Posted by e-Medical PPT Friday, May 11, 2012
vulval pain syndromes
Vulval vestibulitis, a cause of introital dysparunia among  the women of reproductive age  and
dysasthetic Vulvodynia;  a condition  where constant localized vulval pain is experienced,
together form the “vulval pain syndromes” as these relates to vulval pain when infection and organic causes have been excluded.

The diagnosis vulval dermatosis (lichen sclerosus), vestibular papillomatosis and cyclical vulvitis do not fit into a diagnosis of vulval pain syndrome.
 Vestibular papillomatosis where filamentous projections of epithelium are found within the vestibule and inner labia minora is now considered a variant of normal.

Cyclical vulvitis causes intermittent swelling and pain of the labia usually prior to menstruation, which resolves soon after. The patients responded to maintenance treatment with antifungal.

Vulval vestibulitis
Severe pain on vestibular touch or attempted vaginal entry.
Tenderness to pressure localized within the vestibule.
The physical findings of erythema confined to the vestibule.

Test : A swab test is a useful way to demonstrate tenderness within the vestibule.
A cotton tipped swab is applied gently to normal skin as a control and than around different areas of the external genitalia.

Dysasthetic Vulvodynia
It is a cutaneous diathesis causing non localized vulval pain.
Constant neuralgic type of pain in the region of vulva or perineal region occasionally.
 The nature of pain is burning or aching & is after analogous with neuralgic pain syndromes such as post herpetic neuralgia.
Clinical examination  of vulva - normal.
Erythema is anatomical variant.
Allodynia : not usually seen.
Peri or post menopausal women with h/o multiple inappropriate use of topical agents prior to the diagnosis.
Superficial dysparunia is not consistently reported...

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