Multidisciplinary Approach Works Best for Vulvodynia

By Wendling, Patrice | Clinical Psychiatry News, May 2008 | Go to article overview

Multidisciplinary Approach Works Best for Vulvodynia


Wendling, Patrice, Clinical Psychiatry News


CHICAGO -- Vulvodynia is best managed with a multidisciplinary approach with a multidisciplinary approach using a wide variety of therapeutic options, Dr. Hope K. Haefner said at a conference on vulvovaginal diseases sponsored by the American Society for Colposcopy and Cervical Pathology.

Vulvodynia is a complex pain disorder that can be challenging to treat. Although spontaneous remission of symptoms has occurred in some women, rapid resolution of symptomatic vulvar pain is unusual, even with appropriate therapy.

Pain can be continuous or intermittent, and is often aggravated by activities such as sitting, riding, or sexual intercourse. The treatment of vulvar pain is confounded by the fact that the etiol ogy is unknown in most cases.

"I don't think it's one disease, so I don't think there's going to be one cure," said Dr. Haefner, a recognized expert on the subject, and professor of obstetrics and gynecology and codirector of the University of Michigan Center for Vulvar Diseases.

Vulvar care measures to review with patients include using mild soaps for bathing, avoiding soap on the vulva, keeping the vulva dry without the use of hair dryers, wearing white 100% cotton underwear during the day, and sleeping without underwear. Wicking briefs can be used if sweating is a problem.

If menstrual pads are irritating, 100% cotton pads may be helpful, but the drawback is that none are disposable. Dr. Haefner expressed concern about the use of Always brand sanitary pads, which was a common variable among patients with vulvodynia in a small Canadian case series (Can. Med. Assoc. J. 1996;154:1173-6). "I can't tell you how many patients come back and say that one of the reasons they think they got better is that they stopped using the Always [pads]," she said.

Procter & Gamble, the manufacturer of Always, stated in a letter that its premarket clinical trials, which included more than 1,500 women and specifically evaluated the genital area, did not detect "any increased risk (either in frequency or severity) of irritation as a result of Always products in comparison with other marketed products. ... These studies and other research conducted over the years have shown that a low baseline level of vulvar irritation can be diagnosed during menstruation and at other times, independent of the feminine protection product used." (Can. Med. …

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