and pain, not altered by position or activity. […] By definition, the cause of generalised vulvodynia is unknown. […] Current theories consider generalised vulvodynia is a chronic pain syndrome related to hypersensitive nerves. […] Women who suffer from generalised vulvodynia require a range of treatments to help overcome their cycle of endless pain.

• #41 Persistent Vulvar Pain | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/09/persistent-vulvar-pain

  Persistent vulvar pain is a complex disorder that frequently is frustrating to the patient and the clinician. […] Vulvar pain can be caused by a specific disorder or it can be idiopathic. Idiopathic vulvar pain is classified as vulvodynia. […] The classification of vulvodynia is based on the site of the pain; whether it is generalized, localized, or mixed; whether it is provoked, spontaneous, or mixed; whether the onset is primary or secondary; and the temporal pattern (whether the pain is intermittent, persistent, constant, immediate, or delayed). […] A thorough history should identify the patients duration of pain, medical and surgical history, sexual history, allergies, and previous treatments. […] Cotton swab testing is used to identify the areas of pain (classifying each area of pain as mild, moderate, or severe) and to differentiate between generalized and localized pain.

• #42 What is Vulvodynia?

  https://www.nva.org/what-is-vulvodynia/

  Vulvodynia, simply put, is chronic vulvar pain without an identifiable cause. […] The majority of women with localized vulvodynia have Provoked Vestibulodynia (PVD), in which pain occurs during or after pressure is applied to the vestibule, e.g., with: sexual intercourse, tampon insertion, a gynecologic examination, prolonged sitting, and/or wearing fitted pants. […] PVD is further classified as primary or secondary. […] Women with primary PVD have experienced vestibular pain since the first attempt at vaginal penetration. […] Women with secondary PVD have experienced pain-free sexual intercourse prior to the development of vulvar pain. […] For women with generalized vulvodynia (GV), pain occurs spontaneously and is relatively constant, but there can be some periods of symptom relief.

• #43 What is Vulvodynia?

  https://www.nva.org/what-is-vulvodynia/

  Vulvodynia, simply put, is chronic vulvar pain without an identifiable cause. […] The majority of women with localized vulvodynia have Provoked Vestibulodynia (PVD), in which pain occurs during or after pressure is applied to the vestibule, e.g., with: sexual intercourse, tampon insertion, a gynecologic examination, prolonged sitting, and/or wearing fitted pants. […] PVD is further classified as primary or secondary. […] Women with primary PVD have experienced vestibular pain since the first attempt at vaginal penetration. […] Women with secondary PVD have experienced pain-free sexual intercourse prior to the development of vulvar pain. […] For women with generalized vulvodynia (GV), pain occurs spontaneously and is relatively constant, but there can be some periods of symptom relief.

• #44 Etiology, diagnosis, and clinical management of vulvodynia | IJWH

  https://www.dovepress.com/etiology-diagnosis-and-clinical-management-of-vulvodynia-peer-reviewed-fulltext-article-IJWH

  The characteristics of a woman’s pain may wax and wane over time. […] The bulk of the literature regarding vulvodynia focuses on PVD because this appears to be the most common clinical presentation. […] The gynecologist in general practice plays a pivotal role in helping women with vulvodynia. […] Successful treatment of a woman’s vulvodynia goes beyond identifying a single trigger for the pain, prescribing a single medical treatment, and/or following a generic vulvodynia algorithm. […] The diagnosis and treatment of women with vulvodynia involves recognition and assessment of all the factors influencing her experience of pain. […] The goals of the first clinical interview are: to gather relevant information about the patient’s pain and her medical and psychosexual history; validate that the patient’s pain is real; provide education and support; and provide recommendations regarding skin care and symptom management.

• #45 Vulvodynia Symptoms, Treatment, Causes & Surgery

  https://www.medicinenet.com/vaginal_pain_vulvodynia/article.htm

  Vulvodynia refers to pain in the area of the vulva and vaginal opening. Vulvodynia is considered pain for which there is no known cause. […] This article focuses on pain in the vulvar region and at the opening (introitus) of the vagina. […] Vaginal pain can be chronic and can last for years in some women. […] How is vaginal pain diagnosed? […] No specific tests confirm vulvodynia. Usually, vaginal pain and vulvodynia are diagnosed based on the characteristic symptoms of the condition. […] Vulvodynia is a chronic condition (it may last for months to years) in some women; in others, it may come and go. […] Vulvodynia and vaginal pain can be managed using medical treatments and self-care (home remedies). […] Not all treatments will be effective for every woman, and a woman may have to try different treatments to find the most effective option for her.

• #46 Persistent Vulvar Pain | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/09/persistent-vulvar-pain

  Persistent vulvar pain is a complex disorder that frequently is frustrating to the patient and the clinician. […] Vulvar pain can be caused by a specific disorder or it can be idiopathic. Idiopathic vulvar pain is classified as vulvodynia. […] The classification of vulvodynia is based on the site of the pain; whether it is generalized, localized, or mixed; whether it is provoked, spontaneous, or mixed; whether the onset is primary or secondary; and the temporal pattern (whether the pain is intermittent, persistent, constant, immediate, or delayed). […] A thorough history should identify the patients duration of pain, medical and surgical history, sexual history, allergies, and previous treatments. […] Cotton swab testing is used to identify the areas of pain (classifying each area of pain as mild, moderate, or severe) and to differentiate between generalized and localized pain.

• #47 Etiology, diagnosis, and clinical management of vulvodynia | IJWH

  https://www.dovepress.com/etiology-diagnosis-and-clinical-management-of-vulvodynia-peer-reviewed-fulltext-article-IJWH

  The characteristics of a woman’s pain may wax and wane over time. […] The bulk of the literature regarding vulvodynia focuses on PVD because this appears to be the most common clinical presentation. […] The gynecologist in general practice plays a pivotal role in helping women with vulvodynia. […] Successful treatment of a woman’s vulvodynia goes beyond identifying a single trigger for the pain, prescribing a single medical treatment, and/or following a generic vulvodynia algorithm. […] The diagnosis and treatment of women with vulvodynia involves recognition and assessment of all the factors influencing her experience of pain. […] The goals of the first clinical interview are: to gather relevant information about the patient’s pain and her medical and psychosexual history; validate that the patient’s pain is real; provide education and support; and provide recommendations regarding skin care and symptom management.

• #48 How do health care providers diagnose vulvodynia? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  http://www.nichd.nih.gov/health/topics/vulvodynia/conditioninfo/diagnosed

  Vulvodynia tends to be diagnosed only when other causes of vulvar pain, such as infection or skin diseases, have been ruled out. […] To diagnose vulvodynia, a health care provider will take a detailed medical history, including pain characteristics and any accompanying bowel, bladder, or sexual problems. […] The provider may also perform a cotton swab test, applying gentle pressure to various vulvar sites and asking the patient to rate the severity of the pain. […] Because vulvodynia is often a diagnosis of exclusion, it can be difficult and time-consuming to arrive at an actual diagnosis. […] The diagnostic process can be especially problematic for women who lack health insurance because they may not have the resources to continue seeking care to exclude the many possible causes of pain. […] Moreover, some women may be reluctant to discuss their pain or seek treatment.

• #49 Provoked vulvodynia: diagnosis of perplexing pain condition – Pelviperineology A Multidisciplinary Pelvic Floor Journal

  https://doi.org/10.34057/PPj.2020.39.04.003

  Women with vulvar pain usually go through years of endless visits to health care providers without achieving any significant improvement. […] Therefore, the approach should be very empathic. […] We suggest using a structured questionnaire to obtain the relevant history. […] The cotton-swab test, also known as the Q-tip test, is an easy-to-use test for diagnosing PV. […] At this time, a biopsy is not required to make a diagnosis of vulvodynia. […] The patient usually requests to get an opinion on the severity of her PV. […] However, the severity is determined by the subjective level of pain at vaginal intercourse by using the Marinoff’s criteria. […] The first part of the consensus terminology contains a list of recognized causes of vulvar pain, including Candida and bacteriologic vaginal infections, dermatoses, deformities, birth lacerations, and past trauma.

• #50 Vulvar pain syndromes: Making the correct diagnosis | MDedge

  https://mdedge.com/obgyn/article/64467/menopause/vulvar-pain-syndromes-making-correct-diagnosis

  Many cases of generalized vulvodynia and localized vulvodynia (vestibulodynia) are mistakenly attributed to yeast infection, pudendal neuralgia, and other entities. Avoid those pitfalls by using a reliable roadmap for evaluation, differentiation, and identification of the various forms of vulvar pain. […] The most common cause of chronic vulvar pain is vulvodynia, although lichen simplex chronicus, chronic yeast infections, and non-neoplastic epithelial disorders, such as lichen sclerosus and lichen planus, can also produce irritation and pain. […] The most common „diagnosis” for vulvar pain is vulvodynia. However, the definition of vulvodynia is pain—i.e., burning, rawness, irritation, soreness, aching, or stabbing or stinging sensations—in the absence of skin disease, infection, or specific neurologic disease. Therefore, even though the usual cause of vulvar pain is vulvodynia, it is a diagnosis of exclusion, and skin disease, infection, and neurologic disease must be ruled out.

• #51 Persistent Vulvar Pain | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/09/persistent-vulvar-pain

  The vulva and vagina should be examined, and infection ruled out when indicated using tests, including wet mount, vaginal pH, fungal culture, and Gram stain, or other available point-of-care testing or polymerase chain reaction testing. […] A musculoskeletal evaluation would help rule out musculoskeletal factors associated with vulvodynia, such as pelvic muscle overactivity and myofascial or other biomechanical disorders. […] Medications used to treat vulvar pain include topical, oral, and intralesional medicinal substances, as well as pudendal nerve blocks and botulinum toxin. Tricyclic antidepressants and anticonvulsants also can be used for vulvodynia pain control. […] Women with vulvodynia should be assessed for pelvic floor dysfunction. Biofeedback and physical therapy, including pelvic floor physical therapy, can be used to treat localized and generalized vulvar pain.

• #52 Vulvar pain syndromes: Making the correct diagnosis | MDedge

  https://mdedge.com/obgyn/article/64467/menopause/vulvar-pain-syndromes-making-correct-diagnosis

  Chronic pain is more likely to be caused by skin disease than by infection. Lichen simplex chronicus causes itching; any pain is due to erosions from scratching. […] Several other infectious conditions or their treatments can cause vulvar pain. For example, herpes (particularly primary herpes infection) is classically associated with vulvar pain. The pain is so great that, at times, the patient requires admission for pain control.

• #53 Vulvodynia and Vulvar Vestibulitis: Challenges in Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0315/p1547.html

  The evaluation of patients with vulvar vestibulitis or vulvodynia should include a thorough history, pelvic examination, fungal and bacterial cultures, and KOH microscopic examination. Biopsy of any suspicious areas should be performed using acetowhitening and/or colposcopy to rule out dermatoses or neoplastic lesions. […] Vulvodynia is a multifactorial problem with subsets that may overlap. Proper management is based on identification of the subsets of vulvodynia and identification of any concurrent infections that may be appropriately treated. Family physicians working together with gynecologists who are experienced in treating patients with vulvodynia can properly diagnose vulvodynia, identify subsets and institute the management plan that can best benefit the patient.

• #54 Vulvar pain syndromes: Making the correct diagnosis | MDedge

  https://mdedge.com/obgyn/article/64467/menopause/vulvar-pain-syndromes-making-correct-diagnosis

  Chronic pain is more likely to be caused by skin disease than by infection. Lichen simplex chronicus causes itching; any pain is due to erosions from scratching. […] Several other infectious conditions or their treatments can cause vulvar pain. For example, herpes (particularly primary herpes infection) is classically associated with vulvar pain. The pain is so great that, at times, the patient requires admission for pain control.

• #55 Etiology, diagnosis, and clinical management of vulvodynia | IJWH

  https://www.dovepress.com/etiology-diagnosis-and-clinical-management-of-vulvodynia-peer-reviewed-fulltext-article-IJWH

  The specific goals of the clinical examination for women with vulvodynia include exclusion of other diagnoses, patient education, and localization of her vulvar pain. […] The key criteria for diagnosing PVD are a history of severe pain during attempted vaginal entry and tenderness to pressure (palpation with a cotton swab) localized to the vestibule in the absence of other pathology. […] The first step in helping the woman and couple is to validate that the pain is real and that it has a name, ie, vulvodynia. […] The second step is to provide suggestions regarding skin care and symptom management. […] Recommending local estrogen replacement in perimenopausal and postmenopausal women with vulvodynia is the first step in addressing vulvar discomfort in this age group. […] A variety of medical therapies have been proposed by experts for the treatment of vulvodynia.

• #56 Diagnosis – The National Vulvodynia Association

  https://www.nva.org/learnpatient/diagnosis/

  Upon examination, the vulvar tissue may either appear red and swollen, or perfectly normal. By comparing the vestibular tissue, you can see that the vestibule on the top is very red. Even though the vestibule in the bottom photo shows very little redness, this woman had severe pain that made sexual intercourse and inserting a tampon impossible. Thus, the severity of a woman’s pain doesn’t necessarily correlate with the degree of visible redness. […] Prior to your appointment, you should consider downloading and completing the International Pelvic Pain Society’s thorough pelvic pain questionnaire. You can either fax the form to your provider prior to your appointment or bring it with you. In addition, you should bring your pain diary. […] Some women with vulvodynia also suffer from other disorders, such as interstitial cystitis (painful bladder syndrome), irritable bowel syndrome, fibromyalgia, temporomandibular joint and muscle disorders, endometriosis and/or chronic fatigue syndrome. When you are seeking care and treatment, it is important to discuss all of your symptoms/conditions with your health care provider, even if you don’t think they are related. […] The NVA and five other non-profit organizations formed the Chronic Pain Research Alliance to advocate for those who suffer from more than one of the above disorders. Additional information on these conditions can be viewed at http://www.chronicpainresearch.org.

• #57 Diagnosis – The National Vulvodynia Association

  https://www.nva.org/learnpatient/diagnosis/

  Upon examination, the vulvar tissue may either appear red and swollen, or perfectly normal. By comparing the vestibular tissue, you can see that the vestibule on the top is very red. Even though the vestibule in the bottom photo shows very little redness, this woman had severe pain that made sexual intercourse and inserting a tampon impossible. Thus, the severity of a woman’s pain doesn’t necessarily correlate with the degree of visible redness. […] Prior to your appointment, you should consider downloading and completing the International Pelvic Pain Society’s thorough pelvic pain questionnaire. You can either fax the form to your provider prior to your appointment or bring it with you. In addition, you should bring your pain diary. […] Some women with vulvodynia also suffer from other disorders, such as interstitial cystitis (painful bladder syndrome), irritable bowel syndrome, fibromyalgia, temporomandibular joint and muscle disorders, endometriosis and/or chronic fatigue syndrome. When you are seeking care and treatment, it is important to discuss all of your symptoms/conditions with your health care provider, even if you don’t think they are related. […] The NVA and five other non-profit organizations formed the Chronic Pain Research Alliance to advocate for those who suffer from more than one of the above disorders. Additional information on these conditions can be viewed at http://www.chronicpainresearch.org.

• #58 Provoked vulvodynia: diagnosis of perplexing pain condition – Pelviperineology A Multidisciplinary Pelvic Floor Journal

  https://doi.org/10.34057/PPj.2020.39.04.003

  Provoked vulvodynia typically presents with pain during intercourse. The etiology of this condition has not been elucidated, and the diagnostic procedures are unfamiliar to many health care providers. […] The present paper is the first to present a contemporary approach to the diagnosis of vulvodynia based on medical history, physical examination, and the use of specific instruments and tests, based on a recent consensus terminology of vulvodynia. […] Vulvodynia is currently defined as a vulvar pain of at least three months, without a clear identifiable cause, which may have potential associated factors. […] The most common presentation of vulvodynia is PV, with severe entry dyspareunia, sometimes preventing the possibility to have intercourse. […] The approach to diagnosis has also been amended by the introduction of the consensus terminology.

• #59 Vulvodynia Symptoms, Treatment, Causes & Surgery

  https://www.medicinenet.com/vaginal_pain_vulvodynia/article.htm

  Vulvodynia refers to pain in the area of the vulva and vaginal opening. Vulvodynia is considered pain for which there is no known cause. […] This article focuses on pain in the vulvar region and at the opening (introitus) of the vagina. […] Vaginal pain can be chronic and can last for years in some women. […] How is vaginal pain diagnosed? […] No specific tests confirm vulvodynia. Usually, vaginal pain and vulvodynia are diagnosed based on the characteristic symptoms of the condition. […] Vulvodynia is a chronic condition (it may last for months to years) in some women; in others, it may come and go. […] Vulvodynia and vaginal pain can be managed using medical treatments and self-care (home remedies). […] Not all treatments will be effective for every woman, and a woman may have to try different treatments to find the most effective option for her.

• #60 All about vulvodynia | Top Doctors

  https://www.topdoctors.co.uk/medical-articles/navigating-vulvodynia

  Vulvodynia, which is a type of vulval pain syndrome, involves chronic exterior vaginal or vulvar pain for over three months. […] Unlike vaginismus, vulvodynia involves pain primarily on the exterior of the vagina or vulva, persisting for over three months without any identified alternative causes. It is essentially a diagnosis of exclusion, often complicating clinical assessments. […] The process involves dedicating time to sit down with the woman, understanding when her symptoms began, exploring the information she has received, her attempted remedies, what alleviates or exacerbates her condition, and identifying her preferences and limitations in terms of comfort. […] However, given that it’s a diagnosis of exclusion, it’s imperative to rule out other potential causes. A thorough examination by a seasoned professional is essential, focusing on the vulva itself to check for dermatological conditions and excluding infections such as thrush, STIs, and bacterial vaginosis.

• #61 Vulvodynia (vulval pain)

  https://www.nhs.uk/conditions/vulvodynia/

  Vulvodynia is pain in the vulva (area around the outside of the vagina) that lasts at least 3 months and does not have a specific cause. It can have a big effect on your life, but there are treatments that can help. […] Vulvodynia can affect women of all ages. Anyone with a vulva can have vulval pain. […] There’s usually no change to the way your vulva looks, but it may feel uncomfortable or painful. […] If you see a GP about vulval pain, they’ll ask about your symptoms. They may also ask if you’ve had any skin conditions or infections in your vagina, or if having sex is painful. […] A swab may be taken to help rule out other conditions that can cause vaginal soreness, such as an infection. […] If the cause of your vulval pain cannot be found, you may be referred to a specialist for help managing the pain. […] The main aim of treatment for vulvodynia is to help manage the pain. […] No single treatment works for everyone, and you may need to try several treatments to find out what works best for you.

• #62 Diagnosis – The National Vulvodynia Association

  https://www.nva.org/learnpatient/diagnosis/

  Upon examination, the vulvar tissue may either appear red and swollen, or perfectly normal. By comparing the vestibular tissue, you can see that the vestibule on the top is very red. Even though the vestibule in the bottom photo shows very little redness, this woman had severe pain that made sexual intercourse and inserting a tampon impossible. Thus, the severity of a woman’s pain doesn’t necessarily correlate with the degree of visible redness. […] Prior to your appointment, you should consider downloading and completing the International Pelvic Pain Society’s thorough pelvic pain questionnaire. You can either fax the form to your provider prior to your appointment or bring it with you. In addition, you should bring your pain diary. […] Some women with vulvodynia also suffer from other disorders, such as interstitial cystitis (painful bladder syndrome), irritable bowel syndrome, fibromyalgia, temporomandibular joint and muscle disorders, endometriosis and/or chronic fatigue syndrome. When you are seeking care and treatment, it is important to discuss all of your symptoms/conditions with your health care provider, even if you don’t think they are related. […] The NVA and five other non-profit organizations formed the Chronic Pain Research Alliance to advocate for those who suffer from more than one of the above disorders. Additional information on these conditions can be viewed at http://www.chronicpainresearch.org.

• #63 How do health care providers diagnose vulvodynia? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  http://www.nichd.nih.gov/health/topics/vulvodynia/conditioninfo/diagnosed

  Vulvodynia tends to be diagnosed only when other causes of vulvar pain, such as infection or skin diseases, have been ruled out. […] To diagnose vulvodynia, a health care provider will take a detailed medical history, including pain characteristics and any accompanying bowel, bladder, or sexual problems. […] The provider may also perform a cotton swab test, applying gentle pressure to various vulvar sites and asking the patient to rate the severity of the pain. […] Because vulvodynia is often a diagnosis of exclusion, it can be difficult and time-consuming to arrive at an actual diagnosis. […] The diagnostic process can be especially problematic for women who lack health insurance because they may not have the resources to continue seeking care to exclude the many possible causes of pain. […] Moreover, some women may be reluctant to discuss their pain or seek treatment.

• #64 Aetiology, diagnosis, and clinical management of vulvodynia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7258372/

  The role of biopsy in making the diagnosis remains uncertain. […] The vulvar pain may also be reflected pain from other parts of the body, such as the back or flanks, so musculoskeletal evaluation should be considered. […] Vulvodynia is a complex disorder that can be difficult to treat. […] The lack of data about the effectiveness of various treatment options for vulvodynia, and many of the commonly recommended treatments have not been systematically studied in randomised, controlled trials. […] The overall success of self-diagnosis and treatment remains unclear. […] Vulvodynia is a disease that is not well known in the circles of health care providers. The lack of clarity in its aetiology results in the presence of multiple methods for treatment, with various durations and levels of success. None of them can be effective in all cases. This requires use of a strictly individual approach to every single patient.

• #65 Vulvodynia Demystified: Vulvar Pain Causes and Treatments – ETCOA

  https://www.centerofendometriosis.com/blog/vulvodynia-101-metro-detroit-etcoa/

  Vulvodynia is chronic pain or discomfort that occurs around the opening of your vagina (vulva). Women often describe the pain as burning, stabbing, or throbbing. It can last for months or years, be intermittent or constant, and occur in only one area of the vulva or multiple areas. […] Getting a diagnosis for vulvodynia means finding a compassionate womens health specialist who will perform a comprehensive evaluation. In a 2003 study, 60% of women who sought treatment for this condition visited 3 or more doctors for their symptoms, and many could not get a diagnosis. At Endometriosis Treatment Center of America, we can provide effective, multi-modal treatment for vulvodynia. […] The main symptom of vulvodynia is chronic vulvar painpain that lasts for 3 months or more. This pain can be debilitating and interfere with your day-to-day life. Other symptoms include: Vaginal burning, Pain with intercourse, Vaginal throbbing, Vaginal itching and irritation, A feeling of rawness around the vagina.

• #66 Are You Dealing With Vulvodynia? Symptoms & Treatments | PrimeHealth DenverScroll to topScroll to top

  https://primehealthdenver.com/vulvodynia/

  Vulvodynia is pain around the opening of your vagina that lasts at least 3 months. There is no clear cause for this pain. There may be some swelling, but many people with it have a normal-looking vulva. […] If you are experiencing pelvic pain, ask your doctor or your OB-GYN about diagnosing the underlying cause so that you can talk about a treatment plan. […] Vulvodynia is a chronic pain condition of the vulva (around the opening of your vagina) characterized by pain or discomfort that lasts 3 months or longer. […] The American College of Obstetricians and Gynecologists specifies that primary vulvodynia is not caused by skin disorders, infections, or other medical conditions. […] It occurs in at least 3%-7% of women. According to a 2012 study, only about 1% of women with vulvodynia have been diagnosed — somewhat due to women not seeking help, somewhat due to doctors incorrectly diagnosing.

• #67 Vulvodynia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vulvodynia/diagnosis-treatment/drc-20353427

  During a pelvic exam, a doctor inserts one or two gloved fingers inside the vagina. Pressing down on the abdomen at the same time, the doctor can check the uterus, ovaries and other organs. […] With vulvodynia, your gynecologist or another member of your care team likely will ask you questions about your medical and sexual history. You’ll also be asked if you’ve had any surgeries. […] Your outer genitals and vagina are checked for signs of an infection or other causes of your symptoms. A sample of cells from your vagina might be taken to test for an infection caused by yeast or bacteria. Your health care professional also might insert a gloved finger into your vagina to check the pelvic floor muscles for tenderness. […] A moistened cotton swab is used to gently check for specific areas of pain in your vulva. If a painful area is found, you’ll likely be asked what it feels like and how much it hurts.

• #68 The Physical Exam

  https://www.vulvodyniatoolkit.com/visits/the-physical-exam

  When vulvodynia is suspected, it is important to rule out other potential causes of vulvar pain. […] The purpose of the physical exam is to rule out other conditions, pain mapping, and assess the contribution of elevated pelvic floor tone and the steps of the physical exam. […] Diagnosing vulvodynia is challenging. How do you know your patient has vulvodynia? The patients report of pain is a reliable diagnostic indicator. […] The pain may be present all the time (spontaneous) or only with touch (provoked). Many words can be used to describe the vulvar pain from pressure to burning. […] Q-Tip Test result is greater than 3/10. This is considered a positive Q-Tip Test and is consistent with provoked vestibulodynia. […] Once the diagnosis has been confirmed, the physical exam findings should be reviewed with the patient and an overview of vulvodynia provided using the following checklist.

• #69 Diagnosis – The National Vulvodynia Association

  https://www.nva.org/learnpatient/diagnosis/

  Upon examination, the vulvar tissue may either appear red and swollen, or perfectly normal. By comparing the vestibular tissue, you can see that the vestibule on the top is very red. Even though the vestibule in the bottom photo shows very little redness, this woman had severe pain that made sexual intercourse and inserting a tampon impossible. Thus, the severity of a woman’s pain doesn’t necessarily correlate with the degree of visible redness. […] Prior to your appointment, you should consider downloading and completing the International Pelvic Pain Society’s thorough pelvic pain questionnaire. You can either fax the form to your provider prior to your appointment or bring it with you. In addition, you should bring your pain diary. […] Some women with vulvodynia also suffer from other disorders, such as interstitial cystitis (painful bladder syndrome), irritable bowel syndrome, fibromyalgia, temporomandibular joint and muscle disorders, endometriosis and/or chronic fatigue syndrome. When you are seeking care and treatment, it is important to discuss all of your symptoms/conditions with your health care provider, even if you don’t think they are related. […] The NVA and five other non-profit organizations formed the Chronic Pain Research Alliance to advocate for those who suffer from more than one of the above disorders. Additional information on these conditions can be viewed at http://www.chronicpainresearch.org.

• #70 Diagnosis – The National Vulvodynia Association

  https://www.nva.org/learnpatient/diagnosis/

  Upon examination, the vulvar tissue may either appear red and swollen, or perfectly normal. By comparing the vestibular tissue, you can see that the vestibule on the top is very red. Even though the vestibule in the bottom photo shows very little redness, this woman had severe pain that made sexual intercourse and inserting a tampon impossible. Thus, the severity of a woman’s pain doesn’t necessarily correlate with the degree of visible redness. […] Prior to your appointment, you should consider downloading and completing the International Pelvic Pain Society’s thorough pelvic pain questionnaire. You can either fax the form to your provider prior to your appointment or bring it with you. In addition, you should bring your pain diary. […] Some women with vulvodynia also suffer from other disorders, such as interstitial cystitis (painful bladder syndrome), irritable bowel syndrome, fibromyalgia, temporomandibular joint and muscle disorders, endometriosis and/or chronic fatigue syndrome. When you are seeking care and treatment, it is important to discuss all of your symptoms/conditions with your health care provider, even if you don’t think they are related. […] The NVA and five other non-profit organizations formed the Chronic Pain Research Alliance to advocate for those who suffer from more than one of the above disorders. Additional information on these conditions can be viewed at http://www.chronicpainresearch.org.

• #71 Provoked vulvodynia: diagnosis of perplexing pain condition – Pelviperineology A Multidisciplinary Pelvic Floor Journal

  https://pelviperineology.org/articles/provoked-vulvodynia-diagnosis-of-perplexing-pain-condition/doi/PPj.2020.39.04.003

  The cotton-swab test, also known as the Q-tip test, is an easy-to-use test for diagnosing PV. At this time, a biopsy is not required to make a diagnosis of vulvodynia. […] The patient usually requests to get an opinion on the severity of her PV. However, the severity is determined by the subjective level of pain at vaginal intercourse by using the Marinoff’s criteria. […] The first part of the consensus terminology contains a list of recognized causes of vulvar pain, including Candida and bacteriologic vaginal infections, dermatoses, deformities, birth lacerations, and past trauma. These should be excluded before a diagnosis of vulvodynia can be made. […] In most cases, vestibular examination is sufficient, and no other test is required to diagnose PV. However, additional testing may be necessary in the following women: In women with associated deep dyspareunia or deep pelvic pain, vaginal ultrasound examination and possibly magnetic resonance imaging studies should be carried out to diagnose endometriosis. […] Diagnosing PV should be conducted according to a structured plan. Diagnosis is based on the understanding of the associated factors of PV as described in the consensus terminology.

• #72 Etiology, diagnosis, and clinical management of vulvodynia | IJWH

  https://www.dovepress.com/etiology-diagnosis-and-clinical-management-of-vulvodynia-peer-reviewed-fulltext-article-IJWH

  The studies reviewed regarding the use of anticonvulsants, eg, gabapentin, pregabalin, or lamotrigine, to treat vulvodynia have reported success rates in the range of 50%82%. […] In regards to the surgical treatment of sexual pain secondary to provoked vestibulodynia, the literature would suggest that surgery is an effective intervention. […] A comprehensive analysis of the research regarding medical and surgical treatments for vulvodynia is beyond the scope of this paper. […] Vulvodynia is a chronic pain condition that is best understood in terms of a combination of biological, psychological, and social factors affecting a woman’s health, ie, the biopsychosocial model of illness.

• #73 Persistent Vulvar Pain? Learn About Vulvodynia Symptoms, Causes, and Treatments

  https://www.chicagopelvic.com/blog/persistent-vulvar-pain-vulvodynia-explained

  Persistent vulvar pain can be distressing and confusing, especially when the cause is unclear. If you experience pain in the vulva that lasts for three months or more, you might have a condition called vulvodynia. […] Vulvodynia is a chronic pain condition characterized by pain in the vulva area, which is the external part of the female genitalia. For pain to be considered vulvodynia, it must persist for at least three months without other known identifiable cause. […] Diagnosing vulvodynia requires a comprehensive approach, including a detailed medical history, symptom assessment, and physical examination. The journey to diagnosing vulvodynia can be difficult for both patients and healthcare providers because it is a diagnosis of exclusion without known specific cause. […] Heres what you can expect for vulvodynia diagnosis from a pelvic floor PT evaluation at Chicago Pelvic Health and Wellness: Medical History and Symptom Discussion: Your provider will ask about your symptoms, medical history, and lifestyle to understand better what might be causing your pain.

• #74 Persistent Vulvar Pain | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/09/persistent-vulvar-pain

  An emerging treatment for vulvodynia is transcutaneous electrical nerve stimulation. […] When other nonsurgical management options have been tried and failed, and the pain is localized to the vestibule, vestibulectomy may be an effective treatment. […] Although optimal treatment remains unclear, consider an individualized, multidisciplinary approach to address all physical and emotional aspects possibly attributable to vulvodynia. […] It is important to begin any treatment approach with a detailed discussion, including an explanation of the diagnosis and determination of realistic treatment goals.

• #75 Vulvodynia – Wikipedia

  https://en.wikipedia.org/wiki/Vulvodynia

  Vulvodynia is a chronic pain condition that affects the vulvar area and occurs without an identifiable cause. Symptoms typically include a feeling of burning or irritation. It has been established by the ISSVD that for the diagnosis to be made symptoms must last at least three months. […] Diagnosis is by ruling out other possible causes. This may or may not include a biopsy of the area. […] The condition is one of exclusion and other vulvovaginal problems should be ruled out. The diagnosis is based on the typical complaints of the patient, essentially normal physical findings, and the absence of identifiable causes per the differential diagnosis. Cotton swab testing is used to differentiate between generalized and localized pain and delineate the areas of pain and categorize their severity. […] In recent years, diagnostic algorithms for the diagnosis of the various sub-types of and causes of vulvar pain have been developed and refined. The International Society for the Study of Women’s Sexual Health (ISSWSH) supports this diagnostic algorithm.

• #76 Treatment of Vulvar Pain: A Worthwhile Clinical Challenge

  https://info.primarycare.hms.harvard.edu/perspectives/articles/treatment-vulvar-pain

  Many people experience sexual pain or dysfunction at various points throughout their lifetime, and womens sexual pain conditions are often mis- or undiagnosed. A common pain disorder in women is vulvar pain, commonly referred to as vulvodynia or vestibulodynia, and it can have debilitating consequences for ones sexual health and quality of life. […] Vulvodynia (or vestibulodynia) is defined as vulvar pain lasting at least three months and without a clear identifiable cause. This condition affects up to 16% of women worldwide, translating into thousands of women searching for effective treatments, yet only 50% ever receive an accurate diagnosis. […] Because multiple factors are often associated with the development and maintenance of vulvodynia, identification of the relevant factors in each individual has important treatment implications.

• #77 Persistent Vulvar Pain | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/09/persistent-vulvar-pain

  The vulva and vagina should be examined, and infection ruled out when indicated using tests, including wet mount, vaginal pH, fungal culture, and Gram stain, or other available point-of-care testing or polymerase chain reaction testing. […] A musculoskeletal evaluation would help rule out musculoskeletal factors associated with vulvodynia, such as pelvic muscle overactivity and myofascial or other biomechanical disorders. […] Medications used to treat vulvar pain include topical, oral, and intralesional medicinal substances, as well as pudendal nerve blocks and botulinum toxin. Tricyclic antidepressants and anticonvulsants also can be used for vulvodynia pain control. […] Women with vulvodynia should be assessed for pelvic floor dysfunction. Biofeedback and physical therapy, including pelvic floor physical therapy, can be used to treat localized and generalized vulvar pain.

• #78 What is vulvodynia?

  https://www.bbc.com/future/article/20180725-the-health-condition-vulvodynia-is-painful-and-misunderstood

  One recent theory has been that vulvodynia’s symptoms may stem not from the affected part of the body, but in the brain as is the case with other chronic pain disorders. […] There are ways to cope with the pain and treat symptoms of the condition, says Stoehr. But it may take time to find the proper therapy for each individual. […] It’s so important for women to be their own advocates, especially for chronic conditions that don’t have a lot of research, said Stoehr.

• #79 Etiology, diagnosis, and clinical management of vulvodynia | IJWH

  https://www.dovepress.com/etiology-diagnosis-and-clinical-management-of-vulvodynia-peer-reviewed-fulltext-article-IJWH

  The characteristics of a woman’s pain may wax and wane over time. […] The bulk of the literature regarding vulvodynia focuses on PVD because this appears to be the most common clinical presentation. […] The gynecologist in general practice plays a pivotal role in helping women with vulvodynia. […] Successful treatment of a woman’s vulvodynia goes beyond identifying a single trigger for the pain, prescribing a single medical treatment, and/or following a generic vulvodynia algorithm. […] The diagnosis and treatment of women with vulvodynia involves recognition and assessment of all the factors influencing her experience of pain. […] The goals of the first clinical interview are: to gather relevant information about the patient’s pain and her medical and psychosexual history; validate that the patient’s pain is real; provide education and support; and provide recommendations regarding skin care and symptom management.

• #80 Persistent Vulvar Pain | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/09/persistent-vulvar-pain

  An emerging treatment for vulvodynia is transcutaneous electrical nerve stimulation. […] When other nonsurgical management options have been tried and failed, and the pain is localized to the vestibule, vestibulectomy may be an effective treatment. […] Although optimal treatment remains unclear, consider an individualized, multidisciplinary approach to address all physical and emotional aspects possibly attributable to vulvodynia. […] It is important to begin any treatment approach with a detailed discussion, including an explanation of the diagnosis and determination of realistic treatment goals.

• #81 Vulvodynia: Causes, Symptoms, and Treatments

  https://www.webmd.com/women/vulvodynia

  Vulvodynia Diagnosis […] To diagnose vulvodynia, your doctor may: […] Ask about your medical, sexual, and surgical history. This helps them understand exactly where and how much pain (and other symptoms) you’re having. […] Give you a pelvic exam. They’ll check your external genitals and vagina for things that might be causing your symptoms. They might take a sample of cells from your vagina to test for an infection. […] Do a cotton swab test. For this test, the doctor uses a cotton swab to check for exact areas of pain in your vulvar region. […] Do a biopsy. The doctor will take a small piece of tissue from a particular area to examine it further. They’ll only do this if they find a sore or something unusual. […] […] […] There’s no one treatment for vulvodynia that works for all women. You may need to try a mix of things for the best results. Your doctor may suggest:

• #82 Vulvodynia: Causes, Symptoms, Management & Treatment

  https://my.clevelandclinic.org/health/diseases/17878-vulvodynia

  Cotton swab test (point-pressure testing). Your provider will brush a cotton swab gently over parts of your vulva and ask when (and where) the contact feels painful. […] In rare instances, your provider may order a colposcopy or a biopsy of your vulva to rule out conditions unrelated to vulvodynia that may be causing your pain. […] Vulvodynia treatment takes time. Finding the treatment or combination of treatments that bring you pain relief involves trial and error. […] Treatments may include: Topical medications: You can apply creams and ointments that numb your vulva (anesthetics) or stabilize your nerves. […] Oral medication: Antidepressants and anticonvulsants that you can take by mouth can reduce nerve pain. […] A nerve block: Your provider may recommend an injection that prevents pain signals from traveling from your nerves to your brain.

• #83 Vulvodynia: Causes, Symptoms, and Treatments

  https://www.webmd.com/women/vulvodynia

  Medications […] You might get a pill, a cream, or an ointment you rub onto the skin, or a shot. These could include: […] Local anesthetics, such as lidocaine […] Topical estrogen creams […] Tricyclic antidepressants […] Anticonvulsants […] Nerve blocks […] Serotonin-norepinephrine reuptake inhibitors […] Neurostimulation and spinal infusion pump […] Medications with anti-inflammatory effects, such as steroids or mast cell inhibitors […] Botox […] […] […] If you have a type of localized vulvodynia called provoked vestibulodynia, your doctor may suggest surgery to remove painful tissue, especially if other options haven’t helped.

• #84 Vulvodynia Specialist in Melbourne | Dr. Len Kliman

  https://drlenkliman.com.au/services/vulval-and-vaginal-skin-disorders/generalised-unprovoked-vulvodynia/

  Some success in treating generalised provoked vulvodynia comes from a group of medications that work on these nerves to influence their messages. […] A wide variety of antidepressants, anticonvulsants and muscle relaxants can help. […] These medications are called neuromodulators, or chronic pain medicines. […] Examples of these include the oral tricyclic medications such as Amitriptyline. […] This medication is used to reduce the hypersensitivity of the nerve endings. […] Other medications used for this condition include Gabapentin and similar drugs. […] These medications can be made into creams by compounding pharmacies. […] There is also evidence that women with vulval pain often suffer from sexual problems. […] Engaging in sexual counselling has been shown to not only help couples with intimacy but often reduces pain. […] Finding ways to have sexual activity with the least amount of pain is vital.

• #85 Vulvodynia Symptoms, Treatment, Causes & Surgery

  https://www.medicinenet.com/vaginal_pain_vulvodynia/article.htm

  Vulvodynia is not associated with cancer or with any serious medical diseases, but it may be a source of chronic pain and emotional discomfort for some women. […] How is vaginal pain diagnosed? […] Some of the medications that have been useful include: Topical estrogen creams, Topical or local anesthetics, Tricyclic antidepressants, Anticonvulsants (anti-seizure medications are sometimes useful in managing chronic pain). […] Other medical therapies for women with severe vulvodynia include: Injections of interferon or nerve blocks, in which medications are injected to reduce signals from nerves in the affected areas.

• #86 Persistent Vulvar Pain | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/09/persistent-vulvar-pain

  The vulva and vagina should be examined, and infection ruled out when indicated using tests, including wet mount, vaginal pH, fungal culture, and Gram stain, or other available point-of-care testing or polymerase chain reaction testing. […] A musculoskeletal evaluation would help rule out musculoskeletal factors associated with vulvodynia, such as pelvic muscle overactivity and myofascial or other biomechanical disorders. […] Medications used to treat vulvar pain include topical, oral, and intralesional medicinal substances, as well as pudendal nerve blocks and botulinum toxin. Tricyclic antidepressants and anticonvulsants also can be used for vulvodynia pain control. […] Women with vulvodynia should be assessed for pelvic floor dysfunction. Biofeedback and physical therapy, including pelvic floor physical therapy, can be used to treat localized and generalized vulvar pain.

• #87 Vulvodynia: Causes, Symptoms, Management & Treatment

  https://my.clevelandclinic.org/health/diseases/17878-vulvodynia

  Physical therapy: Physical therapy can loosen muscle tension in your pelvic floor. […] Counseling: Individual counseling, couples counseling or sex therapy may help you improve those areas of your life negatively impacted by vulvodynia, like sexual relationships. […] If you have persistent pain in your vulva, schedule an appointment with your primary care provider or gynecologist.

• #88 Vulvodynia | ACOG

  https://www.acog.org/womens-health/faqs/vulvodynia

  Vulvodynia is pain that lasts for 3 months or longer and is not caused by an infection, skin disorder, or other medical condition. […] If you have vulvar pain, your gynecologist or other health care professional will try to rule out the most common causes of vulvar pain first. […] Your gynecologist also will examine the vulva and vagina carefully. A sample of discharge from the vagina may be taken. […] You also may have a biopsy of the vulvar skin. […] Several medications can be used to treat vulvodynia. Medications can be taken in pill form (oral), injected into the affected area, or applied to the skin (topical). […] A nerve block is a type of anesthesia in which an anesthetic drug is injected into the nerves that carry pain signals from the vulva to the spinal cord. […] A vestibulectomy is the removal of the painful tissue from the part of the vulva called the vestibule. It can be used for women who have vulvodynia specific to this area and for whom other treatments have not worked.

• #89 Vulvodynia (vulval pain)

  https://www.nhs.uk/conditions/vulvodynia/

  Vulvodynia is pain in the vulva (area around the outside of the vagina) that lasts at least 3 months and does not have a specific cause. It can have a big effect on your life, but there are treatments that can help. […] Vulvodynia can affect women of all ages. Anyone with a vulva can have vulval pain. […] There’s usually no change to the way your vulva looks, but it may feel uncomfortable or painful. […] If you see a GP about vulval pain, they’ll ask about your symptoms. They may also ask if you’ve had any skin conditions or infections in your vagina, or if having sex is painful. […] A swab may be taken to help rule out other conditions that can cause vaginal soreness, such as an infection. […] If the cause of your vulval pain cannot be found, you may be referred to a specialist for help managing the pain. […] The main aim of treatment for vulvodynia is to help manage the pain. […] No single treatment works for everyone, and you may need to try several treatments to find out what works best for you.

• #90 Vulvodynia – HealthyWomen

  https://www.healthywomen.org/condition/vulvodynia

  Most women see multiple health care providers before a correct diagnosis is made. […] Diagnosis includes a cotton swab test in which the doctor places pressure on different parts of the vulva area to locate the pain and its relative intensity. […] Vulvodynia can be difficult to diagnose. It’s not uncommon for women to see multiple doctors before getting an accurate diagnosis. […] There is no known cause of vulvodynia. However, we do know it is not caused by an active infection, including sexually transmitted diseases; skin disorders; cancer; or generalized neurologic or psychological disorders. […] There is no cure for vulvodynia, but there are a variety of medications and nondrug therapies. […] Other options include pelvic floor physical therapy, biofeedback, dietary changes, counseling and, in select cases, surgery. […] No single approach works for all women. It often takes time to find a treatment or combination of therapies that will adequately alleviate the pain.

• #91 Vulvodynia: burning and stinging pain in vagina | Advanced OBGYN Care

  https://www.draliabadi.com/womens-health-blog/vulvodynia-acute-chronic-mysterious-vaginal-pain/

  Vulvodynia is a real, debilitating condition that seems to appear from nowhere and demonstrates no observable symptoms. […] Even as recently as ten years ago, vulvodynia was relatively unheard of. Patients often visited many doctors before getting an accurate diagnosis. […] Although the pain can begin misleadingly, by exhibiting some of the symptoms of a urinary tract infection or a yeast infection, the usual treatments for those conditions, are, of course, completely ineffective against vulvodynia. Indeed, they often make the pain worse. […] Treatment for vulvodynia includes both medicinal and physical therapy. In about 70% of patients, application of a compound cream containing gabapentin, amitriptyline, and baclofen results in significant improvement within six months. […] Many of Dr. Aliabadi’s patients have achieved very successful results with the MonaLisa Touch.

• #92 Vulvodynia | Doctor

  https://patient.info/doctor/vulvodynia-pro

  The diagnosis of vulvodynia requires a careful history and confirmatory physical examination. Failure to achieve a satisfactory diagnosis can result in increasing frustration and worsening psychological problems along with phobia about sexually transmitted infections and cancer. […] A thorough history should be taken to include: Duration of pain. Location of pain and radiation. Severity of pain. Type of pain, relieving factors. Whether pain is provoked and, if so, what by (touch, tampons, sexual intercourse, clothes, sitting, etc). […] The purpose of examination is to localise the pain and to exclude other diagnoses. […] A vaginal swab may be useful to rule out infection. […] A biopsy may be required if there are abnormalities on inspection, in which case vulvodynia has already been excluded as a diagnosis.

• #93 Vulvodynia Treatment & Diagnosis at London Pain Clinic

  https://www.londonpainclinic.com/our-services/nerve-pain/gynaecological-pain/vulvodynia/

  Vulvodynia is one of the most severe forms of nerve or neuropathic pain. If you are experiencing soreness, itching, burning, stinging or are suffering from pain following intercourse, you may have vulvodynia. Rapid, accurate identification of vulvodynia is invaluable. Please be aware that if you are coming to see our Consultants regarding vulvodynia or similar conditions, our Consultants will not be undertaking an intimate, internal examination as they are able to diagnose this condition on the basis of self verbal report only. The right treatment starts with the right diagnosis. […] Different underlying causes of vulvodynia require different treatments. This is why it is important to seek an expert diagnosis as quickly as possible.

• #94 Vulvodynia and Vulvar Vestibulitis: Challenges in Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0315/p1547.html

  Vulvodynia is a problem most family physicians can expect to encounter. It is a syndrome of unexplained vulvar pain, frequently accompanied by physical disabilities, limitation of daily activities, sexual dysfunction and psychologic distress. […] Evaluation should include a thorough history and physical examination as well as cultures for bacteria and fungus, KOH microscopic examination and biopsy of any suspicious areas. Proper treatment mandates that the correct type of vulvodynia be identified. […] Vulvodynia is frequently misdiagnosed. In a general gynecologic practice population, the prevalence of this condition may be as high as 15 percent. […] Most patients consult several physicians before being diagnosed. Many are treated with multiple topical or systemic medications, with minimal relief.

• #95 Etiology, diagnosis, and clinical management of vulvodynia | IJWH

  https://www.dovepress.com/etiology-diagnosis-and-clinical-management-of-vulvodynia-peer-reviewed-fulltext-article-IJWH

  The specific goals of the clinical examination for women with vulvodynia include exclusion of other diagnoses, patient education, and localization of her vulvar pain. […] The key criteria for diagnosing PVD are a history of severe pain during attempted vaginal entry and tenderness to pressure (palpation with a cotton swab) localized to the vestibule in the absence of other pathology. […] The first step in helping the woman and couple is to validate that the pain is real and that it has a name, ie, vulvodynia. […] The second step is to provide suggestions regarding skin care and symptom management. […] Recommending local estrogen replacement in perimenopausal and postmenopausal women with vulvodynia is the first step in addressing vulvar discomfort in this age group. […] A variety of medical therapies have been proposed by experts for the treatment of vulvodynia.

• #96 Treatment of Vulvar Pain: A Worthwhile Clinical Challenge

  https://info.primarycare.hms.harvard.edu/perspectives/articles/treatment-vulvar-pain

  Current evidence and international consensus guidelines support psychological intervention and pelvic floor physical therapy as first-line treatments for the management of most chronic vulvar pain. […] Though womens sexual pain conditions are disproportionately mis- or undiagnosed, it doesnt have to be that way. Vulvodynia affects thousands of women worldwide, and healthcare providers have numerous tools to address this common sexual pain disorder. A multidisciplinary model of care is optimal, which typically combines psychotherapy, physical therapy, and medical management. High-quality, biopsychosocial care improves patients sexual health and quality of life, and these benefits may also be experienced by their intimate partners.

• #97 What is vulvodynia?

  https://www.bbc.com/future/article/20180725-the-health-condition-vulvodynia-is-painful-and-misunderstood

  One recent theory has been that vulvodynia’s symptoms may stem not from the affected part of the body, but in the brain as is the case with other chronic pain disorders. […] There are ways to cope with the pain and treat symptoms of the condition, says Stoehr. But it may take time to find the proper therapy for each individual. […] It’s so important for women to be their own advocates, especially for chronic conditions that don’t have a lot of research, said Stoehr.

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