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Vulval pain 

Vulval pain
Vulval pain

Allan B MacLean

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date: 21 April 2021

Vulval pain or pain involving the vulval tissue is discussed in Chapter 9. It becomes chronic when lasting for at least three months. Vulvodynia is a subset of chronic vulval pain, once known causes (infective, inflammatory, neoplastic, neurological, traumatic, iatrogenic and hormone deficiencies) are excluded. It reportedly affects one in six women at some stage of their lives. Uncertain terminology has hampered understanding. Even the latest classification from the International Society for the Study of Vulvovaginal Disease has deficiencies but it allows the discarding of previously used unhelpful terms. Differentiating features between provoked (entry dyspareunia), and unprovoked, localised and generalised, overlap, both in diagnosis and management. Older theories on causation included infection, irritation and inflammation but laboratory-based research has not supported these. Hormonal and neural mechanisms seem more likely to cause the pain, while the interplay of biological, psychological, and social factors has recently gained credence. Publications on successful management demonstrate a powerful placebo effect. The role of specially designated vulval pain clinics, multidisciplinary approaches, and team working is emphasised. General measures in vulval care, such as wearing clothes made of natural fibre, using emollients or carrying out pelvic floor exercises besides reducing stress, can minimise the pain. Topical anaesthetic creams or systemic treatments with antidepressants or anti-epileptics have advocates. Treatment is most effective when careful selection, adequate counselling, and ongoing psychosomatic evaluation address all the interactive factors that initiate, and maintain vulval pain besides modulating patient response. Case scenarios illustrate the complexities of diagnosis and management.

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