
What Casues Vulvar Burning And Pain?

Possibility of Vulvodynia
Detailed Answer:
Hi. Thanks for posting your concern at HCM.
Going through your query, I could relate this type of presentation to few of my patients who practice over enthusiastic hygiene which might irritate the mucosa e.g repeated washing with soaps, using either dettol or savlon or tea tree oil for cleansing etc thus leading on to an irritant dermatitis which confuses both the patient as well as the clinician, as to what is the real cause?? without realising that the overaggressive hygiene that they practice is itself the cause.
General measures:
-Avoid repeated douching, soaps or body wash, in there. Instead you can use just plain water for gentle cleansing.
You don't seem to have any organic cause for the symptoms, vulvodynia is a definite possibility here.
Causes can be nerve irritation, hormonal changes, Allergies or irritation to chemicals or other substances, Hypersensitivity to yeast infections, Muscle spasms etc
Symptoms of vulvodynia usually begin suddenly and can last anywhere from months to years. Although the vulva usually appears normal, it may look a bit inflamed or swollen.
A burning pain is the single most common symptom of vulvodynia.
There is no specific treatment for vulvodynia, however, soaking in lukewarm or cool sitz baths may help.
Orally, Vit B12 in high doses e.g 1500 mcg per day for a month, may help.
Tricyclic antidepressants e.g Amitryptiline 25 mg once daily, increased to thrice daily if required, is also worth trying.
Anticonvulsants like carbamzepine 200 mg twice daily and gabapentin 300 mg once daily and increased to 300 mg thrice daily are other options.
Hope this helps
Regards


Possibility of Vulvodynia
Detailed Answer:
Hi.
Lichen sclerosis is itchy and does'nt cause pain or burning sensation, neither does HPV infection. HPV is usually clinically obvious.
You said that, you had a whitish lesion on vulva, and on biopsy it came out as Benign papillomatous hyperplasia. This could very well be the reason for your symptoms.
A PAP smear is the next logical step in your case to look for any abnormal findings on cytology, even though the biopsy shows that the area sampled is benign.
Apart from this, I could not relate your symptoms with any of the possible diagnosis that you have inquired about or treated for, except for Vulvodynia. Any organic cause or lesion(s) responsible, if present, would obviously have been visible to your gynaecologist (6 of them).
Can you upload a picture?
Regards


Possibility of Vulvar Dystrophy to be ruled out
Detailed Answer:
Hi.
Well Vulvodynia is a diagnosis of exclusion. However, presence of a white lesion and biopsy finding of papillomatous hyperplasia, I would think of another possibility, that of Vulvar dystrophy. Papillomatous hyperplasia, does signify this change(dystrophy). It could be due to HPV. HPV is anyways a localized disease.
Vulvar dystrophy is a change in the skin of the vulva. This skin condition typically manifests as vulvar skin that is too thick or thin, often with white or gray discoloration.
Symptoms can vary from itching, burning, pain with sex, white or gray patch of thickened or thin skin on the vulva, redness or sores, stinging and irritation.
Any white lesion on vulva should be thoroughly investigated to rule out malignant changes. Therefore the need for PAP smear. I think you should wait for the PAP test result and then follow it up with a 'gynecology specialist".
Regards


Herpes
Detailed Answer:
Hi.
Herpes can easily be diagnosed clinically during an episode. Herpes, specially recurrent herpes is not very symptomatic and may even pass unnoticed. It presents as discrete, fluid filled vesicles Or erosions associated with pain or burning sensation.
Did she take the sample(swab) for culture Or microscopy?
The advantage of blood test for herpes (HSV ELISA) is that it remains positive for a long time after infection.
The major disadvantage of the culture is its high rate of false negatives. Because a culture works by requiring virus that is active, if a lesion is very small, or is already beginning to heal, there may not be enough virus present for an accurate culture. Moreover beyond 48 hours of the symptoms appearing, there is a risk of receiving a false negative test result. Viral culture is even less accurate during recurrences (positive in only about 30% of recurrent outbreaks).
Regards

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