Vulvodynia associated with celiac disease


 
 CASE REPORTS 
 Vulvodynia associated with coeliac disease Christine Costello Consultant (Haematology), J. R. Smith Senior Lecturer (Gynaecology) Chelsea and Westminster Hospital, London Case Report 
 
 A 44 year old woman presented with a six-month history of recurrent vulvovaginitis. She complained of burning, itching and a greenish vaginal discharge. The symptoms were worse before and after periods and soreness precluded the use of tampons. There was superficial dyspareunia with pain on penetration and splitting of the fourchette even when using 
 lubricating jelly.
 
 General and abdominal examination was unremarkable. Genital examination revealed some atrophy of the external genitalia, inflammation and tenderness in the perivestibular area with Q-tip swab pressure. In addition a small ulcer in the anterior fornix of the vagina, a normal-looking cervix and a retroverted uterus with normal adnexae were found. Highvaginal and endocervical swabs were taken for culture and chlamydia detection and colonoscopy and vulvoscopy were performed. 
 
 Vaginal pH was 5, and there was no evidence of bacterial, viral or chlamydia1 infection. Vaginal and cervical cytology were normal. Hormone assays did not suggest that the woman was menopausal. Colposcopy was normal, vulvoscopy revealed a small split at the posterior fourchette with no areas of aceto-white.
 
 Initial management was with advice to have saline baths, avoid perfumed soaps and avoid wearing tights. Dienoestrol@ cream (Ortho Pharmaceuticals Ltd, High Wycombe, Buckinghamshire, UK) was prescribed in view of the atrophic vagina although 
 oestradiol levels were normal. The patient was empirically treated with oral metranidazole in view of the vaginal pH and observable discharge. Her partner was referred for genitourinary examination which proved to be normal. No improvement of the patient’s symptoms occurred, although the later addition of DaktocorP 1% cream (Janssen Pharmaceutical Ltd, Wantapp, Oxfordshire, UK) led to some improvement for a few weeks.