儿童及青少年人群中的外阴痛：关于临床表现与管理的病例系列研究

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中文摘要

研究目的： 外阴痛是一种慢性外阴疼痛性疾病，在儿科与青少年妇科（PAG）中仍未被充分认识，常导致诊断和管理延迟。尽管局部加巴喷丁（TG）在成人中显示出应用前景，但儿科结局数据仍然有限。本病例系列旨在描述单家学术机构PAG患者中外阴痛的临床表现、管理及结局。
方法： 回顾性审查2021年7月至2025年期间在PAG诊所诊断为外阴痛的78例患者的病历。
结果： 就诊时的中位年龄为16岁。该队列具有多样性，56%的患者自认为西班牙裔/拉丁裔。41%的患者此前曾在其他机构接受评估，但均未被诊断为外阴痛。排尿困难是最常报告的症状（44%），95%的患者记录有前庭压痛或棉签试验阳性。症状表现因月经初潮状态而异，瘙痒、烧灼感和刺激感在初潮前患者中更常见，而性交痛、无法耐受卫生棉条和痛经仅在初潮后患者中观察到。85%的患者被处方TG±利多卡因。在坚持治疗的TG患者中，63%在3个月时报告显著改善或症状缓解，92%在1年时报告改善。在两个时间点均持续改善者占59%。3例患者因局部刺激而停止治疗。
结论： 外阴痛在PAG中仍是一种未被充分认识的疾病，许多患者经历诊断延迟和误诊。TG似乎耐受良好，并与良好的临床结局相关，支持进一步开展研究，将其与其他治疗方式在PAG人群中进行比较。

英文摘要

STUDY OBJECTIVE: Vulvodynia is a chronic vulvar pain condition that remains underrecognized in pediatric and adolescent gynecology (PAG), often resulting in delayed diagnosis and management. Although topical gabapentin (TG) has demonstrated promise in adults, pediatric outcome data remain limited. This case series aims to characterize the presentation, management, and outcomes of vulvodynia in PAG patients at a single academic institution.
METHODS: Medical records of 78 patients diagnosed with vulvodynia at a PAG clinic between July 2021-2025 were reviewed.
RESULTS: The median age at presentation was 16 years. The cohort was diverse, with 56% of patients identifying as Hispanic/Latino. 41% were previously evaluated elsewhere, yet none were diagnosed with vulvodynia. Dysuria was the most reported symptom (44%), and vestibular tenderness or a positive Q-tip test was documented in 95% of patients. Symptom presentation varied by menarchal status, with pruritus, burning, and irritation more common among premenarchal patients, while dyspareunia, tampon intolerance, and dysmenorrhea were observed exclusively among postmenarchal patients. TG ± lidocaine was prescribed to 85% of patients. Among treatment-adherent TG patients, 63% reported significant improvement or symptom resolution at 3 months, and 92% at 1 year. Sustained improvement at both time points was observed in 59%. Three patients discontinued treatment because of local irritation.
CONCLUSION: Vulvodynia remains an underrecognized condition in PAG, with many patients experiencing delayed diagnosis and misdiagnosis. TG appeared well tolerated and was associated with favorable clinical outcomes, supporting further research comparing its use to other treatment modalities in PAG populations.