The Clinical Utility of the Vulvar Pain Assessment Questionnaire: A Pilot Study.

OBJECTIVE: The aim of the study was to document treatment-seeking experiences of women with chronic vulvar pain, comfort communicating about pain, and test the clinical utility of the screening version of the Vulvar Pain Assessment Questionnaire, screening version (VPAQscreen). MATERIALS AND METHODS: Patients scheduled for an appointment with the Program in Vulvar Health at Oregon Health and Science University were invited to complete the VPAQscreen and answer descriptive questions about previous treatment-seeking experiences and communication with health care providers. Clinicians provided provisional diagnoses based on VPAQscreen summaries, final diagnoses based on gynecological examination, and commented on alignment with clinical observations. Patients gave feedback on the accuracy and helpfulness of the VPAQscreen summary, characteristics of the questions asked, and whether their comfort communicating increased. RESULTS: Participants reported previously seeing approximately 5 medical doctors and 2 other health care providers and perceived them as lacking knowledge of vulvar pain syndromes. Providers indicated that VPAQscreen summaries aligned with clinical presentations and suggested provisional diagnoses with more than 80% accuracy. Participants reported that VPAQscreen summaries were helpful and accurate in summarizing symptoms. Most reported that the number, range, and readability of VPAQscreen questions were good or excellent. More than half reported that completing the VPAQscreen increased comfort when speaking with their Oregon Health and Science University physician. CONCLUSIONS: Patients with vulvar pain often endure a lengthy process of consulting multiple clinicians before securing care. The VPAQscreen was more than 80% accurate in predicting diagnosis at this specialty clinic and was useful in assisting patients with expressing symptoms. The applicability of the VPAQscreen in general practice is unknown, although it shows promise.

Vulvar pain: a phenomenological study of couples in search of effective diagnosis and treatment.

Vulvar vestibulitis syndrome (VVS), a vulvar pain disorder, continues to puzzle medical and mental health professionals due to its unknown etiology and lack of effective treatment. This study used transcendental phenomenology methodology to explore the experiences of couples in which the woman has a diagnosis of VVS. Sixteen in-depth semi-structured interviews were conducted with 13 heterosexual couples and 3 women. Four essences emerged: (1) In search of ... the medical journey required extensive searching for knowledgeable and respectful practitioners to provide treatment. (2) The process of developing a personal understanding of this disorder led many couples to question their role in causing and maintaining VVS. (3) Developing strategies for coping with painful intercourse led to three strategies: becoming non-sexual, using alternatives to vaginal sex, and altering or enduring painful intercourse. (4) Feelings of isolation were experienced as adapting to this chronic pain syndrome was often a lonely process. Clinical suggestions included: treating the couple, not just the woman with VVS; encouraging couples to broaden definitions about the importance and primacy of vaginal intercourse and suggest alternative sexual activities less likely to cause vulvar pain; developing shared meaning as a couple, and assisting couples in locating physicians and resources. Suggestions are relevant for couples with VVS and those with chronic health problems affecting sexual relationships.

Vulval skin disease: clinical features, assessment and management.

This article outlines the issues involved in assessing and managing patients who present with a vulval skin condition. It describes the anatomy of the vulval area, many of the skin conditions that nurses may encounter in their practice and potential treatment options for these conditions. The importance of accurate history-taking is emphasised and described, and appropriate referral to a specialist is also discussed.

Lichen sclerosus of the vulva in women: assessment, diagnosis, and management for the nurse practitioner.

PURPOSE: To describe the etiology, clinical manifestations, assessment, and management of vulvar lichen sclerosus (LS) in women. DATA SOURCES: Selected research and clinical articles in professional journals and online websites, peer review, educational technical bulletin from professional organization and the authors' professional clinical experiences. CONCLUSIONS: Vulvar LS can manifest with varied symptoms that may mimic other common vulvar disorders such as infections. Careful assessment of the vulva and biopsy of any suspicious skin changes are needed for diagnosis and management of vulvar LS. Treatment with high-potency topical corticosteroids may alleviate uncomfortable symptoms and reduce physical changes. Follow-up management is essential to check for progressing problems such as introital stenosis and to assess for skin changes that may indicate vulvar squamous cell carcinoma. IMPLICATIONS FOR PRACTICE: Accurate diagnosis and successful management of vulvar LS requires thorough assessment of the genitalia, knowledge of the disorder and appropriate treatment and follow-up management.

Practical tips for assessment and management of vulvar and vaginal human papillomavirus.

Human papillomavirus (HPV) infection has been strongly associated with intraepithelial neoplasia and cancers of the lower genital tract. Due to either better detection or increased incidence of this infection, there is a greater demand for colposcopy. Historically, clinicians have focused their colposcopic investigation on the cervix, often neglecting evaluation of the vulva and vagina. Because HPV is a multicentric disease, these areas should not be overlooked. Nurse colposcopists need to assess and manage women who have HPV-related vulvovaginal lesions that are either symptomatic or have the potential to advance to cancer.

An assessment of vulval lichen sclerosus.

Vulval lichen sclerosus (L.S.) has been assessed clinically, colposcopically, and histologically to ascertain the suitability of including this condition in the nomenclature proposed by the International Society for the Study of Vulval Disease (I.S.S.V.D). In many cases the macroscopic appearance of lichen sclerosus is characteristic, but this is not always the case. Histologically, the appearances of the dermal hyaline change, the reduction in the length and the number of rete pegs, to a lesser extent thinning of the dermis and sometimes thinning of the epidermis are characteristics. The presence of dermal inflammatory cells and changes in the thickness of the keratin layer are, however, much more variable. Exact measurements of the various layers of the vulval skin are not necessary in the routine assessment of lichen sclerosus. The present study justifies the inclusion of lichen sclerosus on histological criteria in the I.S.S.V.D.'s nomenclature.

Erosions and ulcers of the vulva: diagnosis, incidence, and management.

In a study of 877 patients with disorders of the vulva seen at a vulva clinic, 375 (43%) presented with an erosion or ulceration or a condition in which an erosion or ulceration developed as a complicating feature. One hundred sixty-one of these patients had a sexually transmitted disease. This report identifies the conditions associated with erosions and ulcerations of the vulva by incidence and provides a simple clinical classification of them as an aid in diagnosis. Methods of study of this group of diseases and their management are discussed.