Transcript of VPS Podcast 5 - Vulvodynia: a podcast lecture by David Nunns

This is a transcript of the soundtrack from VPS Podcast 5, which is a slide presentation. You can view the slides accompanying the soundtrack at Podcast 5 - Vulvodynia: a podcast lecture by David Nunns. Timings of each slide are provided in order to aid quick location.


Slide 1 (00:00) Vulvodynia

This is a podcast lecture, focusing on vulvodynia. It’s designed mainly for health professionals, but some patients might find it of interest. My name’s David Nunns, and I work in Nottingham in the Gynaecology Department there. I have a vulval clinic once a fortnight and see many women with vulval disease, including vulvodynia.

Slide 2 (00:28) Topics to be covered

In this lecture, I wanted to cover the following topics: a little bit about the causes of vulval pain; how to assess a woman with vulvodynia; a bit about management of vulvodynia; covering a little bit about the framework of care for health professionals when it comes to managing patients with vulvodynia; and to finally focus on the work of the Vulval Pain Society.

Slide 3 (01:02) Picture

This picture shows a normal vulva in a post-menopausal woman. When we talk about the vulva, we talk about the external female genitalia. As you can see, laterally there’s the hair-bearing labia majora, the inner folds of the skin are the labia minora, clitoris, clitoris hood at the top and the perineum between the anus and the vagina. Centrally, in this patient it’s quite obvious to see the vestibule area – this is the area of skin between the lower part of the vagina and the labia minora, and this patient looks quite red. This doesn’t imply any evidence of inflammation, but it’s quite normal because the skin in this area is thinner. The vulva’s richly innervated by nerve endings and it’s the site of a number of primary skin conditions such as lichen sclerosus and lichen planus, but it can also be involved as a skin surface with skin disease elsewhere such as psoriasis and eczema.

Things can get complicated on the vulva because it’s the sexual organs, so there can be a number of knock-on effects on an individual’s sex life, but also the skin comes into contact with a lot of potential irritants, such as over the counter products, topical treatments and even urine. So things can get complicated, and sometimes there can be more than two things going on on the vulva at once, particularly with chronic patients.

Slide 4 (02:44) Framework for assessing vulval problems

This is the framework that I use when I see a patient with a difficult vulval problem. As was mentioned before, sometimes patients might have a couple of problems going on at the same time. I divide the framework up into infection, inflammation of the vulva, i.e. skin conditions, neoplastic problems and pain syndrome problems. I think this is helpful because some patients, for example with lichen planus, might need a vulvodynia-type strategy, because many of these patients present with pain. Also, some patients, for example with lichen sclerosus, can have a secondary candidal infection.

Slide 5 (03:32) Vulval eczema

I’m not going to talk about infection or the cancerous/precancerous conditions of the vulva because I think those problems are quite easily diagnosed by most doctors, but I just wanted to briefly mention vulval eczema. This is the commonest condition that we would see within a vulval clinic. There are different types of vulval eczema, which is essentially itchy, inflamed skin. Most eczema is fairly obvious after taking a history and examining the patient, but sometimes very subtle eczema can produce very small fissures or splits in the skin that present with a vulval pain problem, and these can easily be missed and overlooked. These are often like very small paper cuts and the vulva needs to be examined closely to detect them.