Vulvodinia

BJD
R E V I E W A RT I C L E British Journal of Dermatology

Guidelines for the management of vulvodynia
D. Mandal,*,*** D. Nunns,  M. Byrne,à J. McLelland,§ R. Rani,– J. Cullimore,** D. Bansal,   F. Brackenbury,àà G. Kirtschig§§ and M. Wier,–– British Society for the Study of Vulval Disease (BSSVD) Guideline Group
*Genitourinary Medicine, Warrington Hospital, Lovely Lane, Warrington,Cheshire WA5 1QG, U.K.  Department of Gynaecological Oncology, Nottingham City Hospital, Nottingham NG5 1PB, U.K. àGenitourinary Medicine, St Mary’s Hospital, Jefferiss Wing, London W2 1NY, U.K. §Department of Dermatology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne NE1 4LP, U.K. –Centre for Sexual Health, Tameside and Glossop PCT, Ashton-under-Lyne, U.K. **Department ofGynaecology, Princess Margaret Hospital, Swindon SN4 0AT, U.K.   Genitourinary Medicine, Queen’s Hospital, Burton on Trent DE13 0RB, U.K. ààNational Lichen Sclerosus Support Group §§Departments of Dermatology, Churchill Hospital, Oxford OX3 7LJ, U.K. and Vrige Universteit, 1007 MB Amsterdam, the Netherlands ––Genitourinary Medicine, Clair Simpson House, Barnet, EN5 3DJ, U.K. ***University of Manchester,Stopford Building, Oxford Road, Manchester, M13 9PL U.K.

Summary
Correspondence
Debashis Mandal. E-mail: debashis.mandal@whh.nhs.uk; debashis_mandal@compuserve.com

These guidelines for the management of vulvodynia have been prepared by the British Society for the Study of Vulval Diseases Guideline Group. They present evidence-based guidance for treatment, with identification of the strength ofevidence available at the time of preparation of the guidelines.

Accepted for publication
20 January 2010

Key words
guidelines, vulval pain, vulvodynia

Conflicts of interest
None declared. DOI 10.1111/j.1365-2133.2010.09684.x

Introduction and background
This guideline is to help clinicians assess and manage patients with vulvodynia. Vulvodynia has been defined by the InternationalSociety for the Study of Vulvovaginal Diseases (ISSVD) as vulval discomfort, most often described as a burning pain, occurring in the absence of relevant visible findings or a specific, clinically identifiable, neurological disorder. Patients can be further classified by the anatomical site of the pain (e.g. generalized vulvodynia, hemivulvodynia, clitorodynia) and also by whether pain is provoked orunprovoked (see Table 1). Clinical care should follow the principles of general chronic pain management. Treatment should be holistic and focus not only on the primary site of pain but on its subsequent impact on the patients’ lifestyle and sexual functioning. The evaluation of different treatments is very difficult because published research on vulvodynia has many limitations with poor patientselection, limited follow-up data and a paucity of randomized clinical trials (RCTs).

Methods
The evidence for these guidelines was reviewed by the British Society for the Study of Vulval Diseases (BSSVD) guidelines group looking at all published literature on vulvodynia to date. The group consists of gynaecologists, dermatologists, genitourinary physicians and patients. We searched the literatureusing the terms ‘vulvodynia’, ‘vestibulodynia’, ‘vulval pain’ and ‘vestibulitis’. The classification of evidence levels and grades of recommendations for this review are given in Appendix 1. Table 2 gives a summary of the following recommendations Recommendation 1 An adequate pain history should be taken to assess the degree of symptoms and the impact on the woman. The clinician should categorizewhich subgroup of vulvodynia the patient has according to the ISSVD definitions (e.g. provoked ⁄unprovoked pain).
Ó 2010 The Authors

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Journal Compilation Ó 2010 British Association of Dermatologists • British Journal of Dermatology 2010 162, pp1180–1185

Guidelines for the management of vulvodynia, D. Mandal et al. 1181

Grade of recommendation C; evidence level IV Vulvodynia has...