Diagnosis

In 1977, Friedrich and Dodson proposed guidelines for characterizing vulvodynia as follows:

1. Chronic symptoms

2. A lack of abnormal physical findings

3. Refraining from sexual intercourse because of symptoms

4. Emotional lability

5. Reluctance of the patient to acknowledge a psychological component to the condition (28).

Specific diagnostic criteria proposed by Friedrich in 1987 and still in use today include:

1. Vulvar erythema as the sole physical finding,

2. Pain upon vestibular touch or entry, and

3. Tenderness upon localized vestibular pressure (24).

In Friedrich's time, vulvodynia was thought to have psychosomatic origins and was diagnosed after all other causes were eliminated (28).

Today, vulvodynia remains a diagnosis of exclusion (26): pathologic findings are limited to erythema and causal agents cannot be isolated (28). Common presenting symptoms include vulvar burning, itching, aching, stinging, and stabbing pain (Fig. 2; Ref. 43). A comprehensive diagnostic work-up includes a symptom history, medical history, pelvic examination, vaginal cultures, and pain mapping. The pelvic examination should yield no physical abnormalities (6). Medical conditions that could cause symptoms, such as cysts, ulcers, tumors, spinal cord lesions, and dermatoses, must be ruled out, and vaginal cultures are needed to exclude urogenital infections (e.g., yeast infections, urinary tract infectious, herpes simplex, etc.) as the etiology of pain (26).

Pain mapping is an integral part of the diagnostic process. The traditional procedure for this is the cotton-swab test (10,26), in which the clinician applies

Burning Itching Aching Stinging Stabbing

Figure 2 Self-reported vulvar pain descriptors obtained through University of Medicine and Dentistry of New Jersey survey data from a population of women with a clinically confirmed diagnosis of vulvodynia (DIAGNOSED) and a population of women who reported symptoms of vulvodynia via a telephone interview (SYMPTOMATIC). Source: From Ref. 43.

Burning Itching Aching Stinging Stabbing

Figure 2 Self-reported vulvar pain descriptors obtained through University of Medicine and Dentistry of New Jersey survey data from a population of women with a clinically confirmed diagnosis of vulvodynia (DIAGNOSED) and a population of women who reported symptoms of vulvodynia via a telephone interview (SYMPTOMATIC). Source: From Ref. 43.

Subjective Drawing
Figure 3 The cotton-swab test enables the clinician to map vulvar pain and allows the patient to rate pain sensation on a subjective scale.

pressure to designated areas of the vestibule using the swab (Fig. 3). The patient rates sensation on a scale of one (no pain) to five (maximum pain) (44). However, this test has limited reproducibility, because the outcome depends upon the clinician's subjective assessment of pain and the individual degree of pressure each practitioner exerts; the degree of pressure applied to the vulva varies from one clinician to another, and so this method lacks reliability.

An alternative to the cotton-swab test is the vulvalgesiometer, an instrument developed by investigators at McGill University in Montreal, Canada, specifically for the purpose of gathering standardized pain information from vulvodynia patients (45,46). The vulvalgesiometer consists of several syringes, each holding a spring calibrated to a preset tension. The clinician inserts a cotton-tipped swab into the end of the syringe and performs pain mapping. The spring standardizes the amount of pressure applied to each part of the vestibule and the patient indicates when pain is felt. As the degree of pressure applied is no longer dependent upon the clinician performing the examination, results should be consistent (45,46). Another method, a vulvar algesiometer designed by Curnow (47), utilizes a handheld probe that is connected to a main control unit that runs an alternating current. Force delivered by the probe is increased until the patient reports pain. The maximum force utilized by this device is eight milli-newtons.

Although the diagnostic process can be complex and there is no common protocol used by clinicians, the critical point in making the diagnosis is to exclude all other pathologic entities that can be causing the vulvar pain (Fig. 4) (48).

Menstrual Cycle Diag
Figure 4 Diagnostic algorithm for vulvodynia. Source: From Ref. 47. (See insert p. 6.)

color

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

Get My Free Ebook


Post a comment