The prevalence of generalized vulvodynia (previously referred to as generalized vulvar dysesthesia) may have been historically under-recognized by the medical profession. No one treatment works in every case. The clinician should inquire about any initiating factors or associated events such as medical illness, pelvic or vulvovaginal surgery, childbirth, injury to the back or hips, or development of a vulvar lesion that may provide clues to etiology. Brief paresthesias (abnormal sensations such as burning, prickling or tingling) also are characteristic. While it was previously thought that chronic vulvar pain is a rare complaint, it may simply have been under-recognized by the medical profession — in fact, the disorder only received a diagnostic code about five years ago.

Young women are predominantly affected. This content does not have an English version. Beth Israel Medical Center, Department of Pain Med. Unlike the lignocaine (lidocaine) ointment described above, which can be used regularly on the vulva, with EMLA cream it is best to seek advice from your doctor as the use of EMLA long-term with respect to timing and dose of treatment is not clear. Topical steroids usually are of no benefit. Renew Your Subscription and List Your Practice for Free! What works for one woman may not work for the other.

0000013756 00000 n

}Wd=��`�Hz?�}��2A?d-���*4�[�0�)�`������..n�J��){>̗Px�,8�@��*M�_�נ�*��Z����jo�c��9���c�x�(�9��9����cY\\#���B*(d�zK@HK;I����/�7PJ���zA��k3�Ջ*}����e1��E{?Yy[\�I Injuries from unicycles or horseback riding are documented examples of sports trauma leading to vulvar pain. Symptoms include tenderness and profound burning in the genital region.

0000008706 00000 n Make a donation.

0000031504 00000 n Check out these best-sellers and special offers on books and newsletters from Mayo Clinic. Harlow B. 0000010183 00000 n As it crosses the sacrospinous ligament and courses along the pelvic sidewall, the pudendal nerve is vulnerable to traction (pulling), pressure, and injury from a wide variety of insults. 0000016178 00000 n While the tricyclics have not been linked to birth defects, the avoidance of all medications during the first trimester is advised. Last fall, the National Institute of Child Health and Human Development funded a 5-year prevalence study on vulvodynia in the general population. Does your menstrual cycle affect your pain? Accessed May 1, 2017. 0000018098 00000 n Masheb RM, Nash JM, Brondolo E, and Kerns RD. An advantage of using the cream is that it may produce short-term relief from pain when applied to vulval skin. 0000006552 00000 n Vulvodynia. 0000008283 00000 n

The most common type of cream is a zinc oxide cream, commonly used to treat diaper rash.

iW�l>�~��A���ZO Spadt SK, et al. 0000010250 00000 n When might I expect to get relief from my discomfort? Some types of vaginal surgery may injure the pudendal nerve, resulting in VDY. In a pelvic exam, your physician inserts two gloved fingers inside your vagina. Topical Medications Used to Treat Vulvodynia Topical medication Dosage Side effectsa 5% lidocaine ointment Apply to skin as needed; dispense 30-g tube. For many, a combination of treatments works best. 74:243. Vulvodynia is defined as chronic vulvar itching, burning, and/or pain that causes physical, sexual, and psychological distress. To look for evidence of VDY, the clinician can untwist the end of a cotton swab to create a cotton wisp and move it across the vulva and vestibule to assess the patient’s response to light touch.

0000003575 00000 n 0000025708 00000 n Acta Obstet Gynecol Scand. Vulvodynia: Strategies for Treatment ANDREW T. GOLDSTEIN, MD,* ... EMLA cream (lidocaine 2.5% and prilocaine 2.5%) (AstraZeneca Pharmaceuticals LP, Wilmington, DE) Apply to skin as needed; do not exceed 2.5gover20to25cm2 ofskinsurface (for example, a 5 cm 3 5-cm area) Dispense 30-g tube 0000029131 00000 n 0000017206 00000 n Many feel that they have a constant yeast infection. Most patients experience a huge sense of relief once a concrete diagnosis is made, feeling reassured that their pain is real and that the condition is neither malignant nor communicable. 0000002224 00000 n According to epidemiologist Bernard Harlow, PhD, associate professor of Obstetrics, Gynecology, and Reproductive Epidemiology, Harvard Medical School, “the preliminary data suggests that possibly millions of women may be affected at some point during their lifetime.”. desipramine, imipramine, doxepin.

Accessed May 1, 2017. The products found within are not intended to diagnose, treat, cure or prevent diseases. 0000029109 00000 n

To rule out a tumor, herniated disc, severe arthritis, spinal stenosis, or arachnoiditis, x-ray or magnetic resonance imaging (MRI) may be useful. For vulvodynia, questions to ask your doctor include: Your doctor is likely to ask you questions, such as: Mayo Clinic does not endorse companies or products. Accessed May 1, 2017. Many patients report noticeable improvement and relief within 48 hours. Branches of the pudendal nerve lie directly over the belly of the obturator internus muscle. 0000008390 00000 n All rights reserved. Gabapentin lacks the anticholinergic side effects of the tricyclics and is preferred by physicians because of its favorable side-effect profile. Vulvodynia is defined as chronic vulvar itching, burning, and/or pain that causes physical, sexual, and psychological distress. VDY should be considered when a woman with a history of herpes is successfully suppressed on acyclovir but continues to complain of irritative symptoms or pain. The pain is so bad I can't sit down. They may also experience pain from wearing tight pants or tights and if sitting for a long period such as riding a bicycle. Opioid and adjuvant analgesics [syllabus]. However, if one tricyclic is not helpful, others should be tried, e.g. I actually had the procedure done last night; my doctor used a BLT cream to numb the area (which is similar to Lido or EMLA cream).

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