Vulvodynia (chronic vulval pain)

What you need to know• Vulvodynia is chronic vulval pain lasting more than three months without an identifiable cause, and is classified as primary (present from the first physical contact) or secondary (arising after an initial pain-free period) • A variation of the cotton swab test can be used to localise and quantify pain • Treatment includes pelvic floor physiotherapy, psychotherapy, and oral neuropathic pain medications A 35 year old woman presents to her general practitioner saying penetrative sex with her partner is painful and that the pain has been progressively increasing in severity over the past year.She describes the pain as burning and located around the opening of the vagina.Vulvodynia is chronic vulval pain lasting more than three months without an identifiable cause. 1 2 It can be classified as primary-present from the first physical contact-or secondary, arising after an initial pain-free period. 2 The pain may be localised to a specific area, such as the vestibule or clitoris, or generalised, involving the entire vulva. 2 The exact mechanism of why vulvodynia occurs is not fully understood and is likely multifactorial.Multiple, large population based surveys in the US estimate the lifetime prevalence of vulvodynia to be 10-28% in the general population.4 Qualitative studies show themes of delayed diagnosis (in many cases years), symptoms minimised by healthcare providers, and a lack of awareness and understanding by health professionals.3 4 For example, in interviews with 10 women aged 25 to 57 in the UK diagnosed with vulvodynia, participants reported experiencing disbelief, stigmatisation, and minimisation of their symptoms by physicians. 4 Interviews of eight women aged 23 to 32 in Norway revealed similar patient experiences.3 Vulvodynia, like other vulval pain, often affects quality of life, causing extreme discomfort or pain while wearing underwear, trousers, or while sitting.It can also hinder intimate relationships, gynaecological examinations and procedures, and choice of menstrual products, and can negatively impact daily activities such as going to work, school, and recreational activities. What you should coverTake a focused history:• Where is the pain located?For example, is it localised to a certain portion of the genitalia?Pain confined to the clitoris is clitorodynia, and to the vestibule or vaginal entrance is vestibulodynia.• How long has the vulval pain been present?The minimum duration required for a diagnosis of vulvodynia is three months.1This is part of a series of occasional articles on common problems in primary care.