What is Localised Provoked Vulvodynia (LPV)?

Vulva Doctors frequently explain that: “vulvodynia is a chronic vulvar pain condition. Localised provoked vestibulodynia (LPV) is the most common subset of vulvodynia, the hallmark symptom being pain on vaginal penetration. Young women are predominantly affected. LPV is a hidden condition that often results in distress and shame; it is frequently unrecognised, and women usually see a number of health professionals before being diagnosed, which adds to their distress and confusion” [1].

Seeing a Vulva Specialist at the London Pain Clinic guarantees that you will be given an accurate diagnosis, after which your Vulva Pain Doctor will devise a cutting-edge personalised treatment protocol for you to get started on right away

Putting a Spotlight on Localised Provoked Vestibulodynia

This condition can be defined as: experiencing tenderness when pressure or gentle touch is applied to the vulvar vestibule. This scenario is due to:

• Localised neuro-inflammatory changes in the mucosa (including an elevated concentration of pro-inflammatory peptides (chains of amino acids), and
• An excessive number of nerves with C-fibres. When these are stimulated, for example, through pressure or touch, this can lead to a feeling of prolonged burning
• Hypertonicity of the pelvic floor muscles which results in narrowing of the vagina and muscular pain [1]

In a Nutshell

Discomfort in the vulvar can be described as feeling like a red hot poker has been inserted within. Vulva Doctors find that patients with LPV experience the same general symptoms. These include feelings of:

• Rawness
• Tenderness
• Burning
• Itchiness
• Stabbing
• Tearing
• Stinging [1]

Of note: in many cases, women can be symptom-free as long as they do not experience any pressure or touch. Generally speaking, their pain is exacerbated by wearing tight clothing, inserting tampons, or having sexual intercourse [1].

“Pain or burning characteristically continues after intercourse, often lasting a few hours but sometimes several days (after sensation). Pain may be so severe as to preclude sexual intercourse” [1]

Diagnosis From a Vulva Doctor

Whilst there is no standard test for localised provoked vestibulodynia, your Vulva Consultant will be able to attain a diagnosis based ona typical history, the ruling out of other painful vulvar conditions, and your examination and test results. Moreover, it is important to understand that vulvodynia can be present at the same time as other vulvar conditions. To that end, it can only

become apparent if the pain persists after any other conditions have been dealt with. For example, long-term candidiasis is often associated with the onset of localised provoked vestibulodynia, through the pain-sensitising impact of continual painful sex and long-standing inflammation. And this is why Vulva Consultants check for potential candidiasis in LPV sufferers [1].

Knowing the nature and location of your pain are crucial for an accurate diagnosis. To that end, your Vulva Doctor will review your medical history and ask you the following questions:

• Is your pain restricted to the entrance of your vagina?
• Is you pain continual? Is it just when touched? Or both?
• Do you experience an after-sensation? And if this is the case, how long does it last?
• Do you have a history which implies chronic vulvovaginal candidiasis?
• Do you have a history of dermatitis or eczema?
• Do you have a comorbid pain disorder?
• Do you have insomnia?
• Do you suffer from depression or anxiety?

Generalised Unprovoked Vulvodynia

This condition which typically presents in older women, is less common than LPV, and its onset could be gradual or sudden, [1].

Reference

[1]. Henzell, H., & Berzins, K. (2015). “Localised provoked vestibulodynia (vulvodynia): assessment and management.” Australian Family Physician. Volume 44, Issue 7.