Differentiating overlapping symptoms of vulvodynia and pudendal neuralgia

Neuropathic Pain Masquerading as Dermatologic Symptoms: A Case of Misleading Cutaneous Presentation

Neuropathic pain presenting as dermatologic symptoms can occur when damaged or dysfunctional nerves manifest with symptoms that resemble skin-related conditions. We present a case of a 62-year-old male who presented with burning pain and redness in the perineum and gluteal cleft. Initially, the patient was treated for dermatologic symptoms, resulting in the resolution of erythema. However, the pain persisted, prompting a neurologic workup. Despite the improvement of skin symptoms, the patient's pain persisted, prompting a neurological workup. Diagnostic imaging revealed significant degenerative changes in the lumbar spine, supporting a neuropathic etiology. This case highlights the importance of considering neurologic disorders in dermatologic practice, especially when cutaneous symptoms persist despite appropriate dermatological treatments.

Help-seeking experiences and intimate partner support in vulvodynia: A qualitative exploration

BACKGROUND

Vulvodynia is a poorly understood chronic pain condition characterized by persistent and unexplained pain in the vulva. Given the intimate nature of the pain, partners may play an important role in promoting self-management and help-seeking behaviours among women with vulvodynia.

OBJECTIVES

The current study aimed to explore the role of partner support in pain experiences and help-seeking behaviours among women with vulvodynia.

DESIGN

A qualitative interpretive design was used.

METHODS

Ten women with vulvodynia (M age = 37.9 years) were interviewed using a semi-structured non-directive topic guide. Data were analysed using reflexive thematic analysis.

RESULTS

Three themes around help-seeking experiences were constructed from the data: (1) 'It's Been a Battle' - Failed by the Healthcare System; (2) 'It's Just the Vulva' - Dismissed by Healthcare Professionals; and (3) 'I Diagnosed Myself' - The Patient Becomes the Expert. Participants described negative help-seeking experiences characterized by long delays to diagnosis, lack of awareness and understanding from healthcare professionals, minimization of symptoms, and having to advocate for and demand care. A further three themes pertaining to partner support were also developed: (1) 'That Person to Listen to You' - Source of Emotional Support; (2) 'Why Don't You Try This?' - Finding Solutions Together; and (3) 'He Forgets that it's Still There' - Vulvodynia is a Foreign Concept. Partners provided emotional support and showed empathy and understanding, and practical support by accompanying women to medical appointments and help with pain management. However, participants felt partners' understanding of vulvodynia was limited and that this impacted their relationships.

CONCLUSIONS

Findings highlight a lack of continuity of care and multidisciplinary approach to treatment, with help-seeking experiences being mainly negative in this sample. Increasing public awareness of vulvodynia and improving healthcare access is crucial to improving physical and psychological outcomes for this group. Partners can play an important role in supporting people with vulvodynia; however, other outlets of support should be further explored.

Inter- and Intra-Examiner Reliability Study of Two-Point Discrimination Test (TPD) and Two-Point Estimation Task (TPE) in the Sacral Area of Pain-Free Individuals

Tactile acuity is typically measured by a two-point discrimination test (TPD) and a two-point estimation task (TPE). In the back area, they are only conducted in the lumbar and cervical regions of the spine. Considering that such measurements have not been conducted in the sacral regions, the purpose of this study was to assess the inter- and intra-examiner reliability of the TPD and TPE at the level of the S3 segment. The study included 30 pain-free subjects aged 20-30 years. Tests were performed with a pair of stainless hardened digital calipers. The TPD was measured in two locations: 5 and 15 cm from the midline; for TPE both, points were located inside the measured area. Session 1 involved assessments by two examiners in 10-min intervals. Session 2 was measured by one examiner, at analogous intervals between tests. The TPD inter-rater reliability was excellent for mean measurements (ICC3.2: 0.76-0.8; ICC3.3: 0.8-0.92); the intra-rater reliability was excellent for mean measurements (ICC2.2: 0.79-0.85; ICC2.3: 0.82-0.86). The TPE inter-rater reliability was good to excellent for mean measurements (ICC3.2: 0.65-0.92; ICC3.3: 0.73-0.94); the intra-rater reliability for all studies (ICC2.1, ICC2.2, ICC2.3) was excellent (0.85-0.89). Two measurements are sufficient to achieve good reliability (ICC ≥ 0.75), regardless of the assessed body side.

Treatment of Vestibulodynia with Submucosal Injections of IncobotulinumtoxinA into Targeted Painful Points: An Open-Label Exploratory Study

The studies carried out to date on vulvodynia treatment with botulinum neurotoxin type A (BoNT/A) have followed generic injection protocols and reported contradictory outcomes on its effects. The aim of the present study was thus to propose a protocol for injecting BoNT/A into targeted painful points, to comprehensively assess the clinical effect of BoNT/A treatment and identify the risk/protective factors for successful treatment. Thirty-five vestibulodynia patients were treated with submucosal injections of incobotulinumtoxinA and assessed 8, 12 and 24 weeks after their treatment. Their clinical and pelvic statuses were assessed from self-reported questionnaires (Visual Analogue Scale (VAS), Female Sexual Function Index (FSFI), Marinoff's Dyspareunia Scale (MDS), Hospital Anxiety and Depression Scale (HADS), Catastrophizing Scale (CS)), physical examinations and surface electromyography (sEMG). The patients reported a reduction in provoked vestibulodynia (FSFI, p < 0.01; Collapse

Key Words

• algometer
• botulinum toxin A
• sexual function
• surface electromyography
• vestibulodynia
• vulvodynia

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MESH Headings

• Humans
• Female
• Vulvodynia/drug therapy
• Botulinum Toxins, Type A/therapeutic use
• Pain
• Pain Threshold

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Affiliation(s)

Paula Villa-Muñoz Servicio De Ginecología Y Obstetricia, Hospital Universitari I Politècnic La Fe, 46026 Valencia, Spain; (P.V.-M.); (F.J.N.-A.)
Monica Albaladejo-Belmonte Centro De Investigación E Innovación En Bioingeniería (CI2B), Universitat Politècnica De València, 46022 Valencia, Spain;
Francisco J. Nohales-Alfonso Servicio De Ginecología Y Obstetricia, Hospital Universitari I Politècnic La Fe, 46026 Valencia, Spain; (P.V.-M.); (F.J.N.-A.)
Jose Alberola-Rubio Sonda Devices S.L., 46004 Valencia, Spain;
Javier Garcia-Casado Centro De Investigación E Innovación En Bioingeniería (CI2B), Universitat Politècnica De València, 46022 Valencia, Spain;

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Dermatographism with vulvar symptoms

Dermatographism (DG) is characterized by a localized, inducible, wheal-and-flare response along the distribution of mechanical pressure. We report an illustrative case of DG with vulvar symptoms (DG-VS) and review the literature on this rarely recognized but easily treated etiology of vulvar complaints. A 35-year-old woman presented with a 1-year history of vulvar pruritus unresponsive to antifungal, antibacterial, and steroid treatments. A prior punch biopsy was nondiagnostic. Vulvar examination revealed normal architecture and no cutaneous abnormalities. She was markedly dermatographic with a scratch test. DG-VS was diagnosed. The patient achieved complete symptomatic control on low-dose hydroxyzine. She maintains excellent control at 3.5 years. In the literature, a typical patient with DG-VS is of reproductive age, with several years’ history of vulvar symptoms (itching, burning, pain, or swelling) and repeated empiric treatment for infectious/inflammatory etiologies. Exacerbation with sexual activity, menstruation, or wearing tight clothing is characteristic and supports the role of mechanical pressure in inducing focal symptoms. Dermatologic changes to the vulvar skin are rarely noted. DG-VS is diagnosed based on clinical findings, symptom patterns, and a positive scratch test and is treated with antihistamines. DG-VS remains absent from current vulvar disease guidelines. In the complex world of vulvar pain and itch, an etiology so easily screened for and readily treated warrants consideration.

Diagnostic and therapeutic algorithm for pudendal nerve entrapment syndrome

Pudendal nerve entrapment syndrome is widely unknown and often misdiagnosed or confused with other pelvic floor diseases. The aim is to develop a diagnostic and therapeutic algorithm based on a review of the existing literature. For its diagnosis, an anamnesis will be carried out in search of possible aetiologies, surgical history, and history of pain, assessing location and irradiation, intensity on the visual analogue scale, timing, triggering factors and rule out alarm signs. A physical examination will be performed, looking for trigger points or areas of fibrosis with transvaginal / transrectal palpation of the terminal branches of the nerve. With a doubtful diagnosis, an anaesthetic block of the pudendal nerve can be performed. Once the diagnosis is confirmed, the treatment will begin staggered with lifestyle changes, drug therapy and physiotherapy. In view of the failure of these measures, invasive therapies such as botulinum toxin injection, pulsed radiofrequency and decompression surgery or spinal cord stimulation will be used.