In 1987, Dr. Eduard G. Friedrich, affiliated with the University of Florida, College of Medicine, at Gainesville, described in finer detail the condition of painful sensations localized at the vulvar vestibule. Pain came in response to light pressure; something he called Vulvo Vestibular Syndrome, which we now call PVD. The patients who were first investigated reported genital pain that consisted mostly of burning sensations when their exterior genitals were exposed to light pressure typical of touching or sexual intercourse. Apparently, the pressure was such that non-affected women would not consider it harmful. Dr. Friedrich’s observations led him to establish the criteria according to which the diagnosis of PVD can be made, when the vestibular mucosa around the entrance to the vagina demonstrates:

 

- Increased sensitivity to pain (hyperalgesia)

- Redness (erythema)

- Swelling (oedema)

 

Since then, the different causes of PVD have been investigated by many scientists and clinicians, and a great deal of new information has come to light to help in effectively treating this puzzling condition.

We now know that the pain can be highly localized around the vaginal entrance or vestibule, or can spread to the vulva (the generalized term for the external female genitals) and to the perineum (the area between the vagina and the anus).

 

We also know that genital pain can come on spontaneously, without any touching or other provocation, or as a result of light pressure (the “provoked” part of PVD). Another puzzling characteristic is that this condition can emerge during the first incidence of sexual intercourse, but can suddenly appear after a long period of normal sexual functioning, and any time in between. In other words, there’s no way to predict when this condition might manifest itself in the arc of an individual’s sexual history. In addition, it is now accepted that, although it’s often possible for an expert eye to identify tell-tale redness and tenderness in the  mucosa  around the vaginal entrance, symptoms of PVD may exist without any apparent visual signs, making it all the harder to diagnose and treat.

 

Diagnosis Can Be Tricky

 

One firm rule has emerged for diagnosis: symptoms must be present for at least three months to warrant a diagnosis of PVD. PVD is always accompanied by pain during sex – at penetration, or during or after intercourse. In any event, it’s important for the healthcare provider treating someone with PVD to look for the presence of tension in the pelvic floor muscles, which can make pain during sex much worse and must be evaluated and treated separately.

There are several other causes of genital pain in women, apart from PVD, and it’s important to rule them out before proceeding with treatment.

page 7
page 8