eISSN: 2299-0038
ISSN: 1643-8876
Menopause Review/Przegląd Menopauzalny
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vol. 11
Review paper

Vulvodynia: pathogenesis, diagnosis and current treatment possibilities

Nina Rybak, Diana Mazurek, Jan Kotarski

Przegląd Menopauzalny 2012; 1: 36–40
Online publish date: 2012/02/29
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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.

vulvodynia, pathogenesis, diagnosis, treatment


Arnold LD, Bachmann GA, Rosen R, Rhoads GG. Assessment of vulvodynia symptoms in a sample of US women: a prevalence survey with
a nested case control study. Am J Obstet Gynecol 2007; 196: 128.e1-6.

Sadownik LA. Clinical profile of vulvodynia patients. A prospective study of 300 patients. J Reprod Med 2000; 45: 679-84.

Reed BD, Haefner HK, Punch MR, et al. Psychosocial and sexual functioning in women with vulvodynia and chronic pelvic pain. A comparative evaluation. J Reprod Med 2000; 45: 624-32.

Reed BD, Advincula AP, Fonde KR, et al. Sexual activities and attitudes of women with vulvar dysesthesia. Obstet Gynecol 2003; 102: 325-31.

Van Lankveld JJ, Weijenborg PT, ter Kuile MM. Psychologic profiles of and sexual function in women with vulvar vestibulitis and their partners. Obstet Gynecol 1996; 88: 65-70.

Moyal-Barracco M, Lynch PJ. 2003 ISSVD terminology and classification of vulvodynia: a historical perspective. J Reprod Med 2004; 49: 772-7.

Reed BD, Crawford S, Couper M, et al. Pain at the vulvar vestibule:
a web-based survey. J Low Genit Tract Dis 2004; 8: 48-57.

Goetsch MF. Vulvar vestibulitis: prevalence and historic features in
a general gynecologic practice population. Am J Obstet Gynecol 1991; 164: 1609-14.

Harlow BL, Stewart EG. A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? J Am Med Womens Assoc 2003; 58: 82-8.

. Edwards L, Mason M, Phillips M, et al. Childhood sexual and physical abuse. Incidence in patients with vulvodynia. J Reprod Med 1997; 42: 135-9.

Bazin S, Bouchard C, Brisson J, et al. Vulvar vestibulitis syndrome: an exploratory case-control study. Obstet Gynecol 1994; 83: 47-50.

Nyirjesy P. Vulvar Vestibulitis Syndrome: A Post-infectious Entity? Curr Infect Dis Rep 2000; 2: 531-5.

Arnold LD, Bachmann GA, Rosen R, et al. Vulvodynia: characteristics and associations with comorbidities and quality of life. Obstet Gynecol 2006; 107: 617-24.

. O’Hare PM, Sherertz EF. Vulvodynia: a dermatologist's perspective with emphasis on an irritant contact dermatitis component. J Womens
Health Gend Based Med 2000; 9: 565-9.

Umpierre SA, Kaufman RH, Adam E, et al. Human papillomavirus DNA in tissue biopsy specimens of vulvar vestibulitis patients treated with interferon. Obstet Gynecol 1991; 78: 693-5.

Tschanz C, Salomon D, Skaria A, et al. Vulvodynia after CO2 laser treatment of the female genital mucosa. Dermatology 2001; 202: 371-2.

Gaitonde P, Rostron J, Longman L, Field EA. Burning mouth syndrome and vulvodynia coexisting in the same patient: a case report. Dent Update 2002; 29: 75-6.

Zolnoun DA, Rohl J, Moore CG, et al. Overlap between orofacial pain and vulvar vestibulitis syndrome. Clin J Pain 2008; 24: 187-91.

Prayson RA, Stoler MH, Hart WR. Vulvar vestibulitis. A histopathologic study of 36 cases, including human papillomavirus in situ hybridization analysis. Am J Surg Pathol 1995; 19: 154-60.

Chadha S, Gianotten WL, Drogendijk AC, et al. Histopathologic features of vulvar vestibulitis. Int J Gynecol Pathol 1998; 17: 7-11.

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: 171-8.

Halperin R, Zehavi S, Vaknin Z, et al. The major histopathologic characteristics in the vulvar vestibulitis syndrome. Gynecol Obstet Invest 2005; 59: 75-9.

Lundqvist EN, Hofer PA, Olofsson JI, Sjöberg I. Is vulvar vestibulitis an inflammatory condition? A comparison of histological findings in affected and healthy women. Acta Derm Venereol 1997; 77: 319-22.

Weström LV, Willén R. Vestibular nerve fiber proliferation in vulvar vestibulitis syndrome. Obstet Gynecol 1998; 91: 572-6.

Tympanidis P, Terenghi G, Dowd P. Increased innervation of the vulval vestibule in patients with vulvodynia. Br J Dermatol 2003; 148: 1021-7.

Bornstein J, Cohen Y, Zarfati D, et al Involvement of heparanase in the pathogenesis of localized vulvodynia. Int J Gynecol Pathol 2008; 27: 136-41.

Omoigui S. The biochemical origin of pain: the origin of all pain is inflammation and the inflammatory response. Part 2 of 3 – inflammatory profile of pain syndromes. Med Hypotheses 2007; 69: 1169-78.

. Foster DC, Hasday JD. Elevated tissue levels of interleukin-1 beta and tumor necrosis factor-alpha in vulvar vestibulitis. Obstet Gynecol 1997; 89: 291-6.

Gerber S, Bongiovanni AM, Ledger WJ, Witkin SS. Defective regulation of the proinflammatory immune response in women with vulvar vestibulitis syndrome. Am J Obstet Gynecol 2002; 186: 696-700.

. Gerber S, Bongiovanni AM, Ledger WJ, Witkin SS. A deficiency in interferon-alpha production in women with vulvar vestibulitis. Am J Obstet Gynecol 2002; 186: 361-4.

Foster DC, Sazenski TM, Stodgell CJ. Impact of genetic variation in interleukin-1 receptor antagonist and melanocortin-1 receptor genes on vulvar vestibulitis syndrome. J Reprod Med 2004; 49: 503-9.

Jeremias J, Ledger WJ, Witkin SS. Interleukin 1 receptor antagonist gene polymorphism in women with vulvar vestibulitis. Am J Obstet Gynecol 2000; 182: 283-5.

Pukall CF, Binik YM, Khalifé S, et al. Vestibular tactile and pain thresholds in women with vulvar vestibulitis syndrome. Pain 2002; 96: 163-75.

Giesecke J, Reed BD, Haefner HK, et al. Quantitative sensory testing in vulvodynia patients and increased peripheral pressure pain sensitivity. Obstet Gynecol 2004; 104: 126-33.

Glazer HI, Jantos M, Hartmann EH, Swencionis C. Electromyographic comparisons of the pelvic floor in women with dysesthetic vulvodynia and asymptomatic women. J Reprod Med 1998; 43: 959-62.

McKay E, Kaufman RH, Doctor U, et al. Treating vulvar vestibulitis with electromyographic biofeedback of pelvic floor musculature. J Reprod Med 2001; 46: 337-42.

. Glazer HI. Dysesthetic vulvodynia. Long-term follow-up after treatment with surface electromyography-assisted pelvic floor muscle rehabilitation. J Reprod Med 2000; 45: 798-802.

Bergeron S, Binik YM, Khalifé S, et al. Vulvar vestibulitis syndrome: reliability of diagnosis and evaluation of current diagnostic criteria. Obstet Gynecol 2001; 98: 45-51.

McKay M. Dysesthetic (“essential”) vulvodynia. Treatment with amitriptyline. J Reprod Med 1993; 38: 9-13.

Reed BD, Caron AM, Gorenflo DW, Haefner HK. Treatment of vulvodynia with tricyclic antidepressants: efficacy and associated factors. J Low Genit Tract Dis 2006; 10: 245-51.

Stolar AG, Stewart JT. Nortriptyline for depression and vulvodynia. Am
J Psychiatry 2002; 159: 316-7.

Morgan V, Pickens D, Gautam S, et al. Amitriptyline reduces rectal pain related activation of the anterior cingulate cortex in patients with irritable bowel syndrome. Gut 2005; 54: 601-7.

Freysoldt A, Fleckenstein J, Lang PM, et al. Low concentrations of amitriptyline inhibit nicotinic receptors in unmyelinated axons of human peripheral nerve. Br J Pharmacol 2009; 158: 797-805.

Sud R, Spengler RN, Nader ND, Ignatowski TA. Antinociception occurs with a reversal in alpha 2-adrenoceptor regulation of TNF production by peripheral monocytes/macrophages from pro- to anti-inflammatory. Eur J Pharmacol 2008; 588: 217-31.

Ben-David B, Friedman M. Gabapentin therapy for vulvodynia. Anesth Analg 1999; 89: 1459-60.

Jerome L. Pregabalin-induced remission in a 62-year-old woman with
a 20-year history of vulvodynia. Pain Res Manag 2007; 12: 212-4.

Zolnoun DA, Hartmann KE, Steege JF. Overnight 5% lidocaine ointment for treatment of vulvar vestibulitis. Obstet Gynecol 2003; 102: 84-7.

Bergeron S, Bouchard C, Fortier M, et al. The surgical treatment of vulvar vestibulitis syndrome: a follow-up study. J Sex Marital Ther 1997; 23: 317-25.

Bohm-Starke N, Rylander E. Surgery for localized, provoked vestibulodynia: a long-term follow-up study. J Reprod Med 2008; 53: 83-89.

Goetsch MF. Surgery combined with muscle therapy for dyspareunia from vulvar vestibulitis: an observational study. J Reprod Med 2007; 52: 597-603.

McCormack WM, Spence MR. Evaluation of the surgical treatment of vulvar vestibulitis. Eur J Obstet Gynecol Reprod Biol 1999; 86: 135-8.

Leclair CM, Goetsch MF, Lee KK, Jensen JT. KTP-nd:YAG laser therapy for the treatment of vestibulodynia: a follow-up study. J Reprod Med 2007; 52: 53-8.

Reid R, Omoto KH, Precop SL, et al. Flashlamp-excited dye laser therapy of idiopathic vulvodynia is safe and efficacious. Am J Obstet Gynecol 1995; 172: 1684-1701.

Yoon H, Chung WS, Shim BS. Botulinum toxin A for the management of vulvodynia. Int J Impot Res 2007; 19: 84-7.

Walsh KE, Berman JR, Berman LA, Vierregger K. Safety and efficacy of topical nitroglycerin for treatment of vulvar pain in women with vulvodynia: a pilot study. J Gend Specif Med 2002; 5: 21-7.
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