ABSTRACT
CONTEXT: Vulvodynia is a term used to describe chronic burning and/or pain in the vulva without objective physical findings to explain the symptoms. The terminology and classification of vulvodynia continue to evolve, and much remains to be understood about the prevalence, pathogenesis, natural history, and management of this distressing condition. STARTING POINT: James Aikens and colleagues showed that chronic vulval pain (vulvodynia or vulvar dysaesthesia) is associated with worse depressive symptoms (Am J Obstet Gynecol 2003; 189: 462-66). However, the increased scores for depression in this case-control study were attributed to sexual disinterest and experience of chronic pain rather than to features of depressive disorder. These results lend weight to the increasing need for better understanding of the pathogenesis of vulval pain and how to manage it appropriately. WHERE NEXT? The aetiology of vulvodynia and effectiveness of treatments need further study. Appraising the available literature, we have formulated a useful approach to patients with chronic vulval pain. There is a pressing need for further case-control studies of potential causes of vulvodynia and for randomised trials of interventions.
Subject(s)
Amines , Cyclohexanecarboxylic Acids , Pain/diagnosis , Paresthesia/diagnosis , Vulvar Diseases/diagnosis , gamma-Aminobutyric Acid , Acetates/therapeutic use , Anticonvulsants/therapeutic use , Antidepressive Agents, Tricyclic/therapeutic use , Biofeedback, Psychology/methods , Chronic Disease , Female , Gabapentin , Humans , Pain Management , Paresthesia/therapy , Vulvar Diseases/therapyABSTRACT
BACKGROUND: Erosive lichen planus causes erosion of the vulva and vagina and characteristic oral lesions. Dyspareunia is usual, and vaginal stenosis may occur. This report highlights the clinical features and the response to medical therapy. CASES: We report the case histories of three women who presented to the Vulvovaginal Disorders Clinic of the University of Iowa with long histories of dyspareunia and advanced vaginal scarring. In each case, the clinical diagnosis of erosive lichen planus was obvious but had not been made previously. All three women have responded well to topical treatment with tacrolimus 0.1% ointment. CONCLUSION: Erosive lichen planus should be suspected in a case of vaginal erosion or narrowing. Surgical management is inappropriate when the mucosa is eroded. Inspection of the mouth may confirm the diagnosis.
Subject(s)
Lichen Planus/diagnosis , Vaginal Diseases/diagnosis , Vulvar Diseases/diagnosis , Female , Humans , Immunosuppressive Agents/therapeutic use , Lichen Planus/drug therapy , Middle Aged , Tacrolimus/therapeutic use , Vaginal Diseases/drug therapy , Vulvar Diseases/drug therapyABSTRACT
We report a case of atypical Reiter's syndrome occurring in a female patient who had severe, ulcerative vulvar disease develop in association with conjunctivitis, low back pain, stomatitis, and psoriasiform skin lesions. Vulvar lesions have rarely been described in Reiter's syndrome and are not well characterized.
