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