Pelvic Floor and Other Pelvic Disorders
Vulvodynia
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Definition
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Vulvar discomfort occuring in the absence of relevant visible findings or a specfici, clinically-identifiable, neurological disorder.
Symptoms
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- Burning
- Stabbing
- Stinging
- Itching
- Allodynia (light touch perceived as pain)
- Hyperalgesia (mildly noxious stimulus perceived as severely noxious)
- Functional limitation (e.g. pain during intercourse, using tampons, sitting)
Diagnosis
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Symptoms should be present for 3-6 months before this diagnosis is considered.
Other conditions that should be ruled out include;
- Vulvovaginal candidiasis
- Bacterial vaginosis
- Trichomoniasis
- Genital herpes
- Neuropathic viruses (e.g. Herpes zoster)
- HPV
- Lichens simples chronicus
- Lichens simples sclerosus
- Lichens planus
- Contact dermatitis
- Atrophic vaginitis
- Squamous cell carcinoma
- Pudendal nerve injury
- Referred pain from sacral nerve roots after disc injury
- Neurologic disease (e.g. MS)
Classifications
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Generalized vulvodynia;
- Almost constant, typically burning pain
- Affects the entire vulva
- Provoked (sexual, non-sexual or both)
- Unprovoked
- Mixed (provoked and unprovoked)
Localized vulvodynia / vestibulodynia;
- Localized to vulvar vestibule
- Burning / cutting pain at entrance of vagina
- Provoked (sexual, non-sexual or both)
- Unprovoked
- Mixed (provoked and unprovoked)
Co-Morbidities
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- Interstitial cystitis
- Fibromyalgia
- Irritable Bowel Syndrome
- Depression
- Dyspareunia
- TMJ or facial pain
- Overactive pelvic floor
Dyspareunia / Vaginismus[edit | edit source]
Definition[edit | edit source]
Dyspareunia: Painful vaginal penetration in the absence of disease
Vaginismus: Inability to penetrate due to spasm of the muscles
Causes[edit | edit source]
- Painful scar / episotomy
- Vulvodynia - Interstitital cystitis
- Protective response to infection, inflammation, injury or decreased estrogen or fear
Lichens Simplex[edit | edit source]
- Chronic irritation of the vulva
- Leads to itching, scratching and thickening of the skin
- Vulva can be weepy, causing moisture
Lichens Sclerosis[edit | edit source]
- Auto-immune disorder
- Itching or burning
- Skin with white patches
- Scars and adhesions of the vulva
- Easily bruised and torn
Lichens Planus[edit | edit source]
- Chronic mucocutaneous disease
- Itching or burning
- Scar adhesions
- On the vulva and in the vagina
- Affects other mucosal membranes e.g. oral, genital, esophageal - oral rash typically occurs first
- Significant pain
Desquamative Inflammatory Vaginitis[edit | edit source]
Definition[edit | edit source]
- Profuse discharge with irritation of the vulva and vagina
- Inflammation causes the vaginal wall to peel or shed (desquamation)
- No cancerous, contagious or bacterial origin known
Signs and Symptoms[edit | edit source]
- Pus-like yellow/green discharge
- May be vulvar burning and itching
- Usually no odour
- PAP smear may be abnormal
- No improvement with anti-biotics or anti-fungals
Atrophic Vaginitis[edit | edit source]
- Decreased estrogen causes thinning of the vaginal epithelium leading to inflammation
- Can cause vaginal soreness, itching and dyspareunia
- Sores and cracks can occur spontaneously
- Can have an odours discharge
Interstitial Cystitis / Painful Bladder Syndrome[edit | edit source]
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