Vulvar Pain in Adolescents
Adolescence is the life period when vulvar pain of various etiologies, and specifically vestibulodynia/vulvodynia, begins to be diagnosed, investigated, and treated (Bachmann et al. 2006; Clare and Yeh 2011; Graziottin and Murina 2011; Reed et al. 2014).
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Vulvar Pain in Adolescents
Adolescence is the life period when vulvar pain of various etiologies, and specifically vestibulodynia/vulvodynia, begins to be diagnosed, investigated, and treated (Bachmann et al. 2006; Clare and Yeh 2011; Graziottin and Murina 2011; Reed et al. 2014). The focus of this chapter will be the analysis of different types of vulvar pain in nulliparous adolescents (please see Chap. 7). Vulvar pain and its different etiologies will be presented with a pathophysiologic reading, carefully based on adolescents’ wording, listened to and questioned during almost four decades of clinical practice by one of the authors (AG) (“practice-based evidence”) and continuously and dynamically analyzed with the ongoing scientific evidence (“evidence-based medicine”). Vestibulodynia/clitorodynia/vulvodynia are subsets of the vulvar pain. The International Society for the Study of Vulvar Diseases defines vulvodynia as a chronic pain or discomfort involving the vulva for more than 3 months and for which no obvious etiology can be found (Haefner 2007). Vulvodynia descriptors are summarized in Box 6.1. If the etiology is evident (e.g., lichen sclerosus can affect adolescence as well), then the woman has chronic vulvar pain secondary to lichen sclerosus, if this is the only finding (Sadownik 2014). Thus, vulvodynia is a diagnosis of exclusion. However, the woman could also have both conditions, lichen sclerosus and vestibulodynia that should be carefully evaluated.
Box 6.1. Vulvodynia Descriptors
• Women and adolescents with vestibulodynia/vulvodynia do not usually use the word “pain” to describe their discomfort. • They use words such as itching, burning, stinging, irritation, stabbing, and/or rawness.
© Springer International Publishing Switzerland 2017 A. Graziottin, F. Murina, Vulvar Pain, DOI 10.1007/978-3-319-42677-8_6
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6 Vulvar Pain in Adolescents
• The classification of vulvodynia is currently based on a description of the pain: –– The adolescent’s symptoms may be: • Generalized to the whole vulva (generalized vulvodynia) • Localized to a specific area such as the clitoris (clitorodynia) or the vestibule of the vagina (vestibulodynia) –– The pain may be: • Provoked (caused by direct touch, inserting a tampon, or sexual touch) –– Unprovoked (spontaneous, i.e., present without touch) –– Mixed (Haefner 2007)
Unfortunately, many healthcare providers (HCPs) consider the “dynia” group the paradigm, the unique essence of vulvar pain, which is not. Therefore, a careful listening to and reporting in the medical record of the precise adolescent’s wording may help to exactly qualify her vulvar complaint. Of note, many predisposing, precipitating, and perpetuating factors are not usually described in the population study on vulvodynia. They will be discussed here because also a few clinical cases may inspire a more comprehensive reading of the complex pathophysiology of vulvar pain. Predictors and vulnerabilities will be briefly considered as well. Preventive strategies with a few key points on treatment
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