History taking
A thorough assessment of symptoms can often point to a diagnosis when combined with the clinical examination findings. Table 50.1 outlines some key questions to ask in the history and why.
The impact of the vulval symptoms on function should always be explored. ‘How do the symptoms affect you?' or ‘What do you miss as a result of the problem?' are helpful questions to ask. A psychosexual history should be investigated if appropriate. Often referral of patients with a vulval problem might reveal sexual pain as the main complaint and secondary psychosexual problems such as vaginismus, avoidance, phobia of touch, and loss of libido (6). Recognition of this as the significant problem for the patient is important so that treatment can focus on self-management or with a psychosexual counsellor.Women with vulval pain should have a detailed pain history taken covering the pain's nature, severity, site, and aggravating or relieving factors. Some patients with vulvodynia have pain at other body sites and vulvodynia may be a part of a chronic regional pain syndromes (7). Not infrequently patients may be upset and frustrated which may in part be explained by disjointed care, ineffective treatments, and a lack of understanding of the condition by clinicians.
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