Vulvodynia
Vulvodynia
Vulvodynia is chronic pain and discomfort of the vulva that is not caused by an infection, skin disease or cancer. It is likely that many factors, including those related to the body’s nerves, hormones or immune system, are involved.
Two types of vulvodynia are recognized: generalized vulvodynia and localized vulvodynia. In generalized vulvodynia, the pain is felt over the entire vulvar area. In localized vulvodynia, the pain is felt on a specific area of the vulva. Vulvar vestibulitis syndrome (VVS) is a specific form of localized vulvodynia. In VVS, the pain is felt only in the vestibule (the area around the opening of the vagina), usually in response to touch or pressure.
Symptoms
Pain is described as burning, stinging and rawness. Additional symptoms include itching, aching, soreness, throbbing and swelling.
Symptoms can start and stop without warning or they may occur only when the area is touched, such as while inserting a tampon, having sex or wearing snug underwear. Some women report symptoms when doing certain activities, such as during exercise, after urinating, or while sitting or resting. The pain also may have no relationship to touch or pressure and may be constant.
Diagnosis
We will try to rule out other known causes of pain first. We most likely will perform a physical exam and may order specific tests. You may be asked questions about your symptoms and medical history, such as when symptoms occur, what treatments you have tried, and whether you have any chronic infections or skin problems.
We will examine the vulva and vagina carefully. If any skin changes are found, tests may be done. A swab test may be done to find out whether the pain is generalized or localized. In this test, the health care provider uses a cotton swab to touch areas of the vulva and vestibule. The goal is to find where the pain is and whether it is mild, moderate or severe.
Treatments
The first step in vulvodynia treatment usually involves avoiding products, clothing and other items that come in contact with the vulva and that may be irritating, such as soaps and products containing deodorants, perfumes and dyes. Wear cotton underwear and switch to cotton menstrual products. Pay close attention to what makes your symptoms worse, and avoid the things that provoke your pain. While you are experiencing pain, applying cool gel packs may bring relief.
For some women, certain foods make symptoms worse while other foods help relieve symptoms. An elimination diet may help you identify these foods. In this kind of diet, you cut out one type of food at a time and note whether this makes your symptoms better or worse. Foods commonly associated with triggering symptoms include caffeine, sugar, acidic foods and processed foods.
The following medications have been found to be helpful in treating vulvodynia:
- Local anesthetics
- Antidepressants and anti-seizure drugs
- Hormone creams
Physical therapy can relax tissues in the pelvic floor and release tension in muscles and joints. Biofeedback is a form of physical therapy that trains you to strengthen the pelvic floor muscles. Strengthening these muscles may help to lessen your pain.
A nerve block — an anesthetic drug injected into the nerves that carry pain signals from the vulva to the spinal cord — interrupts pain signals and can provide short-term and sometimes long-term pain relief.
Vestibulectomy, the removal of the painful tissue from the vestibule, can be used for women who have VVS for whom other treatments have not worked. The procedure may help relieve pain and make sex more comfortable. It is not recommended for women with generalized vulvodynia.
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Ventricular Tachycardia
Ventricular tachycardia (VT) is a rapid type of heartbeat that starts in the lower part of the heart (ventricles). VT is a potentially lethal arrhythmia and can lead to cardiac arrest. Anyone with a diagnosis of this arrhythmia must seek emergency medical attention during an episode.
Symptoms
- Heart palpitations
- Fast pulse
- Chest pain
- Lightheadedness and fainting
Diagnostics and Tests
Typically, VT occurs in patients with abnormal hearts most commonly due to a history of heart attacks and/or heart failure. As with any arrhythmia, the most important first step is making a diagnosis. A diagnosis is obtainable by an ECG (shown below) during the event or by performing an electrophysiology study.
An electrophysiology study is a diagnostic, catheter-based procedure. Our heart rhythm specialists insert a tiny pacemaker wire into the heart via the groin vessels and stimulate the abnormal rhythm in a controlled medical environment to confirm the diagnosis. Once a diagnosis of VT is obtained, the doctor simply turns off the rhythm via the pacemaker wires.
Patients with VT should undergo a complete cardiac work-up, including cardiac imaging and stress testing to rule out underlying reversible causes of this rhythm.
Treatments
Treatment is divided into emergent and long-term therapy. Emergently, either EMS or the ER doctor will shock the heart out of the rhythm. Long-term therapies include medication, insertion of an implantable defibrillator and even catheter ablation to permanently cure the rhythm.
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