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Background: Chronic pain may be perceived differently according to gender and race, which may affect physical health and psychological wellbeing. We evaluated daily pain ratings in black women as compared to white women with provoked vestibulodynia (PVD)., Methods: Seventy-one women (44 black, 27 white) rated pain severity with tampon insertion and sexual intercourse and recorded daily vulvar pain level on a visual analogue scale (0 = no pain to 10 = worst pain imaginable). In addition, they completed the Brief Pain Inventory (BPI) Interference Scale and Hamilton Anxiety Depression Scale (HADS). Multivariate analysis was performed to determine the effect of race on pain intensity after adjusting for functional impairment, affective distress and demographic characteristics., Results: Pain ratings from tampon insertion (6.37 ± 1.89 vs. 5.61 ± 1.98, p = .12) and sexual intercourse (6.28 ± 2.11 vs. 5.29 ± 2.50, p = 0.24) were similar, but daily vulvar pain (4.57 ± 2.27 vs 2.74 ± 2.43, p = <.01) was significantly higher in black women. BPI-interference scores were associated with small, but significant increases in tampon insertion pain (p = <.01, beta = .06 units) and daily pain (p < .01, beta = .10 units) and to a lesser degree with sexual intercourse pain when corrected for multiple comparisons (p = .05, beta = .06 units). Race had no effect on pain after adjusting for other variables., Conclusion: While race was associated with functional impairment, after accounting for this, race was not associated with level of vulvar pain with PVD.

Vulvar pain and discomfort (vulvodynia) are common conditions that can have a significant impact on a patient's quality of life. Vulvodynia is a difficult condition to evaluate and treat. This article gives the primary gynecologist a basic framework with which to identify, diagnose, and begin treatment for these patients and refer if necessary. Initial evaluation and physical examination are discussed in detail. Treatments ranging from self-management strategies to nonpharmacologic and pharmacologic therapies will be explored. Because vulvodynia is a chronic pain disorder, diagnosis is the key to beginning treatment and support for this patient population., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Vulvar pain can be a difficult and frustrating problem for patients and practitioners. Often, no specific etiology can be determined for these symptoms. Treatment can be long and difficult as well.Spondylosyndesis is a common surgical procedure where the vertebrae are fused to decrease motion. There are several indications for this procedure. We report 2 patients who developed vulvar pain postoperatively after a spondylosyndesis procedure. Neither patient had a history of vulvar pain before their procedure. Of note, both patients had had a previous spondylosyndesis procedure in the past.Damage to lumbar nerves during spondylosyndesis procedures may precipitate vulvar pain in some patients.

Background: Localised provoked vulvodynia (former vulvar vestibulitis syndrome) is the most common cause of superficial dyspareunia among young women. In a clinical setting, it is obvious that many women with localised provoked vulvodynia show signs of chronic stress. The objective of this study was to compare chronic stress in a group of women with localised provoked vulvodynia, referred to the vulvar unit at the Division of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden with control women of the same age and educational level, using two independent methods., Methods: Forty-three women with localised provoked vulvodynia and 35 healthy control women underwent a gynecological examination, filled in a health questionnaire, and self-collected saliva for analysis of cortisol at awakening and after 15, 30 and 45 min (morning awakening cortisol). Thirty-three patients and 28 controls completed a stress questionnaire., Results: Morning awakening cortisol was blunted in women with localised provoked vulvodynia (p < 0.05), indicating chronic stress. The stress questionnaire showed more signs of burnout (p < 0.005), and emotional (p < 0.05) and bodily symptoms of stress (p < 0.005) in women with localised provoked vulvodynia compared with control subjects (students t-test)., Conclusion: More women with localised provoked vulvodynia showed blunted morning awakening cortisol and reported more symptoms of stress compared with healthy control women of the same age.

Background: In recent years there has been increasing awareness of chronic vulvar pain, both in the medical and lay communities. The etiology of vulvar pain is largely unknown. Furthermore, there is no worldwide consensus regarding the terminology and classification of this condition, which makes it difficult to compare the results of different treatments. In 2003, following more than three decades of uncertainty, the terminology and classification of vulvar pain was re-established., Aim: To review the development of nomenclature for vulvar pain and the increasing understanding of its pathophysiology., Methods: A literature review was conducted of articles related to the nomenclature of vulvar pain and vulvar diseases, and a summary of the world congresses of the International Society for the Study of Vulvovaginal Disease (ISSVD) from 1976 until 2003., Results: In 1976, members of the ISSVD recognized vulvar pain as a unique entity, and called it burning vulva syndrome. In 1985, the ISSVD renamed this disorder "Vulvodynia" and classified it into two clinically distinctive subsets: dysesthetic vulvodynia and vestibulitis. However, recent studies failed to confirm an inflammatory pathogenesis, and the term vestibulitis was replaced by the term vestibulodynia at the 1999 ISSVD congress. In 2003, the ISSVD reviewed the terminology and used the term vulvodynia, which is further classified as either generalized or localized, and by the presence or absence of stimulus for pain., Conclusions: The re-establishment of the ISSVD terminology and classification in 2003 will help physicians and researchers improve the understanding of chronic idiopathic vulvar pain, and develop effective treatments.

This study assessed the association between pain perception and psychological variables in women with vulvar vestibulitis syndrome (VVS) by comparing 28 VVS women with 50 healthy women. We assessed non genital systemic pain perception with quantitative sensory testing by administering experimental pain stimuli to the forearm. The VVS women demonstrated a lower pain threshold and a higher magnitude estimation of pain, combined with a higher trait anxiety, increased somatization, and a lower body image. Among the VVS women, nonvaginal pain catastrophizing was significantly related to reported pain during coitus. A cluster analysis revealed four subtypes of VVS women, as characterized by levels of pain and personality variables. I suggest implications for the assessment and treatment of women suffering from painful coitus.

Objective: To assess both regional (vulvar) and overall (generalized) pain sensitivity in women with vulvodynia to determine whether both are increased, suggestive of altered central pain processing., Methods: Seventeen patients (aged 18-60 years) with vulvodynia and 23 age-matched control subjects were included in this cross-sectional study. Pressure pain thresholds in the vulvar area were evaluated in 23 defined locations using a newly developed vulvodolorimeter. Peripheral pressure pain sensitivity was assessed by applying 1) continuously ascending pressures to 3 bilateral locations (thumb, deltoid, and shin), and 2) discrete pressure stimuli to the thumb using both an ascending and random sequence of varying pressures., Results: Pain thresholds at all vulvar locations were lower in the women with vulvodynia than in pain-free control subjects. Similarly, peripheral pain thresholds were lower at the thumb in women with vulvodynia when obtained by discrete ascending or random staircase paradigms, as well as at the thumb, deltoid, and shin when tested by dolorimeter (P <.05). Findings were similar in both those with generalized vulvar dysesthesia and those with localized vestibulodynia. The quantitative results obtained with the vulvodolorimeter and with the more subjective cotton-tipped swab testing routinely used in diagnosis were strongly correlated., Conclusion: Women with vulvodynia displayed significantly increased pressure pain sensitivity in both the vulvar region and in peripheral body regions, suggesting a "central" component to the mechanisms mediating this disorder. Both the novel vulvodolorimeter and the thumb pressure stimulator may assist in future experimental tests of this and related hypotheses.

Objective: To evaluate the safety and efficacy of topical nitroglycerin cream for the treatment of vulvar pain in women with vulvodynia., Methods: A total of 34 women diagnosed with vulvodynia were included in this study. Patients were treated with 0.2% nitroglycerin cream in the clinic. The cream was applied directly to the skin at the genital/vulvar area where the pain was located. Patients who did not experience any adverse side effects were instructed to use the cream at home at least three times per week, 5-10 minutes prior to sexual relations. Patients completed a pretreatment pain scale at baseline and a posttreatment pain scale questionnaire 4-6 weeks later., Results: Twenty-one patients completed both the pre- and posttreatment pain scale questionnaires, and 13 patients completed only the posttreatment pain questionnaire. Thirty-one patients (91.5%) stated that "overall" their pain had improved. Analysis of the pre- and posttreatment questionnaires revealed a significant decrease in pain intensity on a scale of 0 (no pain) to 5 (excruciating pain; 3.95-2.57; P < .000). There was also a significant decrease in the frequency of overall painful episodes on a scale of 0 (never) to 4 (always; 3.25-2.15, P < .006). All 21 patients reported "improvement" of pain during sexual activity (3.65-2.15; P < .005)., Conclusion: Topical nitroglycerin is safe and effective in providing temporary relief of introital dyspareunia and vulvar pain in women with vulvodynia. Women who completed this study experienced significant improvement in their overall pain and pain with sexual activity after nitroglycerin use. A larger placebo-controlled study is necessary to establish the optimum dosage level and to minimize the side effects.