RE: National Vulvodynia Association - Winter Issue - Great News!

February 5, 2008

These symptoms include abnormal responses, such as extreme sensitivity to pinprick,

what does this mean, how/where do they do pinprick? How is that associated with PN?

please explain

thanks

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February 5, 2008

I

thought I would add some more information from the newsletter -

In

their last paragraph their summary states: in conclusion, unfortunately,

chronic vulvar pain is a significant problem in women that is not well managed

by the majority of practitioners. It is still commonplace for women to remain

undiagnosed and repetitively told there is nothing wrong and to “just relax”.

As the diagnoses of pudendal neuralgia and pudendal nerve entrapment become

well known, some of the mystique of Vulvodynia may be eliminated. A careful

vulvar evaluation, including a sensory exam, is a necessary part of the

diagnostic procedure in women with chronic vulvar pain. Hypersensitivity to a

pinprick is a sign of neuropathy and helps confirm a diagnosis of pudendal

neuralgia: once diagnosed, effective interventions and medical therapies are available.

If severe pain with sitting is a significant component of the pain syndrome and

medical management is not successful, the patient should be evaluated for

pudendal nerve entrapment. If the patient is an appropriate candidate for

surgical decompression, the procedure can lead to a significant improvement in

quality of life.

In

addition - in the article some of the other highlights were: One criterion that

strongly indicates the need for a surgical procedure is pain that is brought

on, or significantly worsened, by sitting, but relieved by standing or sitting

on the toilet. The most significant reason to use surgical intervention with

pudendal nerve entrapment is an inability to sit due to pain. Medications –

sometimes a combination of two medications at modest doses works better than a

higher dose of one medication, because lower doses limit side effects.

Activities, such as cycling, horseback riding, and squatting, must be

eliminated. The most problematic for a woman is the need to eliminate prolonged

periods of sitting at their place of work. The main risk factors for the

development of pudendal neuralgia or pudendal nerve entrapment are related to

damage to the nerve, or prolonged compression. Risk factors include being thin

(with thin to little or no butt), repetitive prolonged sitting, cycling,

horseback riding, early excessive exercise, gymnastics, dance, excessive

straining due to constipation, falls onto the buttock and sometimes surgical

procedures (hysterectomies and childbirth). Women with pudendal neuralgia have

diffuse vulvar pain, usually referred to as burning, but sometimes described as

a deep aching or throbbing. It can be constant and quite severe.

Gereralized,

as opposed to localized, Vulvodynia is characterized by diffuse, unprovoked burning

or other type of vulvar pain. A thorough evaluation by a vulvovaginal

specialist will typically separate women with generalized Vulvodynia into one

of several different categories. The three main categories are: (1)

inflammatory vaginitis and desquamative inflammatory vaginitis (2) disorders of

infectious origin, most commonly recurrent yeast vulvovaginitis; and (3)

neuropathic pain disorders, most likely pudendal neuralgia (pain along the

distribution of the pudendal nerve).

In

fact, the vast majority of women commonly diagnosed as having generalized

Vulvodynia exhibit symptoms characteristic of neuropathic pain. These symptoms

include abnormal responses, such as extreme sensitivity to pinprick, during a

sensory exam of the vulva. Women with chronic vulvar pain who exhibit

hyperalgesia and other neuropathic pain symptoms would be more appropriately

classified as having pudendal neuralgia.

Nowhere

in the whole newsletter is there any mention of physical therapy!!!!! Very

disturbing and the NVA should be notified that this is a viable therapy

Copied

from NVA newsletter – Winter 2007

nne

From:

VulvarDisorders [mailto:VulvarDisorders ] On

Behalf Of winterberrypath

Sent: Tuesday, February 05, 2008 2:58 PM

To: VulvarDisorders

Subject: National Vulvodynia Association - Winter Issue - Great

News!

I got my NVA newsletter today. Up until today I

was never very

impressed with the newsletters as they basically never said anything

worth any substance (my opinion). And I know they have publication

costs, but it is expensive to subscribe. Although recently, I know of

someone who wrote and said they could not afford it and they got

their subscription for free.

But to get back to the point - this issue was fantastic! I would

encourage everyone to get their hands on a copy if they can. It

covers everything we have discussed on this forum , but in great

detail. I wish I had the text that I could reprint here. It discussed

differentiating Vulvodynia and Pudendal Neuralgia and multilevel

nerve blocks in the treatment of Vulvodynia. There was information on

medication and management of both conditions, including a fantastic

diagram of the pelvis and where all the nerves are located. I

particularly liked the information they provided on nerve blocks. It

also discussed the studies that are now being conducted and what

outcome is expected.

The NVA also released the first continuing medical education

accredited online vulvodynia tutorial. It is free and includes a self-

guided presentation on the prevalence, differential diagnosis,

treatment and proposed etiology of chronic vulvar pain. To access the

tutorial, go to http://learn.nva.org. You

can also get the Vulvodynia

Awareness Campaign information packet by contacting the NIH Resource

Center at 1- - or the National Women's Health Resource

Center at www.Healthywomen.org or 1-

nne

February 5, 2008