Practice Patterns of Clinicians Treating Vulvar Pain
The effective treatment of vulvodynia, a common condition, is a challenge for providers of womens healthcare. A recent investigation by Bernard Harlow, PhD, and Elizabeth Stewart, MD, of Harvard Medical School, demonstrated that up to 16 percent of women suffer from chronic lower genital tract pain at some point in their lives.1 The International Society for the Study of Vulvovaginal Disease describes two distinct subsets of vulvodynia: generalized and localized vulvodynia.2 Although there have been recent changes in the nomenclature of vulvodynia, clinicians have long recognized that some women suffer from pain or burning that is diffusely distributed throughout the vulva, while other women have pain that is localized to one specific area. Decisions regarding the management of both subsets of vulvodynia have been difficult for a variety of reasons. Until recently, there had been no published guidelines for clinicians to follow in the management of patients with vulvodynia. Also, randomized clinical trials demonstrating the superiority of one therapy over another are rare. As such, clinicians typically have relied on personal experience to manage their patients with vulvodynia.
In 2005, Harold Wiesenfeld, MD and the author conducted a survey to determine how experts in the field of vulvodynia are managing their patients. The results of this study, conducted by the University of Pittsburgh Department of Obstetrics, Gynecology, and Reproductive Sciences, was published in the October 2005 issue of the American Journal of Obstetrics and Gynecology.3 Our investigation had multiple goals. First, we sought to determine which treatments for vulvodynia were used most frequently. Secondly, we were interested in finding out in what order these treatments were used; that is, what were the first, second, and third lines of therapy in the clinicians management strategy. Finally, we hoped to discover how clinicians varied their treatment of vulvodynia depending on whether a patient presented with the generalized or localized variant of the condition.
Please refer to the October 2006 issue for the complete text. In the event you need to order a back issue, please click here.