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Until recently, vulvar diseases have not been given sufficient attention by gynecologists. This might be attributable to the timidity of patients with chronic vulvar pruritus, tumor or dyspareunia, which delays diagnosis and treatment. In addition, the nomenclature of vulvar disease was complicated by having been adapted from various dermatological disorders. Only following the establishment of the International Society for the Study of Vulvar Disease (ISSVD) and of specialized clinics, has awareness increased and more attention is now being paid to vulvar disorders. The findings in 242 patients seen during the first year of operation of a vulvar clinic were analyzed. The most common presenting symptom was chronic vulvar pruritus. Non-neoplastic epithelial disorder (dystrophy) was the most common histological finding in the 79 women with pruritus, while 2 were diagnosed as having vulvar intraepithelial neoplasia, and 1 had basal cell carcinoma. In contrast, vulvar vestibulitis was the main diagnosis in 34 women referred for vulvar pain (vulvodynia). Vulvodynia was also associated with other inflammatory processes and with human papilloma virus (HPV) lesions (condylomata). The primary finding in 26 women referred for evaluation of a vulvar "tumor" was epidermal cyst. In only 55 (75.5%) of the 73 referred for suspected HPV lesions was the histologic diagnosis confirmatory. In addition, a few vulvar ulcers were associated with HPV. A single treatment with carbon dioxide laser eradicated the HPV lesions in 93% of the cases. The vulvar clinic contributes to the ambulatory gynecological service by concentrating diagnosis and treatment in a single specialized unit and increases understanding of, and interest in vulvar disease.
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PMID:[The vulvar clinic]. 207 59

Vulvodynia is a complex multifactorial and multidisciplinary clinical syndrome of unexplained vulvar pain, sexual dysfunction, and psychological disability. Because of the absence of abnormal physical findings among such patients, vulvodynia was long thought to be solely a psychosomatic syndrome. The incidence or prevalence of vulvodynia has not been well studied. The recognition of specific subtypes of vulvodynia is important in the management of patients with vulvodynia. The most common subtypes are vulvar vestibulitis syndrome, cyclic vulvovaginitis and dysesthetic vulvodynia. Simple practice guidelines can be developed to facilitate the evaluation and management of such patients. Systematic epidemiological, etiological and therapeutic studies of vulvodynia are urgently needed.
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PMID:Diagnosis and treatment of vulvodynia. 763 10

Vulvodynia is a syndrome of unexplained vulvar pain, sexual dysfunction, and psychological disability. The incidence of prevalence of this condition is not known. Several subtypes of vulvodynia have been recognized. Recognition of the distinct subsets of vulvodynia is a pre-requisite for successful management. Vulvar vestibulitis syndrome, cyclic vulvovaginitis, and dysesthetic vulvodynia are the most common subtypes. Other frequently misdiagnosed vulvar or vaginal conditions which can also cause culvodynia are vulvar papillomatosis, cytolytic vaginosis, lactobacillosis, and desquamative inflammatory vaginitis. In addition, many vulvar dermatoses can cause acute or chronic vulvar itching or pain, and are a frequent cause of differential diagnostic problems. In conclusion, vulvodynia is a complex multifactorial underdiagnosed clinical syndrome. Systematic epidemiologic, etiologic, and therapeutic studies of vulvodynia should be undertaken.
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PMID:Vulvodynia--a complex syndrome of vulvar pain. 773 94

Vulvodynia is a puzzling disorder. Patients experience clear physical complaints of vulvar burning. Often they have consulted many physicians and tried all kinds of treatment. Vulvodynia is often caused by the vulvar vestibulitis syndrome (VVS). To detect VVS an extensive medical and psychosexual history is necessary. Thorough examination of the vaginal vestibule reveals the typical focal erythematous lesions. The aetiology of VVS is unknown. Of the many causal and perpetuating factors a sexual arousal disorder and pelvic floor hypertonia are the main ones. The psychodynamic aspects of these two core symptoms are principal issues in diagnosis and treatment of VVS. Treatment should include all physical, psychological, relational and sexual aspects of the problem. Surgical interventions should be limited to those rare cases in which an integrative approach fails to free the patient from the vicious circle of pain, anxiety and muscle tension.
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PMID:[Vulvodynia caused by vulvar vestibulitis syndrome]. 962 21

Vulvodynia is the symptom of chronic vulvar discomfort characterized by the patient's complaint of burning and sometimes stinging or rawness. It is a multifactorial problem in which no single etiologic factor or pathogenetic mechanism has been identified. Patients with vulvodynia exhibit several features of neuropathic pain, such as allodynia, hyperalgesia, dysesthesia, and chronic pain in the absence of ongoing noxious stimuli. The treatment of vulvodynia has, in the past, focused on irradicating suspected infective causes, such as human papillomavirus, with varying success. More recently, approaches mimicking the therapy of other chronic pain syndromes, eg, the use of low-dose antidepressants, has met with some success. There is a need for uniformity in terminology and therapeutic approach, epidemiologic studies, and controlled trials to advance our management of this problem.
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PMID:Vulvodynia and its differential diagnoses. 975 76

Vulvodynia, defined as vulval pain, soreness or burning as opposed to itching or pruritus, is a common and important problem. Although not a sexually transmitted disease, it often presents to physicians working in that field. The main groups of vulvodynia are those where the symptoms are the consequence of an active dermatosis or infection, and those where it is not attributable to such conditions. In the latter group, the patients fall into two main categories: those of dysesthetic vulvidynia, with constant unprovoked pain, and vulval vestibulitis, with pain provoked by attempted vaginal entry. The recent realization that dysesthetic vulvodynia and vulval vestibulitis may be regarded as pain syndromes is proving a fruitful concept as regards both theory and management of these troublesome conditions.
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PMID:Vulvodynia. Theory and management. 989 79

Vulvodynia is a problem most family physicians can expect to encounter. It is a syndrome of unexplained vulvar pain, frequently accompanied by physical disabilities, limitation of daily activities, sexual dysfunction and psychologic distress. The patient's vulvar pain usually has an acute onset and, in most cases, becomes a chronic problem lasting months to years. The pain is often described as burning or stinging, or a feeling of rawness or irritation. Vulvodynia may have multiple causes, with several subsets, including cyclic vulvovaginitis, vulvar vestibulitis syndrome, essential (dysesthetic) vulvodynia and vulvar dermatoses. Evaluation should include a thorough history and physical examination as well as cultures for bacteria and fungus, KOH microscopic examination and biopsy of any suspicious areas. Proper treatment mandates that the correct type of vulvodynia be identified. Depending on the specific diagnosis, treatment may include fluconazole, calcium citrate, tricyclic antidepressants, topical corticosteroids, physical therapy with biofeedback, surgery or laser therapy. Since vulvodynia is often a chronic condition, regular medical follow-up and referral to a support group are helpful for most patients.
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PMID:Vulvodynia and vulvar vestibulitis: challenges in diagnosis and management. 1019 96

Vulvodynia represents a group of vulvar disorders that can be clinically perplexing. Unfortunately, there are no simple tests for its diagnosis. Patients often are reluctant to report vulvar pain. Some are embarrassed to reveal their perceived "sexual dysfunction" caused by dyspareunia. Others have been told in the past "It's all in you head," or "It's just a yeast infection." Most patients with vulvodynia are seen by multiple practitioners and are placed on a variety of treatments before a correct diagnosis is made. All too often, these treatments are not only ineffective but also damaging. Careful clinical investigation is required for the correct diagnosis and treatment of vulvodynia (Figure 2).
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PMID:Clinical management of vulvodynia. 1037 Aug 43

Vulvodynia is the sensation of burning and/or pain of the vulva in the absence of abnormal clinical findings. We offered acupuncture to twelve patients with this syndrome. All had experienced severe distress and impairment of sexual function and usual treatments had failed. The patients attended weekly for acupuncture and progress was monitored at each visit by enquiry, a questionnaire and a visual analogue scale for pain. Half had treatment for the first five weeks only, the other half for the second five weeks only. Side-effects were negligible. Two patients felt so much improved that they declared themselves 'cured'; three believed their symptoms had improved and wished to continue acupuncture; four felt slightly better and judged acupuncture more effective than any other treatment; and three noted no effect at all. Acupuncture is time-consuming and a large part of its beneficial effect in this study may have come from the regular specialist contact. However, in view of the patients' lack of response to other measures their satisfaction with the acupuncture was surprisingly high.
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PMID:Acupuncture for vulvodynia. 1070 96

Vulvodynia, or chronic vulvar discomfort, has become an increasingly recognized complaint in the medical literature. However, classification, assessment, and treatment for vulvodynia have not been universally established. There is a serious need for greater understanding of this disorder since evidence suggests, although not life-threatening, vulvodynia appears to have a significant impact on quality of life. This article reviews the medical and psychological literature on vulvodynia published since 1983, the first year vulvodynia was recognized as a diagnosis in the medical literature. The purpose of this article is to provide a review of the literature on diagnostic issues, treatment options, and psychosocial sequelae with the aim of highlighting areas in need of future research. Finally, suggestions are made for considering vulvodynia from a multidimensional, chronic pain perspective.
Pain 2000 May
PMID:Vulvodynia: an introduction and critical review of a chronic pain condition. 1077 54


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