Re: Assessment and management of vulval pain
The review article by David Nunns and Ruth Murphy (BMJ 2012;344:e1723) does not mention the significance of a history of lumbar-plexus neuropraxia following a lower limb hyper-extension injury or a "weak leg" during the third trimester of pregnancy, as a cause of vulval allodynia. I reported on four patients with this condition (The Pain 1987 vol.1 no.4). These patients had a comparatively cool lower limb with a reduction in flexion power and a history of limb fatigue in association with allodynia in the territory of the Genito-femoral nerve. History and physical findings indicated a Sympathetic Dependent Pain Syndrome, and they were relieved by lumbar sympathetic block.
Competing interests: No competing interests