Recalcitrant vulvodynia. A clinicopathological study.

This study is an analysis of 26 women with burning vulva syndrome. They seldom had frankly abnormal physical findings, and application of acetic acid and colposcopically directed biopsy are therefore mandatory. Histopathological study showed characteristic features of human papillomavirus (HPV) in 20 patients (77%). HPV has been shown to be a cause of vulvar vestibulitis syndrome and was an associated problem in 3 of the 5 patients who had essential or dysaesthetic vulvodynia. The latter is similar to causalgia, with a poor prognosis for resolution. Single patients had the following specific conditions: lichen planus, lichen sclerosus, mature neuroma and chronic candidiasis. The study shows that vulvodynia is a multifactorial problem for which management strategies have evolved over the course of time. Although interferon-alpha-2b offers much promise for the treatment of vulvodynia caused by subclinical HPV infection, the complete cure rate was only 58%. Overall 38% of patients still experience their problem, which indicates that they should be discouraged from going from physician to physician in the hopes of finding a 'cure'.