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How to diagnose Vulvodynia

Vulvodynia is usually diagnosed when other causes of vulvar pain have been ruled out, such as infections or skin illnesses. A health care practitioner will collect a complete medical history to screen for vulvodynia, including pain complaints and any concurrent bowel, bladder, or sexual issues. A woman may be advised by her provider to have blood drawn to determine her estrogen, progesterone, and testosterone levels. The most often asked question among vulvodynia patients is “how to diagnose vulvodynia.” Keep reading to learn about the vulvodynia testing procedure.

Because vulvodynia is usually diagnosed clinically, determining the accurate diagnosis can be challenging and time-consuming. The diagnostic process can be especially difficult for women who do not have health insurance since they may not have the financial wherewithal to seek care to rule out all potential reasons of discomfort. Furthermore, some women may be hesitant to speak up about their concerns or seek help.

After taking a thorough medical history and interrogating your health history, your clinician should carefully evaluate the vulva, vagina, and vaginal secretions. On a regular basis, yeast and bacterial infections should be cultured. Your doctor may also urge you to have blood drawn to test your estrogen, progesterone, and testosterone levels.

We will not repeat the same information regarding vulvodynia, its treatment, or its symptoms. In this article, we will address the question “how to diagnose vulvodynia and the entire testing procedure.”

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Diagnosis and Management of Vulvodynia

A thorough history is collected, infectious or dermatologic abnormalities are ruled out, and discomfort is evoked in response to light pressure on the labia, introitus, or hymenal remnants.

Several therapy methods have been tried, however research on many of them is lacking. Among the effective treatments are tricyclic antidepressants, selective serotonin reuptake inhibitors, anticonvulsants, pelvic floor biofeedback, cognitive behavioural therapy, local therapies, and (rarely) surgery. The majority of women experience a significant improvement when one or more therapies are employed.

Vulvodynia is characterised by vulvar pain that can range from mild to severe and incapacitating. Most women’s diagnoses are based on a consistent history, the absence of a confirmed infectious or dermatologic aetiology, and discomfort when mild pressure is given to the vulva, introitus, or hymenal areas with a cotton swab. The pain is common during and after intercourse, and other things may aggravate it (e.g., bicycle riding, tampon insertion, extended sitting, wearing tight garments).

Testing Method For Vulvodynia

cotton swab or Q-tip The test is part of a multidisciplinary approach to diagnosing female sexual discomfort, specifically vulvodynia or vestibulodynia. A mental health practitioner conducts a psychological interview to assess vulvodynia. A biologic oriented health care provider, such as a sexual medicine physician, gynaecologist, or physical therapist, does the clinical interview and physical examination.

The clinician should receive extensive information on the woman’s pain history, current reasons for seeking therapy, pain mediators and the impact pain has on many aspects of her life, comorbid disorders, and treatment history and outcomes during the interview. Pain, sexual and psychological functioning, and relationship adjustment are all assessed using self-administered standardised questionnaires.

Following the clinical interview, the patient is placed in stirrups in the lithotomy position for the physical examination. The patient is advised to relax as much as possible. The health care practitioner is positioned comfortably and communicates all manoeuvres to the patient. The labia minora are gently retracted laterally with a gauzpad to reveal the vestibule. Hart’s line, which runs from the middle of the inner labia minora to the hymenal residual tissue, defines the vestibule.

Clinical Presentation

Vulvodynia symptoms may have existed since childhood or the first intercourse, or they may have emerged after years of painless sex. The pain is commonly described as “burning,” but it can also be unpleasant, stinging, prickly, or even pruritic on rare occasions, and it can range from mild to severe. Pain can be severe and continue for hours or days when aroused; women with vulvodynia typically describe hours to days of anguish following intercourse or a pelvic examination.

Allodynia (pain caused by a non painful stimulus) and hyperpathia (pain that is more than expected) allude to a neuropathic cause of vulvodynia discomfort.This classification has helped us understand why certain medications are commonly useless (e.g., corticosteroids, estrogen therapy),

Characteristics of Women with Vulvodynia

We hope this answers your question on how to diagnose vulvodynia. Women with vulvodynia are typically white, in stable, long-term relationships, have been experiencing pain for several years, and have been evaluated by multiple doctors before being diagnosed. The age range is broad, spanning from children (rarely) to adults aged 80 and more, however the majority of women with this disorder are between the ages of 20 and 50.

Vulvodynia is not associated with STDs or risk factors for STDs, but affected women are usually treated for candidal vulvovaginitis.

It was previously assumed that vulvodynia pain was caused by psychological issues. Women with vulvodynia, on the other hand, are mentally comparable to women without the illness, according to recent statistics.

Despite the fact that women with vulvodynia report a decrease in the quality and quantity of their sexual activity since the onset of symptoms, more than half have had intercourse and experienced an orgasm in the preceding month. 1 These females were just as likely to engage in other sexual behaviours as non-painful women (e.g., masturbation, receiving oral sex).

Pathophysiology

Despite ongoing study, little is understood about the etiology of vulvodynia. Women who are affected are more likely to have altered contractile features of the pelvic muscles musculature; biofeedback therapy designed to address these variations frequently results in enhanced muscular function and decreased vulvar pain.

Although women with vulvodynia have been known to be sensitive to touch in the vestibular area, it has only recently been discovered that they also have enhanced sensitivity in peripheral regions such as the upper arm or leg. It is unknown if these muscular alterations and greater systemic sensitivity are caused by the pain illness.

There is debate on whether the inflammatory infiltrate in the vulvar tissue of women with vulvodynia changes. Some studies discovered an increase in inflammatory cells or mast cells, while others discovered that inflammatory cell infiltrates were comparable in vulvodynia patients and control patients.

Vulvar biopsy specimens have recently revealed greater neuronal growth and branching in the vulvar tissue of women with vulvodynia compared to asymptomatic individuals. The cause of this increased neuronal density, as well as its involvement in vulvodynia, are unknown.