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Vulvodynia

Key sources
The following summarized guidelines for the evaluation and management of vulvodynia are prepared by our editorial team based on guidelines from the European Academy of Dermatology and Venereology (EADV 2017).
1

Guidelines

1.Screening and diagnosis

Clinical presentation: recognize that:
vulvodynia is a chronic pain condition lasting months or years before the diagnosis
B
intensity of the discomfort is often variable over time
B
significant improvement or complete remission may occur following treatment or spontaneously
B
candidiasis is frequently an initiating event
B
any acute painful vulvar, urinary or anal condition, such as infection or surgical procedure, may precede the occurrence of vulvodynia, especially if these physical events occur in a context of emotional stress.
B
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  • Differential diagnosis

2.Medical management

Lidocaine
Prescribe local anesthetics such as lidocaine 5% ointment or 2% gel, applied 15-20 minutes before penetrative sex and washing off just before penetration, mostly in patients with introital dyspareunia resulting from provoked vestibulodynia.
B
Offer long-term daily use of lidocaine in patients with vulvodynia.
A

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  • Other topical analgesics

  • Antidepressants and anticonvulsants

3.Nonpharmacologic interventions

Vulval care
Advise avoiding irritating factors in patients with vulvodynia.
B
Advise using emollient soap substitutes in patients with vulvodynia.
B

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  • CBT

  • Physiotherapy

  • Acupuncture

4.Therapeutic procedures

Transcutaneous electrical nerve stimulation: consider offering self-administered transcutaneous electrical nerve stimulation in patients with vulvodynia.
C

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  • Nerve block

  • Botulinum toxin injections

5.Surgical interventions

Vestibulectomy: consider performing vestibulectomy (posterior or total, with or without vaginal advancement to cover the defect) as a last resort in patients with vulvodynia, after failure of all available therapeutic options.
C

6.Follow-up and surveillance

Follow-up: follow-up patients with vulvodynia every 3 months until improvement. Ensure multidisciplinary long-term follow-up.
B