Generalized unprovoked vulvodynia

This chapter focuses on generalized unprovoked vulvodynia (GVD) which refers to an unpleasant sensation, of any quality (stinging, irritation, pain or rawness), that may present anywhere from the anus to the mons pubis, that is diffuse in nature, and which is present without stimulus to the vulva. As vulvodynia is a diagnosis of exclusion, a thorough history and comprehensive physical examination are crucial for a correct diagnosis. GVD is also characterized as pain evoked by a typically non-painful stimulus (allodynia), pain in response to light touch (hyperpathia), increased pain in response to a painful stimulus (hyperalgesia), increased receptive field and persistence of pain long after inputs have ceased. Initial management begins with minimizing vulvar irritation. Based on evidence of effect in other pain disorders, systemic oral medications, specifically tricyclic antidepressants (amitriptyline, desipramine, and nortriptyline) and anti-seizure medications are prescribed to treat GVD.