Washington, DC -- The American College of Obstetricians and Gynecologists (ACOG), along with the American Society for Colposcopy and Cervical Pathology (ASCCP), today issued a new Committee Opinion on the diagnosis and treatment of vulvodynia, a frustrating and painful disorder for some women and often a complex and difficult problem for physicians to treat. The opinion, adapted from ASCCP's Vulvodynia Guideline (2005), is published in the October issue of Obstetrics & Gynecology.
The diagnosis of vulvodynia is given when no other cause can be found for a woman's vulvar pain and discomfort, which can include burning, stinging, irritation, and rawness. The cause of vulvodynia is unknown. However, it is not caused by any commonly identified infections (eg, candidiasis, human papillomavirus [HPV], herpes), inflammation (eg, lichen planus, immunobullous disorder), cancer, or a neurologic disorder.
To diagnose and evaluate patients, cotton swab testing is used to localize painful areas and classify the level of pain. The vagina should be examined and wet prep, vaginal pH, fungal culture, and gram stains should be performed as indicated, according to the committee opinion. Testing for HPV is unnecessary.
There are very few randomized trials of vulvodynia treatments and most treatment information is based on clinical experience, descriptive studies, or reports of expert committees. Some treatments that have been used include medication, biofeedback training, physical therapy, dietary modifications, cognitive behavioral therapy, sex counseling, and surgery. Newer treatments include acupuncture, hypnotherapy, nitroglycerin, and botulinum toxin, according to the document.
Women with vulvodynia are advised to minimize vulvar irritation by wearing 100% cotton underwear; using mild soaps while bathing with no soap applied directly to the vulva; avoiding perfumes, dyes, shampoos, and detergents around the vulva; avoiding douching; refraining from using hair dryers on the vulvar area; using adequate lubrication during intercourse; and patting the vulva area dry after bathing and then applying a topical emollient without preservatives (such as vegetable oil or plain petroleum jelly) to the vulva to hold moisture in the skin.
No single treatment is successful in all women, according to the joint opinion. Expectations for improvement need to be realistically addressed with each patient. Rapid resolution of pain is unusual. Pain reduction may take weeks to months and may not resolve completely. Emotional and psychological support are important for many patients, and sex therapy and counseling may be beneficial.
Committee Opinion #345, "Vulvodynia," is published in the October 2006 issue of Obstetrics & Gynecology.