Harris Victoria, Fischer Gayle, Bradford Jennifer A
Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Northern Clinical School, University of Sydney, Australia.
Aust N Z J Obstet Gynaecol. 2017 Aug;57(4):446-451. doi: 10.1111/ajo.12613. Epub 2017 Mar 13.
There are few published data about the incidence of diagnoses or treatment outcomes, for chronic vulval pain.
To document diagnoses and treatment outcomes in a cohort of chronic vulval pain presentations.
A retrospective case review of the patient database of a private vulval clinic between January 2011 and March 2015.
Five hundred and twenty-five out of 3360 patients (15.6%) met the criterion of vulval pain alone. Mean age was 47.1 years (range 17-86). Average duration of symptoms was 60 months (range 3-432). Overall, 277/525 (52.7%) patients had satisfactory responses to appropriate treatment and 90/525 (17%) had partial improvement. A dermatosis was identified in 322/525 (61.3%) patients and of these, 211/322 (65.5%) had satisfactory responses to appropriate dermatological treatment. In the remaining 203/525 (38.7%) the skin was normal. These patients were questioned around the possibility of a neuromuscular cause for their pain, including pre-existing dysfunction, trauma or previous operations involving the spine, hips or lower limbs. There were 181/203 (89%) patients considered to have a neuromuscular cause for their pain and considered suitable for physiotherapy and/or neuromodulating medications. Of these patients, 63/182 (34.6%) had satisfactory responses to this treatment. One hundred and sixty-six out of 525 (31.6%) described vulval pain only during sexual intercourse. There was no statistically significant difference between different diagnoses and responses to treatment between patients reporting dyspareunia only and those sexually active women who did not experience dysparenunia (29/525, 5.5%).
The majority of this cohort with chronic vulval pain had a dermatological disease with a smaller proportion caused by neuromuscular dysfunction. Both groups are potentially treatable.
关于慢性外阴疼痛的诊断发病率或治疗结果，已发表的数据很少。
记录一组慢性外阴疼痛病例的诊断和治疗结果。
对一家私立外阴诊所2011年1月至2015年3月的患者数据库进行回顾性病例分析。
3360例患者中有525例（15.6%）符合仅外阴疼痛的标准。平均年龄为47.1岁（范围17 - 86岁）。症状平均持续时间为60个月（范围3 - 432个月）。总体而言，277/525（52.7%）的患者对适当治疗有满意反应，90/525（17%）有部分改善。322/525（61.3%）的患者被诊断为皮肤病，其中211/322（65.5%）对适当的皮肤科治疗有满意反应。其余203/525（38.7%）患者皮肤正常。这些患者被询问其疼痛是否可能由神经肌肉原因引起，包括既往功能障碍、创伤或先前涉及脊柱、髋部或下肢的手术。有181/203（89%）的患者被认为其疼痛由神经肌肉原因引起，并被认为适合物理治疗和/或神经调节药物治疗。在这些患者中，63/182（34.6%）对这种治疗有满意反应。525例中有166例（31.6%）仅在性交时描述有外阴疼痛。仅报告性交困难的患者与未经历性交困难的性活跃女性在不同诊断和治疗反应之间无统计学显著差异（29/525，5.5%）。
该组慢性外阴疼痛患者多数患有皮肤病，少数由神经肌肉功能障碍引起。两组患者均有潜在的可治疗性。
