Вульва аймағының созылмалы ауыру синдромы

Chronic pain syndrome of the vulvar area

Vulvodynia is a chronic pain condition that affects the vulvar area and occurs without an identifiable cause. Symptoms typically include a feeling of burning or irritation. It has been established by the ISSVD that for the diagnosis to be made symptoms must last at least three months. The causes of vulvodynia are not fully understood, but there are many sub types of vulvodynia with different causes, The pain can be provoked by touch ("provoked") or constant ("unprovoked"). Some cases of vulvodynia are idiopathic where no specific cause can be determined.

Vestibulodynia, formerly known as vulvar vestibulitis syndrome (VVS), or simply vulvar vestibulitis, refers to pain localized to the vestibular region. It tends to be associated with a highly localized "burning" or "cutting" type of pain. Vestibulodynia is the most common subtype of vulvodynia that affects premenopausal women – the syndrome has been cited as affecting about 10%–15% of women seeking gynecological care.

The pain of vulvodynia may extend into the clitoris; this is referred to as clitorodynia. Clitorodynia may be sometimes caused by clitoris adhesions, a condition where the hood of the clitoris becomes stuck to the clitoris itself. Symptoms may include pain, hypersenstivity, hyposensitivity, difficulty with arousal, muted or absent orgasm. Clitoral adhesions are common among female patients with lichen sclerosus, but also occur among the general population. The prevalence of clitoral adhesions is unknown. Clitorodynia has been neglected in medical research and under recognized in clincical practice.

Vulvodynia has many different sub types and causes. The disease is highly idiopathic. Identifying the cause is important to determine the appropriate treatment. Pain confined to the vulval vestibule, known as vestibulodynia, has at least three known sub types: neuroproliferation, hormonally mediation, and inflammation. Neuroproliferation can be present from birth or acquired later in life. This type of vestibulodynia is known as neuroproliferative vestibulodynia. Hormonally mediated vestibulodynia can be caused by hormonal medications like oral birth control. Inflammatory vestibulodynia can develop as part of an immune response. Other possible causes include Sjögren syndrome, the symptoms of which include chronic vaginal dryness. Others include genetic predisposition to inflammation, allergy or other sensitivity (for example: oxalates in the urine), an autoimmune disorder similar to lupus erythematosus or to eczema or to lichen sclerosus, infection (e. g., yeast infections, bacterial vaginosis, HPV, HSV), injury, and neuropathy—including an increased number of nerve endings in the vaginal area. Some cases seem to be negative outcomes of genital surgery, such as a labioplasty. Initiation of hormonal contraceptives that contain low dose estrogen before the age of 16 could predispose women to vulvar vestibulitis syndrome. A significantly lower pain threshold, especially in the posterior vestibulum, has also been associated with the use of hormonal contraceptives in women without vulvar vestibulitis syndrome. Pelvic floor dysfunction may be the underlying cause of some women's pain. Many co morbidities are commonly associated with vulvodynia, including fibromyalgia, irritable bowel syndrome, interstitial cystitis, pelvic floor dysfunction, endometriosis, depression and anxiety disorders.

The condition is one of exclusion and other vulvovaginal problems should be ruled out. The diagnosis is based on the typical complaints of the patient, essentially normal physical findings, and the absence of identifiable causes per the differential diagnosis. Cotton swab testing is used to differentiate between generalized and localized pain and delineate the areas of pain and categorize their severity. Patients often will describe the touch of a cotton ball as extremely painful, like the scraping of a knife. A diagram of pain locations may be helpful in assessing the pain over time. The vagina should be examined, and tests, including wet mount, vaginal pH, fungal culture, and Gram stain, should be performed as indicated. Fungal culture may identify resistant strains. Surveys have estimated that only about half of the women who meet the criteria for vulvodynia will seek medical help. Many gynecologists are not familiar with this family of conditions. Affected women are also often hesitant to seek treatment for chronic vulvar pain, especially since many women begin experiencing symptoms around the same time they become sexually active. Moreover, the absence of any visible symptoms means that before being successfully diagnosed many patients have been told that the pain is "in their head". The misattribution of women's vulvo vaginal pain to a psychological origin rather than a medical one is traceable back to the influence of Freudian psychoanalysis.

There are a number of possible treatments with none being uniformly effective. It has successful long term outcomes, but is often only offered after conservative measures have failed.

A number of lifestyle changes are often recommended such as using cotton underwear, not using substances that may irritate the area, and using lubricant during sex.

The percentage of women affected is not entirely clear, but estimates range between 10 28%. patients have formed communities to help each other access healthcare and to advocate for better recognition of the disease. Founded in 1994, the National Vulvodynia Association (NVA) is a non profit that helps connect patients to each other and to medical providers who can help them. They maintain a healthcare provider referral list and have geographically organized patient support groups. The NVA secured the first funding for vulvodynia research in the 1990s, and it continues to provide seed grants for research on vulvodynia. Tight Lipped is a second, younger community of vulvodynia patients. Founded in 2019, Tight Lipped started as a story telling podcast focused on ending the stigma and mystery surrounding vulvovaginal pain. It has evolved into a grassroots, patient led organization devoted to changing how chronic vulvovaginal pain conditions like vulvodynia are understood by the medical community and by society. There are several online communities of patients on sites like Facebook and Reddit. Because medical knowledge is so hard to access, patients resort to other patients' knowledge to get help.