Vulvar pain, chronic

Also called essential vulvodynia (literally means "painful vulva"), pain in the vulva, the female external genitalia including the labia, clitoris, and entrance to the vagina. The pain usually is a chronic, diffuse, unremitting sensation of burning which may extend to the perineum, thigh or buttock and is often associated with discomfort in the urethra and rectum. This problem (essential vulvodynia) occurs mainly in postmenopausal women. There are no reliable data on the prevalence of essential vulvodynia. The main symptom is pain, usually a sensation of burning, irritation or rawness of the genitals. The pain is quite variable. It can vanish as suddenly as it started. The main finding demonstrable on a medical physical examination is hyperesthesia. The cause of essential vulvodynia is unknown. There is some evidence that damage to the nerves, particularly the pudendal nerve, supplying this area may play a role. The prognosis without treatment or spontaneous remission may be for unceasing pain, leading to poor quality of life. Rarely, frequency of micturition (urination), stress incontinence, and chronic constipation may also develop. Many treatments have been tried. These include drugs such as amitriptyline, nerve blocks (to numb the vulvar nerves), decompression of the pudendal nerve, and biofeedback therapy (to relax pelvic muscles). At present there is insufficient evidence to document any benefit from amitriptyline or pudendal nerve decompression for women with essential vulvodynia. This is a seemingly minor disease of major consequence for a woman's quality of life. It is a condition of unknown cause without a proven mode of treatment.