Archived Volumes of Past Issues

A New Symptom Of Uterine Leiomyoma

Author Information
Parulekar SV
(Professor and Head. Department of Obstetrics and Gynecology, Seth G.S. Medical College and K.E.M Hospital, Mumbai, India.)

Abstract

Only 35–50% of patients with leiomyomas are symptomatic. Symptoms depend on the location, size, and state of preservationof the leiomyomas. Common symptoms include abnormal uterine bleeding, dysmenorrhea, abdominopelvic pain, a sensation of heaviness or fullness in the pelvic area, leucorrhea, dyspareunia, pressure effects on bladder and/or rectum, and infertility. A case of uterine leiomyoma with vulvar burning is presented.

Introduction

Only 35–50% of patients with uterine leiomyomas are symptomatic.[1] The symptoms depend on the location, size, and state of preservation of the leiomyomas. Common symptoms include abnormal uterine bleeding (menorrhagia, metrorrhagia), dysmenorrhea, abdominopelvic pain, a sensation of heaviness or fullness in the pelvic area, serosanguinous leucorrhea, dyspareunia, pressure effects on bladder and/or rectum, and infertility.[2,3] Vulvar burning has not been associated with uterine leiomyomas so far. The first case of vulvar burning in the world literature is presented.

Case Report

A 54 year old married woman, para 2, presented with intense burning of the vulva for two months. The burning was constant, with no aggravating or relieving factors. There were no other symptoms including dyspareunia. She was menstruating normally. General and systemic examination revealed no abnormality. Local examination of the vulva showed normal features. The touch test was negative. A speculum examination showed normal vagina and cervix. There was no infection in the vagina or vulva. An abdominal and bimanual pelvic examination showed enlargement of the uterus to a size of 16 weeks’ pregnancy. There were two large leiomyomas, one in the anterior wall and the other in the posterior uterine wall. There was no uterine tenderness. Abdominopelvic ultrasonography revealed a 6 cm diameter leiomyoma in the anterior wall of the uterine corpus, and a 7 cm diameter leiomyoma in the posterior uterine wall. Pap smear was normal. Counseling was done. The patient opted for a hysterectomy, which was performed under spinal anesthesia. The patient made an uneventful recovery. The vulvar burning disappeared totally after the hysterectomy, and has not recurred in the period of three years following the hysterectomy.

Discussion

Vulvar burning can be due to a large number of conditions like vulvovaginal candidiasis, trichomoniasis, herpes, herpes zoster, human papillomavirus infection, molluscum contagiosum, Crohn's disease, Behçet's disease, Sjögren's syndrome, systemic lupus erythematosus, vulvar intraepithelial or invasive neolplasia, allergic and contact dermatitis, eczema, lichen planus, lichen sclerosus, hidradenitis suppurativa, pemphigus, pemphigoid, psoriasis, interstitial cystitis, spinal disk problems, and pudendal or genitofemoral neuralgias.[4] It may be psychological too. This patient did not have any of these conditions. Her vulvar burning totally disappeared after hysterectomy, which suggests a cause-effect relationship between the two. It is possible that the burning was psychological, and was relieved by hysterectomy. This could have been a placebo action of the operation. However this is unlikely, because the presenting symptom was vulvar burning, and the leiomyoma was diagnosed on examination. The nerve supply of the anterior portion of the vulva is by the ilioinguinal nerve and the genital branch of the genitofemoral nerve. That of the posterior portion of the vulva is by the pudendal nerve and by the posterior cutaneous nerve of the thigh. The course of these nerves is such that their compression by a pelvic mass is unlikely to occur, that can cause vulvar burning. However it is the only possible explanation of the vulvar burning experienced by the patient. This case is reported so that it is available for future reference, and occurrence of this symptom in any other patient in future may lend credence to the theory of cause effect relationship between uterine leiomyomas and vulvar burning.

References

1.      Stewart E: Uterine Fibroids. The Lancet 2001, 357:293-8.
2.      Williams V, Jones G, Muskopf J, Spalding J, DuChane J: Uterine fibroids: a review of health-related quality of life assessment. J Womens Health 2006, 15:818-29.
3.      Nicholls C, Glover L, Pistrang N: The illness experiences of women with fibroids: an exploratory qualitative study. J of Psychosom Obstet & Gynecol 2004, 25:295-304.
4.      Paavonen J.Diagnosis and Treatment of Vulvodynia. Annals of Medicine 1995;27:175-181.

Citation

Parulekar SV. A New Symptom Of Uterine Leiomyoma. JPGO 2014 Volume 1 Number 6. Available from: http://www.jpgo.org/2014/06/a-new-symptom-of-uterine-leiomyoma.html