Vol 93, No 11 (2022)
Research paper
Published online: 2021-12-03

open access

Page views 4346
Article views/downloads 2012
Get Citation

Connect on Social Media

Connect on Social Media

Vulvodynia in prepubertal girls: diagnosis

Jadwiga Wanczyk-Baszak1, Tomasz Paszkowski1, Ewa Baszak-Radomanska2
Pubmed: 35072227
Ginekol Pol 2022;93(11):867-871.

Abstract

Objectives: To identify specific features of vulvodynia in prepubertal girls, highlight potential triggers and concomitant
diseases, outline diagnostic criteria is neglected problem in adolescent gynecology.

Material and methods: A retrospective study, based on medical records of an outpatient clinic, a cohort of 54 vulvodynia cases was evaluated, aged 3–10 years, seen between January 2016 and July 2018.

Results: The study cohort presented with pain (61%), sometimes aggravated at night, pruritus (44%) and a range of
other varied and unusual vulvar complaints (26%). Concomitant diseases and/or psychological problems were present in
61% of cases. Overactive pelvic muscles accompanying symptoms like urological or gastrological problems were noted
in half of children. Several potential triggers were identified in a third of the cases that were emotionally stressful to
the children. From the commencement of symptoms, 93% of the girls have consulted more than one doctor with 43%
seeing more than three doctors, without receiving a diagnosis of vulvodynia.

Conclusions: A diagnosis of vulvodynia needs to be considered in the absence of vulva pathology with wide range of
vulvar pain, pruritus and discomfort. All persistent or recurrent vulvar discomfort must be taken into consideration as
a vulvodynia symptom, also various non-specific, worrisome complaints. Comorbid urological and gastrological symptoms associated with overactive pelvic muscles should not be overlooked. Chronic pain can be triggered by the psychological distress in some prepubertal girls. Proper diagnosis may prevent long-term negative sequelae, what emphasizes the need for professional education of healthcare providers in adolescent vulvar pain and discomfort.

Article available in PDF format

View PDF Download PDF file

References

  1. Bornstein J, Goldstein AT, Stockdale CK, et al. Consensus vulvar pain terminology committee of the International Society for the Study of Vulvovaginal Disease (ISSVD), the International Society for the Study of Womenʼs Sexual Health (ISSWSH), and the International Pelvic Pain Society (IPPS). 2015 ISSVD, ISSWSH, and IPPS consensus terminology and classification of persistent vulvar pain and vulvodynia. J Low Genit Tract Dis. 2016; 20(2): 126–130.
  2. Pukall CF, Goldstein AT, Bergeron S, et al. Vulvodynia: definition, prevalence, impact, and pathophysiological factors. J Sex Med. 2016; 13(3): 291–304.
  3. Clare CA, Yeh J. Vulvodynia in adolescence: childhood vulvar pain syndromes. J Pediatr Adolesc Gynecol. 2011; 24(3): 110–115.
  4. Hersh JE. Vulvodynia in adolescents: presentation, diagnosis and treatment options. Curr Opin Obstet Gynecol. 2018; 30(5): 293–299.
  5. Simpson RC, Murphy R. Paediatric vulvar disease. Best Pract Res Clin Obstet Gynaecol. 2014; 28(7): 1028–1041.
  6. Reed B, Harlow S, Sen A, et al. Prevalence and demographic characteristics of vulvodynia in a population-based sample. American Journal of Obstetrics and Gynecology. 2012; 206(2): 170.e1–170.e9.
  7. Harlow BL, Stewart EG. A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? J Am Med Womens Assoc (1972). 2003; 58(2): 82–88.
  8. Reed BD, Cantor LE. Vulvodynia in preadolescent girls. J Low Genit Tract Dis. 2008; 12(4): 257–261.
  9. Goldstein AT, Pukall CF, Brown C, et al. Vulvodynia: assessment and treatment. J Sex Med. 2016; 13(4): 572–590.
  10. Nunns D, Mandal D, Byrne M, et al. British Society for the Study of Vulval Disease (BSSVD) Guideline Group. Guidelines for the management of vulvodynia. Br J Dermatol. 2010; 162(6): 1180–1185.
  11. Dunford A, Rampal D, Kielly M, et al. Vulval pain in pediatric and adolescent patients. J Pediatr Adolesc Gynecol. 2019; 32(4): 359–362.
  12. Jantos M, Burns NR. Vulvodynia. Development of a psychosexual profile. J Reprod Med. 2007; 52(1): 63–71.
  13. Kennedy CM, Nygaard IE, Saftlas A, et al. Vulvar disease: a pelvic floor pain disorder? Am J Obstet Gynecol. 2005; 192(6): 1829–34; discussion 1834.
  14. Kielly M, Grover S. Vulvodynia in pre-menarchal girls: A case series. Journal of Pediatric and Adolescent Gynecology. 2016; 29(2): 206–207.
  15. Stecco A, Stern R, Fantoni I, et al. Fascial disorders: implications for treatment. PM R. 2016; 8(2): 161–168.
  16. Friedrich EG. Vulvar vestibulitis syndrome. J Reprod Med. 1987; 32: 110–14.
  17. Lewandowski AS, Palermo TM, Stinson J, et al. Systematic review of family functioning in families of children and adolescents with chronic pain. J Pain. 2010; 11(11): 1027–1038.
  18. Dalton VK, Haefner HK, Reed BD, et al. Victimization in patients with vulvar dysesthesia/vestibulodynia. Is there an increased prevalence? J Reprod Med. 2002; 47(10): 829–834.
  19. Atkinson SD, Prakash A, Zhang Qi, et al. A double-blind efficacy and safety study of duloxetine flexible dosing in children and adolescents with major depressive disorder. J Child Adolesc Psychopharmacol. 2014; 24(4): 180–189.
  20. Mann D, Liu J, Chew ML, et al. Safety, tolerability, and pharmacokinetics of pregabalin in children with refractory partial seizures: a phase 1, randomized controlled study. Epilepsia. 2014; 55(12): 1934–1943.