Vulvodynia Often Triggers Depression, Anxiety

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SAN FRANCISCO -- Vulvodynia so profoundly affects quality of life that management needs to address the physical, psychological, sexual, and relationship problems caused by the pain.

"Support, support, support" patients with vulvodynia by reassuring them that they're not crazy and validating the reality of their pain, Dr. Erika Klemperer said at a meeting sponsored by Skin Disease Education Foundation.

Refer women with vulvodynia for psychological counseling when appropriate, but be clear about why you're doing so. "It's not because we think they're crazy, but because pain makes people crazy," often triggering depression, anxiety, or other problems, said Dr. Klemperer, a private-practice dermatologist in Santa Barbara, Calif.

Vulvodynia is a diagnosis of exclusion defined as vulvar discomfort--usually a "burning" pain--occurring without any relevant visible findings or a specific, clinically identifiable, neurologic disorder. Patients may have generalized vulvodynia or vestibulodynia. An estimated 3%-16% of women experience vulvodynia during their lifetimes.

Dr. Klemperer tells patients: "I know this pain isn't in your head. This is real, and I'm going to be here to get you through this."

Make an effort to understand clearly the patient's and her partner's goals for therapy so that you can guide them toward realistic expectations, because treatment may not cure the problem but should help control the pain. There are few randomized, controlled trials on treating vulvodynia, so therapy rests on expert opinion and few data.

Treatment starts with vulvar care measures, such as avoiding all irritants. "Be really specific," she suggested. Tell patients to wash the genital area using only their fingers and water, then pat dry (not blow dry). Bland emollients may help. For lubrication during intercourse, try olive oil to avoid the preservatives in commercial products.

First-line medication would be a topical anesthetic, especially for vestibulodynia. Other topical therapies tend to burn or are ineffective. Lidocaine 5% ointment or 2% gel may be used as needed or in twice- or thrice-daily regimens. Patients also can apply it 30 minutes before sexual activity but should wipe it off before sex so that it doesn't cause numbness in their partner. …