Generalized vulvodynia

What is it generalized vulvodynia?

Generalized vulvodynia is one of the most common types of vulvodynia or vulvar pain of unknown cause. In men, a similar disorder is known as the male genitalia. dysesthesia. It was previously known as dysesthetic vulvodynia and is a form of cutaneous dysesthesia

Vulvodynia is defined by the International Society for the Study of Vulvovaginal Diseases (ISSVD) such as vulvar pain of at least 3 months duration, without a clearly identifiable cause.

Generalized vulvodynia describes extended pain in the entire vulvar region where there is no physical explanation for it. Pain may be present on the lips, clitoris, vestibule, perineum, Monday pubis and inner thighs. The pain may be constant or not caused by touch or pressure on the vulva. Activities like sex, cycling, and horse riding can worsen symptoms.

What are the symptoms of generalized vulvodynia?

Patients with generalized vulvodynia can describe intermittent or continuous symptoms, including:

• Generalized and widespread vulva discomfort and pain, not altered by position or activity (vulvar burning only when sitting suggests pudendal nerve entrapment)
• Burning, raw meat sensation, irritation, stinging and throbbing sensation in the vulva.
• Pushing, as if the needle is stuck in the vulva, vagina, and / or anus
• The pain can be started by a light touch or pressure (this is called allodynia), but it often occurs spontaneously
• Pain and discomfort sometimes experienced in the urethra or rectum.
• Sexual intercourse can be unpleasant, difficult, or impossible due to discomfort.
• Related to stress and chronic pain conditions such as headaches, face, tongue and mouth pain (burning in the mouth syndrome), fibromyalgia, irritable bowel syndrome, painful bladder syndrome, bloating, fatigue, sleep problems, and eating disorders.

What causes generalized vulvodynia?

By definition, the cause of generalized vulvodynia is unknown. Current theories consider generalized vulvodynia to be a chronic pain syndrome related to hypersensitivity nerves. One or more of the following may play a role in the development of this condition.

• Stretched and inflamed nerves in the vulvar area (entrapment of the pudendal or pudendal nerve neuralgia), spine or related structures
• Trigger points where there is proliferating or sensitized nerve endings in the skin itself
• Previous vulvar skin condition, surgery, or delivery causing scarring or other injury
• Hormonal changes that cause vulvar dryness, especially during menopause.
• Previous inflammatory disorders such as herpes simplex or Herpes zoster /shingles infection
• Emotional stress

Management of generalized vulvodynia

Women suffering from generalized vulvodynia require a variety of treatments to help overcome their cycle of endless pain. A combination of therapies should be used which may include:

• Regular sleep, daily exercise and solving stressful problems.
• Physiotherapy and pelvic floor exercises to relieve muscle spasms and generalized vulvar pain. These can also help associated urethral and intestinal problems.
• Small doses of a tricyclic antidepressant such as amitriptyline (5 to 30 mg), desipramine, or nortriptyline. They are prescribed for at least several weeks or months and, if successful, may need to be continued for the long term. Side effects such as drowsiness, weight gain, and dry mouth occur in up to 50% of patients, especially when they start taking the drug.
• Anticonvulsants like carbamazepine, gabapentin, or pregabalin may control chronic pain. Referral to a pain specialist may be helpful.
• Support and education: both the patient and his partner and their families must understand and learn to cope with the stress that the condition can generate in relationships.