Vulvodynia (chronic vulval pain)

Abstract

A 35 year old woman presents to her general practitioner saying penetrative sex with her partner is painful and that the pain has been progressively increasing in severity over the past year. She describes the pain as burning and located around the opening of the vagina. Vulvodynia is chronic vulval pain lasting more than three months without an identifiable cause.1 2 It can be classified as primary—present from the first physical contact—or secondary, arising after an initial pain-free period.2 The pain may be localised to a specific area, such as the vestibule or clitoris, or generalised, involving the entire vulva.2 The exact mechanism of why vulvodynia occurs is not fully understood and is likely multifactorial. Multiple, large population based surveys in the US estimate the lifetime prevalence of vulvodynia to be 10-28% in the general population.4 Qualitative studies show themes of delayed diagnosis (in many cases years), symptoms minimised by healthcare providers, and a lack of awareness and understanding by health professionals.3 4 For example, in interviews with 10 women aged 25 to 57 in the UK diagnosed with vulvodynia, participants reported experiencing disbelief, stigmatisation, and minimisation of their symptoms by physicians.4 Interviews of eight women aged 23 to 32 in Norway revealed similar patient experiences.3 Vulvodynia, like other vulval pain, often affects quality of life, causing extreme discomfort or pain while wearing underwear, trousers, or while sitting. It can also hinder intimate relationships, gynaecological examinations and procedures, and choice of menstrual products, and can negatively impact daily activities such as going to work, school, and recreational activities.