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Vulvodynia

VULVODYNIA:  Vulvar Pain Syndrome

Vulvar abnormalities are quite common, yet only infrequently talked about. Many women are too embarrassed to bring them up with their primary care physician or even with their gynecologist. Furthermore, in the absence of obvious skin disease these patients are often dismissed as having emotional problems.

Itching and burning of the labia majora and minora are very difficult to tolerate. Cortisone creams are only partially helpful at best. The only hope for adequate treatment lies in accurate diagnosis and treatment of the problem. There are several diseases which cause these symptoms including eczema, lichen simplex chronicus, lichen planus, lichen sclerosis et atrophicus, contact dermatitis, acute and chronic yeast or fungal infections, vaginal discharge, pre-cancerous and cancerous lesions, and vulvar pain syndromes.

Vulvodynia: Chronic burning and itching of the vulva
The whole discourse below are examples of vulvodynia, but the term is often reserved for patients who do not exhibit signs of clinical disease. The patients may have infections within their skin that have not caused inflammation. More often the syndrome is caused by mediators (chemicals released by normal human tissue) that interact with receptors for pain and itching in the skin. Treatment must be systemic.

Eczema
Eczema is not a disease per se but rather a constellation of findings under a microscope that signify inflammation. The most common complaint is itching and the most common signs are red, scaling, scratched skin. Treatment must be systemic (pills) to succeed. This term is often interchanged with dermatitis.

Lichen Simplex Chronicus
This disease is also called neurodermatitis and is an example of mediators within the skin causing burning or itching. When the skin is abraded from rubbing or scratching it changes with redness, scaling, and thickened skin. Treatment must be systemic and topical and must involve preventive measures.

Lichen Planus
This disease is considered autoimmune and occurs in the mouth, on the skin of the body (especially wrists), and on genitalia where it is less well defined. It is very itchy and may cause small red bumps to occur on the mucosal side of the labia minor. Treatment must be systemic and topical.

Lichen Sclerosis et atrophicus
This is a rare disease that often occurs on the genitalia of women. It is characterized by white patches of very thin skin and besides feeling uncomfortable can rarely result in cancer of the skin. This disease is difficult to treat and treatment must be systemic and topical.

Contact Dermatitis
This is an itching inflammation of the skin caused by chemicals that irritate skin or to which patients are allergic. Examples are detergents, fabric softeners, shampoos, soaps, and bleaches. Treatment begins by eliminating offending agents and then involves systemic and topical agents.

Acute and Chronic Yeast and Fungal Infections
Subclinical infections which are not visible to the naked eye can cause burning and itching. Biopsy of the skin of the labia majora may reveal these organisms. Treatment must be directed toward the particular infection.

Vaginal Discharge
Chronic vaginal discharge from hormone stimulation or infection can cause chronic irritation of the vulva. Treatment is directed toward the cause of the discharge.

Precancerous and Cancerous Lesions
A less common sign of skin cancer is itching and burning. Lesions may be flat or raised, colored or white, erosive or bleeding. All lesions must have a skin biopsy.

Vulvar Pain Syndromes
These are encompassed by the above as well as those patients who have no skin disease and are symptomatic. Treatment is aimed at reducing mediator release into the skin and blocking nerve receptors in the skin.

Dr. Edward Lack is a double board certified dermatologist. He is trained in dermatology and venereology and has experience in running a vulvodynia clinic. MetropolitanMD has announced the opening of its own program for vulvodynia and Dr. Lack is the medical director of that program.

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