Pelvic Floor and Other Pelvic Disorders

Vulvodynia

Definition

Vulvar discomfort occuring in the absence of relevant visible findings or a specfici, clinically-identifiable, neurological disorder.

Symptoms

• 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

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

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

• Interstitial cystitis
• Fibromyalgia
• Irritable Bowel Syndrome
• Depression
• Dyspareunia
• TMJ or facial pain
• Overactive pelvic floor

Dyspareunia / Vaginismus

Definition

Dyspareunia: Painful vaginal penetration in the absence of disease

Vaginismus: Inability to penetrate due to spasm of the muscles

Causes

• Painful scar / episotomy
• Vulvodynia - Interstitital cystitis
• Protective response to infection, inflammation, injury or decreased estrogen or fear