Etiology, diagnosis, and clinical management of vulvodynia

Leslie A Sadownik, Leslie A Sadownik

Abstract

Chronic vulvar pain or discomfort for which no obvious etiology can be found, ie, vulvodynia, can affect up to 16% of women. It may affect girls and women across all age groups and ethnicities. Vulvodynia is a significant burden to society, the health care system, the affected woman, and her intimate partner. The etiology is multifactorial and may involve local injury or inflammation, and peripheral and or central sensitization of the nervous system. An approach to the diagnosis and management of a woman presenting with chronic vulvar pain should address the biological, psychological, and social/interpersonal factors that contribute to her illness. The gynecologist has a key role in excluding other causes for vulvar pain, screening for psychosexual and pelvic floor dysfunction, and collaborating with other health care providers to manage a woman's pain. An important component of treatment is patient education regarding the pathogenesis of the pain and the negative impact of experiencing pain on a woman's overall quality of life. An individualized, holistic, and often multidisciplinary approach is needed to effectively manage the woman's pain and pain-related distress.

Keywords: assessment; diagnosis; dyspareunia; etiology; multidisciplinary; sexual pain disorder; treatment; vestibulodynia; vulvodynia.

Figures

Figure 1
Figure 1
Biopsychosocial framework for treating women with vulvodynia. Abbreviations: PF, pelvic floor; prn, as needed.

References

    1. Haefner HK. Report of the International Society for the Study of Vulvovaginal Disease: terminology and classification of vulvodynia. J Low Genit Tract Dis. 2007;11:48–49.
    1. Edwards L. Subsets of vulvodynia: overlapping characteristics. J Reprod Med. 2004;49:883–887.
    1. Clare CA, Yeh J. Vulvodynia in adolescence: childhood vulvar pain syndromes. J Pediatr Adolesc Gynecol. 2011;24:110–115.
    1. Reed BD, Harlow SD, Sen A, et al. Prevalence and demographic characteristics of vulvodynia in a population-based sample. Am J Obstet Gynecol. 2012;206:170.e1–e9.
    1. Moyal-Barracco M, Labat JJ. Vulvodynia and chronic pelvic and perineal pain. Prog Urol. 2010;20:1019–1026.
    1. Xie Y, Shi L, Xiong X, Wu E, Veasley C, Dade C. Economic burden and quality of life of vulvodynia in the United States. Curr Med Res Opin. 2012;28:601–608.
    1. Sadownik LA. Clinical profile of vulvodynia patients: a prospective study of 300 patients. J Reprod Med. 2000;45:679–684.
    1. Nunns D, Mandal D. Psychological and psychosexual aspects of vulvar vestibulitis. Genitourin Med. 1997;73:541–544.
    1. Arnold L, Bachmann GA, Rosen R, Kelly S, Rhoads GG. Vulvodynia: characteristics and associations with comorbidities and quality of life. Obstet Gynecol. 2006;107:617–624.
    1. Ehrstrom S, Kornfeld D, Rylander E, Bohm-Starke N. Chronic stress in women with localised provoked vulvodynia. J Psychosom Obstet Gynaecol. 2009;30:73–79.
    1. Schover LR, Youngs DD, Cannata R. Psychosexual aspects of the evaluation and management of vulvar vestibulitis. Am J Obstet Gynecol. 1992;167:630–636.
    1. Gates EA, Galask RP. Psychological and sexual functioning in women with vulvar vestibulitis. J Psychosom Obstet Gynaecol. 2001;22:221–228.
    1. Bergeron S, Binik YM, Khalifé S, et al. A randomized comparison of group cognitive-behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain. 2001;91:297–306.
    1. Hinchliff S, Gott M, Wylie K. A qualitative study of heterosexual women’s attempts to renegotiate sexual relationships in the context of severe sexual problems. Arch Sex Behav. 2012;41:1253–1261.
    1. Rosen NO, Bergeron S, Glowacka M, Delisle I, Baxter ML. Harmful or helpful: perceived solicitous and facilitative partner responses are differentially associated with pain and sexual satisfaction in women with provoked vestibulodynia. J Sex Med. 2012;9:2351–2360.
    1. Connor JJ, Robinson B, Wieling E. Vulvar pain: a phenomenological study of couples in search of effective diagnosis and treatment. Fam Process. 2008;47:139–155.
    1. Ventolini G. Vulvar pain: anatomic and recent pathophysiologic considerations. Clin Anat. 2013;26:130–133.
    1. Babula O, Bongiovanni AM, Ledger WJ, Witkin SS. Immunoglobulin E antibodies to seminal fluid in women with vulvar vestibulitis syndrome: relation to onset and timing of symptoms. Am J Obstet Gynecol. 2004;190:663–667.
    1. Sarma AV, Foxman B, Bayirli B, Haefner H, Sobel JD. Epidemiology of vulvar vestibulitis syndrome: an exploratory case-control study. Sex Transm Infect. 1999;75:320–326.
    1. Ventolini G, Gygax SE, Adelson ME, Cool DR. Vulvodynia and fungal association: a preliminary report. Med Hypotheses. 2013;81:228–230.
    1. Nguyen RH, Swanson D, Harlow BL. Urogenital infections in relation to the occurrence of vulvodynia. J Reprod Med. 2009;54:385–392.
    1. Bornstein J, Goldschmid N, Sabo E. Hyperinnervation and mast cell activation may be used as histopathologic diagnostic criteria for vulvar vestibulitis. Gynecol Obstet Invest. 2004;58:171–178.
    1. Chadha S, Gianotten WL, Drogendijk AC, et al. Histopathologic features of vulvar vestibulitis. Int J Gynecol Pathol. 1998;17:7–11.
    1. Kahn BS, Tatro C, Parsons CL, Willems JJ. Prevalence of interstitial cystitis in vulvodynia patients detected by bladder potassium sensitivity. J Sex Med. 2010;7:996–1002.
    1. Reed BD, Payne CM, Harlow SD, Legocki LJ, Haefner HK, Sen A. Urogenital symptoms and pain history as precursors of vulvodynia: a longitudinal study. J Womens Health (Larchmt) 2012;21:1139–1143.
    1. Hampson JP, Reed BD, Clauw DJ, et al. Augmented central pain processing in vulvodynia. J Pain. 2013;14:579–589.
    1. Pukall CF, Binik YM, Khalifé S, Amsel R, Abbott FV. Vestibular tactile and pain thresholds in women with vulvar vestibulitis syndrome. Pain. 2002;96:163–175.
    1. Foster DC, Dworkin RH, Wood RW. Effects of intradermal foot and forearm capsaicin injections in normal and vulvodynia-afflicted women. Pain. 2005;117:128–136.
    1. Giesecke J, Reed BD, Haefner HK, Giesecke T, Clauw DJ, Gracely RH. Quantitative sensory testing in vulvodynia patients and increased peripheral pressure pain sensitivity. Obstet Gynecol. 2004;104:126–133.
    1. Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007;30:77–94.
    1. Payne KA, Binik YM, Pukall CF, Thaler L, Amsel R, Khalife S. Effects of sexual arousal on genital and non-genital sensation: a comparison of women with vulvar vestibulitis syndrome and healthy controls. Arch Sex Behav. 2007;36:289–300.
    1. Basson R. The recurrent pain and sexual sequelae of provoked vestibulodynia: a perpetuating cycle. J Sex Med. 2012;9:2077–2092.
    1. Khandker M, Brady SS, Vitonis AF, MacLehose RF, Stewart EG, Harlow BL. The influence of depression and anxiety on risk of adult onset vulvodynia. J Women’s Health (Larchmt) 2011;20:1145–1451.
    1. Brotto LA, Basson R, Gehring D. Psychological profiles among women with vulvar vestibulitis syndrome: a chart review. J Psychosom Obstet Gynaecol. 2003;24:195–203.
    1. Jantos M, Burns NR. Vulvodynia. Development of a psychosexual profile. J Reprod Med. 2007;52:63–71.
    1. Lynch PJ. Vulvodynia as a somatoform disorder. J Reprod Med. 2008;53:390–396.
    1. Nguyen RH, Ecklund AM, Maclehose RF, Veasley C, Harlow BL. Co-morbid pain conditions and feelings of invalidation and isolation among women with vulvodynia. Psychol Health Med. 2012;17:589–598.
    1. Hartmann D. Chronic vulvar pain from a physical therapy perspective. Dermatol Ther. 2010;23:505–513.
    1. Davies S, Quintner J, Parsons R, et al. Preclinic group education sessions reduce waiting times and costs at public pain medicine units. Pain Med. 2011;12:59–71.
    1. Tan O, Bradshaw K, Carr BR. Management of vulvovaginal atrophy-related sexual dysfunction in postmenopausal women: an up-to-date review. Menopause. 2012;19:109–117.
    1. Goetsch MF. Unprovoked vestibular burning in late estrogen-deprived menopause: a case series. J Low Genit Tract Dis. 2012;16:442–446.
    1. Reed BD, Haefner HK, Sen A, Gorenflo DW. Vulvodynia incidence and remission rates among adult women: a 2-year follow-up study. Obstet Gynecol. 2008;112:231–237.
    1. Masheb RM, Kerns RD, Lozano C, Minkin MJ, Richman S. A randomized clinical trial for women with vulvodynia: cognitive-behavioral therapy vs supportive psychotherapy. Pain. 2009;141:31–40.
    1. Brotto LA, Sadownik L, Thomson S. Impact of educational seminars on women with provoked vestibulodynia. J Obstet Gynaecol Can. 2010;32:132–138.
    1. Sadownik LA, Seal BN, Brotto LA. Provoked vestibulodynia – women’s experience of participating in a multidisciplinary vulvodynia program. J Sex Med. 2012;9:1086–1093.
    1. Andrews JC. Vulvodynia interventions – systematic review and evidence grading. Obstet Gynecol Surv. 2011;66:299–315.
    1. Bergeron S, Binik YM, Khalifé S, Pagidas K. Vulvar vestibulitis syndrome: a critical review. Clin J Pain. 1997;13:27–42.
    1. Landry T, Bergeron S, Dupuis MJ, Desrochers G. The treatment of provoked vestibulodynia: a critical review. Clin J Pain. 2008;24:155–171.
    1. Leo RJ, Dewani S. A systematic review of the utility of antidepressant pharmacotherapy in the treatment of vulvodynia pain. J Sex Med. 2013;10:2497–2505.
    1. Leo RJ. A systematic review of the utility of anticonvulsant pharmacotherapy in the treatment of vulvodynia pain. J Sex Med. 2013;10:2000–2008.
    1. Spoelstra SK, Borg C, Weijmar Schultz WC. Anticonvulsant pharmacotherapy for generalized and localized vulvodynia: a critical review of the literature. J Psychosom Obstet Gynaecol. 2013;34:133–138.
    1. Foster DC, Kotok MB, Huang LS, et al. Oral desipramine and topical lidocaine for vulvodynia: a randomized controlled trial. Obstet Gynecol. 2010;116:583–593.
    1. Drabkin R, Calhoun L. Anorgasmia and withdrawal syndrome in a woman taking gabapentin. Can J Psychiatry. 2003;48:125–126.
    1. Brown CS, Foster DC, Wan JY, Rawlinson LA, Bachmann GA, Gabapentin (GABA) Study Group Rationale and design of a multicenter randomized clinical trial of extended release gabapentin in provoked vestibulodynia and biological correlates of response. Contemp Clin Trials. 2013;36:154–165.
    1. De Andres J, Sanchis-Lopez N, Asensio-Samper JM, Fabregat-Cid G, Dolz VM. Peripheral subcutaneous vulvar stimulation in the management of severe and refractory vulvodynia. Obstet Gynecol. 2013;121:495–498.
    1. McDonald JS, Rapkin AJ. Multilevel local anesthetic nerve blockade for the treatment of generalized vulvodynia: a pilot study. J Sex Med. 2012;9:2919–2926.
    1. Bergeron S, Khalifé S, Glazer HI, Binik YM. Surgical and behavioral treatments for vestibulodynia: two-and-one-half year follow-up and predictors of outcome. Obstet Gynecol. 2008;111:159–166.
    1. Nyirjesy P, Sobel JD, Weitz MV, Leaman DJ, Small MJ, Gelone SP. Cromolyn cream for recalcitrant idiopathic vulvar vestibulitis: results of a placebo controlled study. Sex Transm Infect. 2001;77:53–57.
    1. Bornstein J, Tuma R, Farajun Y, Azran A, Zarfati D. Topical nifedipine for the treatment of localized provoked vulvodynia: a placebo-controlled study. J Pain. 2010;11:1403–1409.
    1. Petersen CD, Giraldi A, Lundvall L, Kristensen E. Botulinum toxin type A-a novel treatment for provoked vestibulodynia? Results from a randomized, placebo controlled, double blinded study. J Sex Med. 2009;6:2523–2537.
    1. Bornstein J, Livnat G, Stolar Z, Abramovici H. Pure versus complicated vulvar vestibulitis: a randomized trial of fluconazole treatment. Gynecol Obstet Invest. 2000;50:194–197.
    1. Davis SN, Bergeron S, Binik YM, Lambert B. Women with provoked vestibulodynia experience clinically significant reductions in pain regardless of treatment: results from a 2-year follow-up study. J Sex Med. 2013;10:3080–3087.

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