Symptomatic vulvar burning (vulvodynia) in the absence of abnormal physical findings was long thought to be an unusual psychosomatic gynecologic problem. Within the past decade, however, a number of investigators began to study patients with this frustrating problem. Initial physician insistence on a major role for psychological factors has gradually given way to sophisticated searches for evidence of persistent infectious agents, especially human papillomavirus and Candida. Gynecologists searching for causes and surgical relief of vulvodynia have even reevaluated elements of vulvar anatomy. The purpose of this article is to introduce dermatologists to current perspectives on vulvodynia in the context of the clinical experience of the author, who has been actively involved in the multidisciplinary investigation of this problem since its recognition in the early 1980s. To date, the following five signsymptom complexes have been identified by the author and recognized by other vulvodynia investigators: (1) vulvar dermatoses, (2) cyclic vulvitis, (3) vulvar papillomatosis, (4) vulvar vestibulitis, and (5) essential vulvodynia. A given patient's complaint may be primarily associated with one of these factors, but it is not unusual to see others develop simultaneously or sequentially. Remission or exacerbation of symptoms may occur when treatment for one condition affects the onset of another. It is evident that vulvodynia is a complex diagnosis and that recognition of multiple factors is important to appropriate patient evaluation and management.
Department of Dermatology Grady Memorial Hospital Emory University School of Medicine Atlanta.
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Shafi MI Finn C Luesley DM Jordan JA Rollason TP Carbon dioxide laser treatment for vulval papillomatosis (vulvodynia).
OBJECTIVE: To determine whether women with vulvodynia differ psychologically from women with other vulvar pathology and whether women with essential vulvodynia differ psychologically from women with vulvodynia in whom a cause has been identified. METHODS: Women attending a vulvar clinic were given a package consisting of the Brief Symptom Inventory, the Center for Epidemiologic StudiesDepression Scale, the Barsky Somatosensory Amplification Scale, the Whitely Index for hypochondriasis, and a study questionnaire. A gynecologist and dermatologist then took a careful history and performed a gynecologic examination, colposcopy, biopsies, and laboratory examinations.
CONCLUSIONS: Vulvodynia patients are more psychologically distressed than women with other vulvar pathology, and women with essential vulvodynia are more distressed than vulvodynia patients with an identified physical cause. Optimal management of vulvodynia patients should include attention to anxiety reduction, sexual function, normalization of every-day bodily sensations, reassurance about the absence of serious disease, and coordination of clinical care to ensure the maximum benefit from consultations.
Department of Obstetrics and Gynecology St. Michael's Hospital Toronto Ontario Canada.