Abstract • Symptomatic vulvar burning (vulvodynia) in the absence of abnormal physical findings was long thought to be an unusual psychosomatic gynecologic problem. Within the past decade, however, a number of investigators began to study patients with this frustrating problem. Initial physician insistence on a major role for psychological factors has gradually given way to sophisticated searches for evidence of persistent infectious agents, especially human papillomavirus and Candida. Gynecologists searching for causes and surgical relief of vulvodynia have even reevaluated elements of vulvar anatomy. The purpose of this article is to introduce dermatologists to current perspectives on vulvodynia in the context of the clinical experience of the author, who has been actively involved in the multidisciplinary investigation of this problem since its recognition in the early 1980s. To date, the following five sign-symptom complexes have been identified by the author and recognized by other vulvodynia investigators: (1) vulvar dermatoses, (2) cyclic vulvitis, (3) vulvar papillomatosis, (4) vulvar vestibulitis, and (5) essential vulvodynia. A given patient's complaint may be primarily associated with one of these factors, but it is not unusual to see others develop simultaneously or sequentially. Remission or exacerbation of symptoms may occur when treatment for one condition affects the onset of another. It is evident that vulvodynia is a complex diagnosis and that recognition of multiple factors is important to appropriate patient evaluation and management. (Arch Dermatol 1989;125:256-262) References 1. Tovell HM, Young AW Jr: Evaluation and management of diseases of the vulva . Clin Obstet Gynecol 1978;21:951-955.Crossref 2. Burning vulva syndrome: Report of the ISSVD task force . J Reprod Med 1984;29:457. 3. McKay M: Vulvodynia vs pruritus vulvae . Clin Obstet Gynecol 1985;28:123-133.Crossref 4. Dodson MG, Friedrich EG Jr: Psychosomatic vulvovaginitis . Obstet Gynecol 1978;51( (suppl) ):23s-25s.Crossref 5. Lynch PJ: Vulvodynia: A syndrome of unexplained vulvar pain, psychologic disability and sexual dysfunction . J Reprod Med 1986;31:773-780. 6. Sobel J: Recurrent vulvovaginal candidiasis: A prospective study of the efficacy of maintenance ketoconazole therapy . N Engl J Med 1986;315:1455-1458.Crossref 7. Witkin SS, Jeremias J, Ledger WJ: A localized vaginal allergic response in women with recurrent vaginitis . J Allergy Clin Immunol 1988;81:412-416.Crossref 8. Friedrich EG Jr: The vulvar vestibule . J Reprod Med 1987;32:773-777. 9. Reid R, Greenberg MD, Henson AB, et al: Sexually transmitted papillomaviral infections . Am J Obstet Gynecol 1987;156:212-222.Crossref 10. Growdon WA, Fu YS, Lebherz TH, et al: Pruritic vulvar squamous papillomatosis: Evidence for human papillomavirus etiology . Obstet Gynecol 1985;66:564-568. 11. Reid R, Stanhope CR, Herschman BR, et al: Genital warts and cervical cancer: Evidence of an association between subclinical papillomavirus infection and cervical malignancy . Cancer 1982;50:377-387.Crossref 12. Reid R, Stanhope CR, Herschman BR, et al: Genital warts and cervical cancer: IV. A colposcopic index for differentiating subclinical papillomaviral infection from cervical intraepithelial neoplasia . Am J Obstet Gynecol 1984;149:815-823.Crossref 13. Ferenczy A, Mitao M, Nagai N, et al: Latent papillomavirus and recurring genital warts . N Engl J Med 1985;313:784-788.Crossref 14. Reid R, Greenberg MD, Daoud Y, et al: Colposcopic findings in women with vulvar pain syndromes: A preliminary report . J Reprod Med 1988;33:523-532. 15. Turner MLC, Marinoff SC: Association of human papillomavirus with vulvodynia and the vulvar vestibulitis syndrome . J Reprod Med 1988;33:533-537. 16. Friedrich EG Jr: Vulvar vestibulitis syndrome . J Reprod Med 1987;32:110-114. 17. Pyka RE, Wilkinson EJ, Friedrich EG Jr, et al: The histopathology of vulvar vestibulitis syndrome . Int J Gynecol Pathol 1988;7:249-257.Crossref 18. Marinoff SC, Turner MLC: Hypersensitivity to vaginal candidiasis or treatment vehicles in the pathogenesis of minor vestibular gland syndrome . J Reprod Med 1986;31:796-799. 19. Woodruff D, Friedrich EG Jr: The vestibule . Clin Obstet Gynecol 1985;28:134-141.Crossref 20. Friedrich EG Jr: Therapeutic studies on vulvar vestibulitis . J Reprod Med 1988;33:514-518.
Archives of Dermatology – American Medical Association
Published: Feb 1, 1989