Vulvodynie: een uitdaging voor artsen

Abstract

Vulvodynia: a challenge for physicians Vulvodynia is characterized by vulvar pain present for at least 3 months and for which no other cause can be found. The complaints can be localized, generalized or mixed, may occur spontaneously or be provoked, primary or secondary, intermittently or continuously, and immediately after the triggering stimulus or delayed. The underlying pathogenesis mainly involves hyperinnervation and hypersensitization of both the peripheral and central nervous systems. This is elicited by an abnormal response to an initial trigger. The diagnosis is made through a comprehensive history and clinical examination using the cotton swab test. Other causes for the complaints must be excluded. Treatment requires an individual and multidisciplinary approach and a lot of patience. Comprehensive counselling of the patient about the expected duration and results of the treatment is crucial, so that realistic expectations are set. In primary care, attention should mainly be paid to behavioural changes regarding vulva care. In addition, psycho- and physiotherapy are indispensable. To this date, there is little evidence for the added value of drug therapy compared to a placebo. Experts recommend a topical treatment first. In second line, a switch can be made to oral therapy or local injections. Surgery can be an effective treatment, but given its invasive nature, it should only be considered if other treatments have not been successful. Alternative treatments include acupuncture and hypnosis.