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Vulvodynia (vulval pain): DIY might be somewhat effective

Source: Journal of Women's Health; February 2009

A condition where the whole area of the external female genitalia (vulva) is painful with no apparent reason is called Vulvodynia. There is typically no skin lesion of any kind.  The sensation takes the form of burning and/or soreness. The pain is there most of the time and just normal touch can provoke soreness. It is a very distressing condition not least because treatment tends to give variable results, usually unsatisfactory.

Now, the February 2009 issue of the Journal of Women's Health reports on some sort of progress in management option available to women.  Multi-modal self-management has a "modest effect" in reducing vulvodynia, but low-dose amitriptyline, with or without topical triamcinolone, has no significant benefit, according to the first prospective, randomized trial to compare these treatment approaches. The pilot study was not blinded.

Over a 12-week period, women in this study arm attended weekly 2-hour sessions variously led by a nurse practitioner, a psychologist/sex therapist and a physical therapist who regularly treats vulvodynia patients. The self-management approach included components of education avulvodynia management is difficultnd cognitive-behavioral, physical and sex therapy.

Conducted at a single center, the study recruited participants who reported vulval pain, itching, burning or tenderness of at least 6 months' duration. To mimic the range of symptoms reported to physicians, the pain could be localized or generalized and with or without provocation. Exclusion criteria included active vulvo-vaginal infection.

In this study, the average participant was about 47 years old, Caucasian and married, with above-average education and income. Participants were randomized 2:1:1 to the self-management group, an oral amitriptyline group (10-20 mg/day) or a group receiving both oral amitriptyline and topical triamcinolone (approximately 5 mg/day of 0.1% triamcinolone acetonide). Overall, 43 participants completed the study.

In their intent-to-treat analysis, the researchers found no differences among the three groups in scores on the McGill Pain Questionnaire's Pain Rating Index or Present Pain Index.

When they compared baseline and post-treatment scores within groups, the researchers found significant decreases in the Pain Rating Index total score and the sensory sub-score in the self-management group.

The amitriptyline group showed a decrease from baseline on the questionnaire's quantitative Present Pain Index, and a trend was observed in the self-management group.

The report noted that the study's statistical power was somewhat compromised. Lead author Dr. Candace S. Brown of the University of Tennessee Health Science Center, Memphis, explained that higher-than-expected attrition (from refusal to participate) among the 76 patients originally randomized for the study was a factor, as was the 2:1:1 randomisation scheme.

The authors suggest that the efficacy of the self-management approach might derive from its multimodal strategy, which combined behavioral and physical techniques to address both the emotional and physiological aspects of pain.

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In vulvodynia, the external genitalia looks normal and there is no identifiable skin lesion. Treatment results tend to be unsatisfactory.