276 Obstetrics and Gynecology Board Review •••
❍ What recurrent infection of the vagina has also been associated with vulvodynia development?
Yeast infection.
❍ What should be sent for everyone with vulvar or vaginal burning pain before diagnosing vulvodynia?
Yeast culture.
❍ What form of vulvodynia can antispasmodics and benzodiazepine vaginally treat?
Vaginismus or myofascial pain.
❍ What other chronic pain syndromes can cause dyspareunia?
Chronic bladder pain or spasms, chronic pelvic pain, irritable bowel syndrome, and interstitial cystitis.
❍ What last resort surgical treatment can you offer to a patient with vulvodynia?
Vestibulectomy.
❍ What is the success rate of vestibulectomy?
Approximately 50% will have improvement, 25% remain the same, and 25% have worsening pain.
❍ What is commonly found in patients with vulvodynia?
Depression.
❍ What is the name for point pain at the clitoris?
Clitordynia.
❍ What inflammatory disorders can cause vulvar pain?
Atrophic vaginitis, desquamative vaginitis, lichen sclerosis, lichen simplex chronicus, lichen planus, and
Behcet disease.
❍ What is the most common physical examination finding seen with someone who has vulvodynia?
Erythema.
❍ What are theorized causes of vulvodynia?
Increased urinary oxalates, immune factors, genetic factors, infection, inflammation, and neuropathic changes.
❍ If atrophic changes are noted with a patient reporting vulvar pain, what is the recommended treatment?
Topical estrogen at area of pain or atrophic changes.
❍ Injectable treatment of focal vulvar pain include what?
Trigger point injections with lidocaine or bupivacaine and steroid injections every 3 months.