Vulvodynia: pathogenesis, diagnosis and current treatment possibilities

Vulvodynia is a syndrome of chronic pain localized in vulva, occurring without any distinct reason and visible mucocutaneous alterations. The pain is most often described as burning, stinging, tingling and it can occur spontaneously or be provoked by ordinarily non-painful stimuli such as for example touch or gynecological examination. This condition affects usually young sexually active women resulting in a significant decrease in the general quality of life and sexual dysfunction. Two subsets of this disorder are distinguished: generalized and localized vulvodynia. Pathophysiology of this condition remains unclear, possible causes considered include chronic inflammatory process, immunologic changes and altered pelvic floor musculature contractility. Among women with vulvodynia a higher prevalence of chronic vulvovaginal candidiasis, recurrent urinary tract infections as well as other chronic pain syndromes and allergic skin disorders are observed. The diagnosis of vulvodynia depends mostly on a careful history and physical examination confirming lack of specific vulvar alterations. The diagnostic criteria were proposed in 1987 by Friedrich. Treatment of vulvodynia patients includes pharmacological methods such as tricyclic antidepressants, gabapentin or pregabalin, topical 5% lidocaine, supported by the physical therapy concerning pelvic floor musculature, biofeedback and behavioral therapy. Proper treatment of coexisting vulvovaginal infections and avoiding factors, which could exacerbate the symptoms are equally important. In treatment-resistant cases, invasive procedures such as the pudendal nerve block, surgical or laser vestibulectomy should be considered.