Vestibulodynia
William J. Ledger, Steven S. Witkin in Vulvovaginal Infections, 2017
Despite this grim picture, however, some hope for these women is emerging. Over the years, awareness of VD by all medical care teams has increased. Friedrich proffered the first clinical definition of this syndrome in 1987, calling it “vulvar vestibulitis.”1 The specific diagnostic criteria included vulvar erythema of varying degree, pain on contact of the vestibular glands, and pain with any vaginal entry pressure on the vestibular glands. This could be caused by attempts at intercourse; the introduction of a speculum into the vagina by a physician or by patient activities, such as the insertion of a tampon; or wearing trousers or tight undergarments (e.g., a thong).
Vulvar therapies
Miranda A. Farage, Howard I. Maibach in The Vulva, 2017
Severe or refractory vulvar vestibulitis that has failed medical treatment for 6 months can be treated surgically with vulvar vestibulectomy (9). Many surgeons remove all areas of the vestibule, including areas that do not exhibit pain, because vestibulectomy failures result in recurrences in the remaining vestibule tissue. Surgical excision has been curative or produced significant improvement of symptoms in 66%–85% of patients (9). However, hematoma, wound dehiscence, poor healing, symptom recurrence, or worsening of pain can occur after vestibulectomy. Flash lamp-excited dye laser treatment has been somewhat successful in reducing the need for resective surgery (4).
Pain and sex(uality) among women suffering from vulvar pain
Lisa Folkmarson Käll in Dimensions of Pain, 2012
The women suffering from vulvar vestibulitis experience pain in their body, in everyday life, in sexual practice and in their relationships. Since vestibulitis is a long-term pain and it affects everyday situations these women change their interpretations of pain, body and life over time. They find strategies for handling the multidimensional pain, even though it still is an obstacle in their lives. Their experience and interpretations of vestibulitis differ from the medical description of vestibulitis as a sexual syndrome. It is a painful condition situated in the vulvar area, which means that it affects sexual practice, but also other aspects of everyday life.
Pain and Loss of Pleasure in Receptive Anal Sex for Gay and Bisexual Men following Prostate Cancer Treatment: Results from the Restore-1 Study
Published in The Journal of Sex Research, 2022
Christopher W. Wheldon, Elizabeth J. Polter, B. R. Simon Rosser, Aditya Kapoor, Kristine M. C. Talley, Ryan Haggart, Nidhi Kohli, Badrinath R. Konety, Darryl Mitteldorf, Michael W. Ross, William West, Morgan Wright
Second, there may be a bidirectional relationship between psychological distress and anodyspareunia among GBM (Peixoto & Nobre, 2015). In this study, anodyspareunia was associated with poorer mental health. Given that this sample consists of GBM who described RAI as a pleasurable aspect of their sexuality prior to their prostate cancer diagnosis and who largely described their role in sex identities as “bottoms” or “versatile,” poorer mental health among those experiencing anodyspareunia could result from their inability to resume pleasurable RAI. Thus, the loss of this sexual behavior, and the impact on role in sex identity, could result in psychological distress. Alternatively, as has been found in studies on vulvar vestibulitis (Zolnoun et al., 2006), psychological distress could be an antecedent to anodyspareunia. Muscular spasms and difficulty with relaxation can result from psychosexual distress. Thus, a possible causal relationship between psychological distress and anodyspareunia warrants further study.
Skin diseases of the vulva: eczematous diseases and contact urticaria
Published in Journal of Obstetrics and Gynaecology, 2018
Freja Lærke Sand, Simon Francis Thomsen
Type I allergy with development of IgE antibodies to glycoproteins in human seminal plasma is a rare but important cause of vulvar contact urticaria (Weidinger et al. 2005). Combined contact urticaria to both human seminal plasma and latex has been described (Kint et al. 1994). Contact urticaria after exposure to human seminal plasma in a mother and her three daughters has been published (Chang 1976). The clinical presentation of contact urticaria to human seminal plasma is pruritus, a locally burning sensation, erythema and oedema within minutes after ejaculation (Figure 5) (Weidinger et al. 2005). A systemic allergic reaction has been described in women exposed to human seminal plasma with post-coital dyspnoea, dysphagia, rhinoconjunctivitis, generalised urticaria, gastrointestinal symptoms and anaphylactic shock (Chang 1976). A subgroup of women with vulvar vestibulitis have IgE antibodies to seminal fluid and may be a factor in initiation and persistence of symptoms in these women (Babula et al. 2004).
Vulvodynia – an evolving disease
Published in Climacteric, 2022
Vulval pain or discomfort is common in women and although it may occur at any age, it is more common in the reproductive years and can significantly affect quality of life. At some point in the lives of women in the USA, up to 16% will suffer from chronic vulval pain, which may be assumed to be vulvodynia. Up to 14 million women worldwide are affected with vulvodynia at some stage over the course of their lifetimes. The condition accounts for 10 million doctor visits annually in the USA alone [1]. The concept of vulvodynia arose in the eighteenth century, but it was only in 1987 that Friedrich published criteria for the diagnosis which included provoked severe vestibular pain, associated erythema of the vulva, tenderness upon local vestibular pressure and no other defined vulval pathology [2]. All of the older terminology, such as ‘burning vulva syndrome’, dysesthetic vestibulitis or vulvar vestibulitis, has over the years been modified or deleted. In 2015, a panel of representatives from the International Society for the Studies of Vulvovaginal Disease, the International Society for the Study of Women’s Sexual Health and the International Pelvic Pain Society formulated and updated the consensus of terminology pertaining to vulvodynia [3].
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