TREMOR VULVODYNIA (VULVAL PAIN)

TYPES

2 types can overlap. These are:

Localized provoked vestibulodynia. This happens when there is pain and discomfort when the vestibule or vaginal opening is touched, stimulated, or when there is a foreign object inserted into it e.g. a tampon. It may happen even though there may be no causative agent and the skin will look normal. Pain is commonly caused by pressure. Touching the area with a cotton bud may produce a “cut glass” feeling. In some cases, the clitoral area is involved. Rarely, sexual arousal may cause vestibular pain, even before any tactile stimulation happens. Discomfort can last for several minutes to days afterward.

Spontaneous generalized vulvodynia. Without any direct pressure or any tactile stimulation to the vagina, a pattern of pain and discomfort occurs and affects the whole vulva. A burning sensation, prickling, dryness, or a mild itch is usually felt. Whenever there is tactile stimulation or insertion of a foreign object to the vagina, it will be painless. Furthermore, the skin also looks healthy.

SYMPTOMS

• The discomfort that occurs upon tactile stimulation or insertion of a foreign object
• A burning sensation occurring succeeding intercourse which may last from several minutes to days
• Anxiety and depression resulting from the chronic pain condition

TYPES

Other common types of leg ulcer include:

• Arterial leg ulcers
• Diabetic leg ulcers
• Malignant leg ulcers
• Traumatic leg ulcers
• Vasculitic leg ulcers

Ulcers in the foot are usually caused by diabetes.

SYMPTOMS

Itching, pain, and swelling in the affected leg are characteristic symptoms of a venous leg ulcer.

Discoloration, hardening of the skin around the ulcer, and presence of a foul-smelling discharge may also be present when you have a venous leg ulcer.

If you have a venous leg ulcer, you may exhibit the following conditions:

• discoloration and darkening of the skin around the ulcer
• swollen ankles
• red, flaky, scaly and itchy skin on your legs
• swollen and enlarged veins on your legs
• hardened skin around the ulcer, which may make your leg feel hard
• a heavy feeling in your legs
• an unpleasant and foul-smelling discharge from the ulcer
• aching or swelling in your legs

Signs of an infection

Opportunistic pathogens could cause secondary bacterial infections due to the ulcer. 

Symptoms of an infected leg ulcer may include:

• a green or unpleasant discharge coming from the ulcer
• fever
• redness and swelling of the skin around the ulcer
• worsening pain
• an unpleasant smell coming from the ulcer

DIAGNOSIS

Diagnosis is usually done by knowing the patient’s medical history, asking the patient’s symptoms, and a physical examination. Skin disease and infections must be ruled out by the physician to obtain a proper diagnosis. A swab of the area may be performed and sent out for analysis to rule out thrush. Using a cotton bud, the area of discomfort is mapped out. In most cases of this condition, the skin will look normal and to some extent a degree of redness, which does not indicate a skin infection or skin disease.

BIOPSY

A biopsy is not recommended even in women who show symptoms of vulval pain. Biopsy results in women with symptoms usually come up similar to those who exhibit no symptoms.

TREATMENT

Most cases resolve without any treatment. However, some cases may take a longer time to resolve and warrant medical treatment to alleviate symptoms of tremor vulvodynia (vulval pain):

• Local anesthetic gels
• Neuromodulating medications
• Cortisone ointments
• Counseling for the impact of pain
• Reforming sexual practices
• Diets
• Candida treatment
• Pelvic floor muscle retraining
• Surgical intervention