Report from Cambridge Vulval Pain Society Workshop held at Addenbrooke's Hospital, 19 July 2008

A workshop was held at Addenbrooke's Hospital, Cambridge at the invitation of Dr Jane Sterling, Consultant Dermatologist, where she has a vulval clinic practice there. Around 20 women from the area attended the workshop, which as with other workshops was an informal affair giving women and partners (two partners attended) the opportunity to learn more about vulval problems and share experiences, tips and the frustrations which the problem impacts on their lives. Dr Sterling gave an excellent lecture on vulvodynia from her perspective.

The Cambridge tableTable one (right) covers what we believe leads to the final problem of vulvodynia (unprovoked pain and sexual pain). There can be an initial trigger that happens to the vulva such as a bad attack of cystitis or thrush. This inflammatory condition soon settles leaving residual tenderness. There may be some individuals more genetically predisposed to these problems than others, but it is not clear why some women develop pain and others do not, as most attacks of thrush and cystitis do resolve without any residual pain. It is possible that in the vulval skin there is an increase in the number of nerve fibres and also increased nerve sensitivity leading to the problem of pain. This may lead to unprovoked or touch-sensitive pain which in turn can produce a problem of sexual pain on touch, and finally, a spasm within the pelvic floor muscles leading to a vaginismus response. Pain with sex can lead to avoidance. This will explain the different treatment options that we use for vulvodynia and how treatments should be combined. Drugs such as amitriptyline, nortriptyline and gabapentin can dull the nerve endings; psychosexual counselling can help with the emotional issues surrounding sex-related pain, such as avoidance of sex and the problems of vaginismus, which is an involuntary tightening of the muscles. Desensitising the pelvic floor using vaginal trainers, vibrators and massage of the pelvic floor can be very useful. For more details see the VPS Handbook.

We had a presentation from Judy Birch, who is the Chair of the Pelvic Pain Network, a network related to providing support and advocacy for people with pelvic pain. She gave an outline of her work which includes ensuring that patients are at the heart of any medical committee to help with writing guidelines and giving the layperson's perspective when deciding on how to treat patients. She covered in quite close detail work that she had done to show the scale of the problem of pelvic pain, and in particular pudendal neuralgia, which has an overlap with vulvodynia.

In the afternoon the workshop was more informal. Some women had come long distances such as from Southern Ireland, where services are very scarce. Despite these times of so-called uniformity in the NHS we still have areas of the country where vulval care is poor. Pain management issues, sexual pain and treatment options were all discussed.

We are indebted to Dr Sterling for putting us up for the day. Please keep an eye on the website for further workshops - we may be coming to your area!