Why this book? Women have an intimate problem: chronic vulvar pain, or vulvodynia, as it is termed in medical phraseology. Vulvodynia may affect 12-15% of women: it is therefore a common disorder that every family doctor and every gynecologist can encounter every day in his or her routine work.
The first good reason to write – and read – this book is that although vulvodynia is frequent, it typically remains unaddressed for years. Indeed, this genital pain is neglected by the majority of physicians because it is perceived as difficult to deal with or as “psychogenic” and therefore more of an issue for psychologists than for medical doctors. In fact, in contrast to this outdated view, vulvodynia is a disorder with solid biological causes that are absolutely within the domain of a medical diagnosis.
Like all types of pain, vulvodynia can be multifactorial. Diagnosis requires careful listening to the woman’s symptoms, accurate reading of vulvodynia’s pathophysiology, a competent physical examination focused on detecting all the clinical signs, and renewed attention to the frequent comorbidities (medical and sexual) that may accompany vulvar pain.
The most frequent medical comorbidities are bladder symptoms (postcoital cystitis, bladder pain syndrome), endometriosis, irritable bowel syndrome, fibromyalgia, and headache. Among the sexual comorbidities, coital pain (dyspareunia) is the leading symptom, with its accompanying cohort of secondary loss of desire, vaginal dryness, orgasmic difficulties, and sexual dissatisfaction that can deeply affect a couple’s relationship.
The clinical method for addressing pain of any kind is familiar to every physician: it only requires to be specifically focused on the vulvar area, with a specially sensitive and gentle approach. Why? Because vulvodynia involves the most secret part of the body – the vulva and the introitus of the vagina – and sometimes it may be difficult to disclose problems in this area even to the most intimate of friends. Curing vulvodynia can be an extremely rewarding experience, as cure offers the affected woman a real chance of regaining her full level of wellbeing, with a satisfying intimate life and the possibility of making love again with passion and joy.
Why tips and tricks? To ease the route to a correct diagnosis for every physician who is motivated to help women presenting with genital/vulvar pain. Yes, a physician’s life is professionally too busy. We all have little time to update our knowledge, there are multiple issues, and we all need concise, distilled information that will assist us in rapidly understanding the essence of a clinical picture.
This is why we accepted the challenge of writing a “tips and tricks” version of a clinical book: to offer a synthesis of current knowledge that is easy to read and consult, is quick to the point, and will increase physicians’ confidence in their ability to make a competent diagnosis and to prescribe effective first-line therapy. With this in mind, practical tips are included in every chapter, in a different color, so that the reader will be able to translate epidemiological or pathophysiological considerations into concrete help in the clinical setting from the outset.
In brief, our goal is to empower physicians to rapidly address vulvodynia and its associated comorbidities. The sooner, the better.
- Alessandra Graziottin, MD -
Contents
- 1 Epidemiology of Vulvar Pain and its Sexual Comorbidities
- 2 Vulvodynia – What’s Behind the Name?
- Characteristics and Etiology of Vulvar Pain
- Definitions of Vulvodynia
- Impact of Vulvodynia on Physical and Psychosexual Health
- 3 Vulvodynia and Dyspareunia – How Should they be Addressed?
- Addressing Sexual Issues in the Clinical Setting
- Vaginismus and Dyspareunia: How Can they Contribute to Vulvodynia?
- Pathophysiology
- Clinical Approach: Taking a Clinical History
- Practical Tips
- 4 Postpartum Dyspareunia and Vulvodynia
- The Prevalence of Postpartum Dyspareunia
- Persistent Morbidity and Lack of Professional Recognition
- Prevention of Postpartum Dyspareunia/Vulvodynia
- Accurate Pelvic Floor Training During Pregnancy
- Adequate Assistance at the Second Stage of Labor
- Postpartum Therapy
- 5 What Women with Vulvodynia Complain of: Evaluation of Vulvar Pain
- 6 How Vulvodynia Originates: the Pathophysiology of Vulvar Pain
- How Complex Is Vulvar Pain Transmission into the Central Nervous System?
- What Happens in Neuropathic Pain and why Can We Consider Vulvodynia as a Neuropathic Pain Syndrome?
- Triggers
- What Is the Relationship Between Vestibulodynia and Generalized Vulvodynia?
- What Is the Role of Pelvic Floor Dysfunction?
- What Is the Role of Hormonal Alteration as a Potential Cause of Vulvodynia?
- How Relevant Are Psychosexual Factors in Vulvodynia Patients?
- Why Is There a Frequent Association Between Vulvodynia and Other Chronic Pain Conditions?
- 7 How to Make a Comprehensive Diagnosis of Vulvodynia and its Comorbidities
- Medical History
- Physical Examination
- Diagnoses to Rule out
- Pelvic Floor Evaluation
- Vaginal Inspection
- Tests
- 8 How to Treat Vulvodynia
- Reduction of Triggers and Irritating Stimuli
- How to Reduce Pain in Vulvodynia
- Peripheral Nociceptive Blockade and Central Inhibition
- Oral Agents
- Trigger Point Injection
- Pudendal Nerve Block
- Surgery
- Action Towards Associated Pelvic Floor Dysfunction
- Action Towards Psychosexual Ramification of the Syndrome
- Case Studies
- Case Study: “Julie”
- Case Study: “Sally”
- References
About the Authors
- Alessandra Graziottin, MD is Director of the Centre of Gynecology and Medical Sexology at the H. San Raffaele Resnati in Milan, Italy. She is Chairman of the “Alessandra Graziottin Foundation for the cure and care of pain in women”, which she founded in 2008. Dr. Graziottin has published 15 scientific books (as author, co-author or editor), more than 70 chapters of scientific books, 80 refereed and 240 non refereed papers, 6 lay books and several educational booklets for women. She is Coordinator of the Special Interest Area “Pelvic Pain” and Member of the National Observatory on Sexual Habits and Contraceptive Choices of the Italian Society of Gynecology and Obstetrics (SIGO). She is also Member of the European Working Group of FSDeducation.eu, that develops CME-certified educational material on Female Sexual Dysfunction. She is currently a board member of the Italian Society of Preventive and Social Pediatrics (SIPPS) and Vicepresident of the Italian Society of Psychosomatic Gynecology and Obstetrics (SIPGO). In 2004 she was awarded the Honorary Membership by the Society of Obstetricians and Gynecologists of Canada (SOGC). She has given more than 970 lectures at international and national meetings and courses.
- Filippo Murina, MD is currently First Referent of the Outpatient Department of Vulvar Disease at the V. Buzzi Hospital of Milan, Italy. He received his medical degree at the University of Milan in 1989, where he achieved the specialization in Gynecology and Obstetrics in 1994. Since 2006 he has been Founder and Scientific Director of the Italian Vulvodynia Association (AIV). He is currently a board member of the Italian Society of Vulvology (SIIV), Fellow of the International Society for the Study of Vulvovaginal Disease (ISSVD) and Member of the European College for the Study of Vulval Diseases (ECSVD). He was advisor as Reviewer of the European Journal of Obstetrics & Gynecology and Reproductive Biology, the American Journal of Obstetrics and Gynecology, the Journal of American Academy of Dermatology and the Journal of Women’s Health. Dr. Murina has published 6 scientific books (as author, co-author or editor), 80 papers and proceeding contributions; his recent study on vulvodynia therapy has been published on the British Journal of Obstetrics and Gynecology. As a leading expert in vulvar diseases and vulvar pain, he has given more than 60 lectures at meetings and courses. Since 2008 he has been regular columnist and advisor in Italian health magazines.
Product Details
- Hardcover: 110 pages
- Publisher: Springer; 1st edition (July 29, 2011)
- Language: English
- ISBN-10: 8847019257
- ISBN-13: 978-8847019256
- Product Dimensions: 9.3 x 6.2 x 0.5 inches
List Price: $139.00