Vulvodynia

Vulvodynia ​is defined as chronic pain of the vulva of at least three months duration, without an obviously identifiable cause and it is a diagnosis of exclusion and a form of idiopathic pain disorder ^1,2.

Epidemiology

The incidence of vulvodynia was reported to be ~5% (range 4-8%) in reproductive-age group females ^1,8.

Clinical presentation

Cotton swab test is used to identify the zone of pain with good proficiency of vulvar anatomy. A detailed history of the patient including their sexual history, duration of pain syndrome, allergic history and exclusion of all other possible causes of pain in the vulvar region is mandatory.

Pathology

There are different pathological mechanisms depicted in literature, few of them includes irritation of the nerve pathway from the vulva to the spinal cord. The surge of inflammatory markers like cytokines, genetic vulnerability and pelvic floor muscle instability and weakness.

Treatment and prognosis

Multimodality approach with avoidance of irritating factors, tricyclic antidepressants, anticonvulsants, local pain-relieving drugs, pelvic floor strengthens exercises, physiotherapy, nerve block and sometimes surgical methods are employed to relieve symptoms.

Differential diagnosis

• vulvovaginal infections and inflammatory disorders
• malignancy, e.g. squamous cell carcinoma
• nerve entrapment
• vulvar trauma
• iatrogenic