Dr. Caroline Pukall, Assistant Professor in the Department of Psychology at Queen’s University in Kingston, Ontario, Canada shares how she diagnoses vulvodynia, vestibulitis and vestibulodynia.
Dr. Pukall and Todd Hartley:
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Todd Hartley:
Well, you’ve tuned into the EmpowHer Network, and right now Dr. Caroline Pukall is with us. She is an Assistant Professor at the Department of Psychology at Queen’s University in Kingston, Ontario, Canada. Doctor, how do you diagnose vulvodynia, and let’s say not just vulvodynia but vestibulitis and also vestibule. How do I say it, vestibulodynia?
Dr. Pukall:
Vestibulodynia.
Todd Hartley:
Yeah, how do you diagnose those?
Dr. Pukall:
Well, okay, that’s a really good question. Essentially vulvodynia is a general term that is used to describe chronic vulvar pain usually lasting three to six months or more. Vulvodynia as well is a general term used to indicate that causes for this pain cannot be found, so there are different sub-types of vulvodynia. So the first of which is vestibulodynia, or vestibulitis as it is commonly known as, and the most sort of quick and easy way to diagnose this, so as someone who will see somebody who has vulvar vestibulitis or vestibulodynia, typically what they will say is that they have pain during sexual intercourse. Then the health professional will need to find out, okay, what is happening with this woman: Are there infections? Is there any kind of inflammation? is there some kind of disorder that can explain the pain and go through a gamut of tests in order to rule out any physical explanation for the pain? Most of the time what happens is that any physical findings are ruled out, and so the woman has this pain in the absence of the inflammation or infection and then what one must do is essentially called a cotton swab test. And it’s a very simple test to perform, and essentially it involves the health professional taking a cotton swab and touching, applying pressure with the cotton swab to different areas of the woman’s vulva, so, this will include touching or applying pressure to the labia majora, the labia minora, and to the vulvar vestibule which is located at the entrance of the vagina. Typically, a woman with vestibulitis or vestibulodynia will not report pain in the labia majora or the labia minora but will report severe pain when that cotton swab pressure is applied to the opening of the vagina at the level of the vulvar vestibule, and so that is the way to diagnose vestibulodynia.
The diagnosis for generalized vulvodynia, so this particular pain condition involves sort of a more chronic kind of a more generalized pain to the external genitals. This is much more complicated, and so one must look at neural fiber function and one must really rule out the same conditions that one would rule out for vestibulitis or vestibulodynia but also look to assess nerve fibers that serve the genital area, And of course if there is nothing physical that can be found, then one is diagnosed with generalized vulvodynia. Typically, it is based on the woman's self-report of the chronic pain that is present almost always or always during the day. Sometimes there are patterns where it is worse in the morning or worse in the evening, and it seems to be quite widespread, and so really this one is based on a woman’s self-report and the use of tests to rule out any other physical explanation for that pain.
Todd Hartley:
Well, she is Dr. Caroline Pukall, an Assistant Professor at the Department of Psychology in Kingston, Ontario, at Queen’s University. Dr. Pukall, thank you for joining us.
Dr. Pukall:
Thank you.
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For more information on Dr. Caroline Pukall visit Queen's University in Kingston, Ontario, Canada.