Materiały źródłowe

• #1 Vulvodynia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430792/

  Vulvodynia is a chronic pain condition characterized by persistent vulvar discomfort or pain lasting at least 3 months without a clearly identifiable cause. […] Although the exact cause of vulvodynia remains unknown, potential contributing factors include nerve dysfunction, inflammation, hormonal imbalances, genetic predisposition, and pelvic floor muscle dysfunction. […] The exact cause of vulvodynia remains unknown, and ongoing research aims to identify potential contributing factors. Possible contributing causes include nerve injury or irritation affecting the transmission of pain from the vulva to the spinal cord, an increase in the number and sensitivity of nerve fibers in the vulva, elevated levels of inflammatory substances such as cytokines, abnormal responses to environmental factors, genetic susceptibility, and pelvic floor muscle weakness, spasms, or instability.

• #2 Vulvodynia: Causes, Symptoms, Management & Treatment

  https://my.clevelandclinic.org/health/diseases/17878-vulvodynia

  Vulvodynia is pain in your vulva that lasts longer than three months. Unlike vulvar pain that results from a condition, vulvodynia doesn’t have a clear cause. The pain can be so life-altering that it keeps you from engaging in activities you enjoy. […] Vulvodynia (pronounced vul-vo-DIN-ee-a) is chronic pain in your vulva, and or vagina or genitals, with no apparent cause. […] Vulvodynia is pain lasting three or more months that isn’t an obvious symptom of a specific condition. […] Researchers aren’t sure what causes vulvodynia, but there are many potential causes, including: Inflammation, Hormonal factors, Genetic (inherited) factors, Injury to your nerves (neuropathic problems), Long-term reactions to past vaginal infections, Weakened pelvic floor muscles or muscle spasms, Irritation from harsh products that touch your skin.

• #3 Etiology, diagnosis, and clinical management of vulvodynia | IJWH

  https://www.dovepress.com/etiology-diagnosis-and-clinical-management-of-vulvodynia-peer-reviewed-fulltext-article-IJWH

  Chronic vulvar pain or discomfort for which no obvious etiology can be found, ie, vulvodynia, can affect up to 16% of women. […] The etiology is multifactorial and may involve local injury or inflammation, and peripheral and or central sensitization of the nervous system. […] The etiology of vulvodynia is uncertain and likely multifactorial. There is debate about whether the pain is primarily caused by a local insult or injury, or a maladaptive peripheral and/or maladaptive central pain processing mechanism. […] At a local level, there may be an initial trigger that causes inflammation and/or injury affecting the vulva. This results in repetitive stimulation of pain receptors and ultimately receptor or nerve damage (nociceptive pain). […] Chronic local inflammation may result in an increase in: neurotransmitters and immune-mediated factors; proliferation of unmyelinated nerve fibers; chronic stimulation of afferent primary c fibers; and chronic stimulation of the dorsal horn cells in the spinal cord.

• #4 What Causes Vulvodynia? – The National Vulvodynia Association

  https://www.nva.org/what-is-vulvodynia/what-causes-vulvodynia/

  Vulvodynia is not caused by an active infection or a sexually transmitted disease. […] Through continued research efforts, we move closer to discovering the underlying cause(s) of vulvodynia. […] Researchers speculate that one or more of the following may cause, or contribute to, vulvodynia: An injury to, or irritation of, the nerves that transmit pain from the vulva to the spinal cord. […] An increase in the number and sensitivity of pain-sensing nerve fibers in the vulva. […] Elevated levels of inflammatory substances in the vulva. […] An abnormal response of different types of vulvar cells to environmental factors such as infection or trauma. […] Genetic susceptibility to chronic vestibular inflammation, chronic widespread pain and/or inability to combat infection. […] Pelvic floor muscle weakness, spasm or instability.

• #5 Vulvodynia – Wikipedia

  https://en.wikipedia.org/wiki/Vulvodynia

  Vulvodynia is a chronic pain condition that affects the vulvar area and occurs without an identifiable cause. Symptoms typically include a feeling of burning or irritation. It has been established by the ISSVD that for the diagnosis to be made symptoms must last at least three months. […] The causes of vulvodynia are not fully understood, but there are many sub-types of vulvodynia with different causes, including an excess of nerve fibers, hormonal imbalances, inflammation, and muscular dysfunction. Some factors influencing the disease may include genetics, immunology, and possibly diet. […] Vulvodynia has many different sub-types and causes. The disease is highly idiopathic. Identifying the cause is important to determine the appropriate treatment. […] Pain confined to the vulval vestibule, known as vestibulodynia, has at least three known sub-types: neuroproliferation, hormonally-mediated, and inflammation. Neuroproliferation can be present from birth or acquired later in life. This type of vestibulodynia is known as neuroproliferative vestibulodynia. Hormonally-mediated vestibulodynia can be caused by hormonal medications like oral birth control. Inflammatory vestibulodynia can develop as part of an immune response.

• #5 Vulvodynia – Wikipedia

  https://en.wikipedia.org/wiki/Vulvodynia

  Many co-morbidities are commonly associated with vulvodynia, including fibromyalgia, irritable bowel syndrome, interstitial cystitis, pelvic floor dysfunction, endometriosis, depression and anxiety disorders. […] There are a number of possible treatments with none being uniformly effective. Treatments include: […] Many patients who have vulvodynia also have high-tone pelvic floor, meaning that their pelvic floor muscles are too tight. This may contribute to their pain in the area. Pelvic floor physical therapy may help treat the pelvic floor dysfunction and help the patient gain greater control over their pelvic floor muscles. […] Vestibulectomy is a surgery to remove the vulval vestibule, and it may be recommended for certain patients. It has been suggested as a first-line treatment for neuroproliferative vestibulodynia. It has successful long-term outcomes, but is often only offered after conservative measures have failed.

• #6 Vulvodynia: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0401/p1231.html

  There is controversy about whether changes exist in the inflammatory infiltrate in vulvar tissue of women with vulvodynia. […] More recently, vulvar biopsy specimens have shown increased neuronal proliferation and branching in the vulvar tissue of women with vulvodynia compared with tissue of asymptomatic women. […] Allodynia (i.e., pain elicited by a nonpainful stimulus) and hyperpathia (i.e., when a stimulus causes greater pain than expected) suggest a neuropathic cause of the pain of vulvodynia. […] This characterization has led to improved understanding of why certain therapies often are not useful (e.g., corticosteroids, estrogen therapy), and why others that have been effective in the treatment of other neuropathic disorders may be of use in patients with vulvodynia (e.g., amitriptyline, gabapentin [Neurontin]). […] Although the pain of vulvodynia seems to be neuropathic, many medications that have been used effectively in the treatment of other neuropathic disorders have been used in patients with vulvodynia.

• #7 Frontiers | Localized Provoked Vulvodynia-An Ignored Vulvar Pain Syndrome

  https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2021.678961/full

  The histopathology of the vulvar vestibule in LPV demonstrates two distinctive pathologic features, infiltration with lymphocytic inflammatory cells and proliferation of sensory nerve fibers. […] The presence of lymphoid aggregates and increased density of B cells, including activated plasma cells are the major differences between the vestibular tissue from women with LPV and samples from control women. […] Nerve fiber proliferation and hyperinnervation is consistently observed in virtually all histopathological studies of the vestibular areas of LPV patients. […] Thus, tender zone hyperinnervation is due at least in part to proliferation of nerve fibers known to detect mechanical pain contributing to the hypersensitivity to touch in LPV. […] In aggregate, the pathophysiological evidence suggests that LPV has a biological basis and that microbial antigens such as Candida can induce a prolonged cutaneous hypersensitivity response in the vulvar vestibular epithelial cells in a subset of susceptible women. However, the overall evidence is still relatively limited, and some studies question the role of inflammation in driving LPV. […] The pathogenesis of primary LPV and secondary LPV may also differ so that the microbial cause is more likely related to secondary LPV. Clearly, LPV is a clinical diagnosis and may have multiple etiologies.

• #7 Frontiers | Localized Provoked Vulvodynia-An Ignored Vulvar Pain Syndrome

  https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2021.678961/full

  Localized provoked vulvodynia (LPV) causes dyspareunia among reproductive aged women. We review the pathogenesis of LPV and suggest that LPV is an inflammatory pain syndrome of the vestibular mucosa triggered by microbial antigens in a susceptible host. Tissue inflammation and hyperinnervation are characteristic findings which explain symptoms and clinical signs. […] The pathogenesis of LPV involves microbial, immunological and genetic components. Inflammation and hyperesthesia within well-defined areas of the vestibule well explain the symptoms and signs of LPV. […] Many lines of evidence suggest that Candida is one trigger antigen causing LPV. Women with LPV have a history of recurrent vulvovaginal candidiasis (RVVC) more often than control women. […] A familiarity analysis of LPV patients treated by vestibulectomy suggests a genetic predisposition.

• #8 Vulvodynia: Pain Management Strategies

  https://www.mdpi.com/1424-8247/15/12/1514

  The neurophysiopathology of vulvodynia is varied and is characterised by sensory abnormalities of the peripheral and central nervous system. […] Allodynia and hyperalgesia are typical features of vulvodynia and are often associated with other chronic pain conditions. […] It would seem that the primum movens is the development of a chronic inflammatory framework of the vulvar mucosa that in the long run leads to an increase in the density of the nerve fibres of the vestibule. […] Numerous psychophysical studies, that have investigated numerous sensory modalities- temperature, light touch, puncture or relative pressure on peripheral and central somatosensory channels- have shown an increased pain sensitivity at the urogenital area in women with vulvodynia compared to healthy controls. […] A dysregulation of the pain modulation system is also suggested by functional data from resonance studies.

• #9 Vulvodynia: Current state of the biological science

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5568852/

  Hypothetically, regional changes in the biochemical milieu via changes in cytokine, neurokine, chemokine, or prostanoid signaling could alter ion channel activity of the peripheral pre-terminal axon. […] Vulvodynia-affected mucosa demonstrates various degrees of alterations in neurokines, cytokines, and neural responsiveness. […] Vulvodynia has been proposed by some to have a neuro-inflammatory pathogenesis, similar to other chronic pain conditions. […] How and why inflammatory pain localizes to the vulvar vestibule in LPV remains a potentially fruitful area of future research. […] A number of studies report an increase in nerve fiber density in LPV corresponding to regional heightened mechanical allodynia and hyperalgesia. […] The results of several psychophysical studies suggest that LPV is associated with sensory abnormalities, and evidence of both central and peripheral sensitization exist.

• #9 Vulvodynia: Current state of the biological science

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5568852/

  The International Society for the Study of Vulvovaginal Disease (ISSVD) defines vulvodynia as chronic vulvar pain without visible dermatosis. […] Vulvodynia often occurs in the context of other comorbid pain conditions, with irritable bowel syndrome and fibromyalgia being the most prevalent. […] As our understanding of vulvodynia evolves beyond the rudimentary classification of LPV, GVD, and primary and secondary types, nomenclature will be based on a clearer understanding of disease phenotype with improved diagnostic reliability and better-defined disease models. […] A number of psychophysiologic events have been recognized to occur concurrently and to varying degrees in afflicted individuals, these include: Pro-inflammatory cell migration to the vulvar vestibule, Local production and release of pro-inflammatory, pain-inducing substances, Regional hyperinnervation of C fibers, Regional lowering thresholds to varied stimuli, Development of central sensitization, Autonomic dysfunction, ie, postural hypotension, Manifestation of somatization, depression, anxiety, and hypervigilance, Superimposed pelvic floor muscle hypercontractility resulting in introital narrowing and muscle pain, Sexual dysfunction.

• #10 Mechanisms of Vulvodynia Involving Dysregulation of Pro-Resolving Lipids – Research Projects – Falsetta Lab – University of Rochester Medical Center

  https://www.urmc.rochester.edu/labs/falsetta/projects/mechanisms-of-vulvodynia

  Localized provoked vulvodynia (LPV) is characterized by acute and lasting pain in response to light touch of the vulvar vestibule (area immediately surrounding the vaginal opening), which is associated with a reduction in quality of life. […] The origins of vulvodynia are poorly understood, and no current therapy targets the root of the disease or is completely curative, perhaps save surgical amputation of the affected tissue. […] We have determined that a persistent low level of inflammation, generally undetectable clinically, is a key contributor to vulvodynia. […] Most recently, we have uncovered evidence pointing to a defect in the ability to resolve this inflammation, which may be the product of alterations in the presence or abundance of the molecules that help resolve inflammation named specialized pro-resolving mediators (SPMs) and the receptors that recognize these SPMs.

• #11 Vulvodynia: Pain Management Strategies

  https://www.mdpi.com/1424-8247/15/12/1514

  Inflammatory factors Although several studies have obtained conflicting results, it is thought that there may be a correlation between the development of vulvodynia and a chronic inflammatory condition. […] Neuroselective sensory dysfunction of the pudendal nerve Murina et al. conducted a study to objectively assess vulvodynia using the current perception threshold (CPT) neurometer. […] A condition characterised by intense pain sensations that usually begin in the extremities and may also include the sexual organs. […] Increased sensitivity of the peripheral regions of the body Giesecke et al. conducted a study to assess both regional (vulvar) and general pain sensitivity in women with vulvodynia to determine whether both are increased, indicative of impaired central pain processing.

• #12

  https://link.springer.com/article/10.1007/s00404-022-06424-4

  This short opinion aimed to present the evidence to support our hypothesis that vulvodynia is a neuroinflammatory pain syndrome originating in the pelvic visceral nerve plexuses caused by the failure of weakened uterosacral ligaments (USLs) to support the pelvic visceral nerve plexuses, i.e., T11L2 sympathetic and S24 parasympathetic plexuses. […] Activation of sensory visceral nerves causes a neuro-inflammatory response in the affected tissues, leading to neuroproliferation of small peripheral sensory nerve fibers, which may cause hyperalgesia and allodynia in the territory of the damaged innervation. […] A peripheral neurologic mechanism leading to neuroproliferation has been recognized in women with vulvodynia and in animal models. […] If the USLs are lax, gravitational force or contractile force from intrapelvic muscles may displace the unsupported plexuses, inadvertently stimulating them. Afferent signals then pass to the brain but are (wrongly) interpreted as coming from an end-organ site so that tenderness is experienced at the innervation target of the nerve.

• #13

  https://link.springer.com/article/10.1007/s00404-022-06424-4

  Activation of visceral sensory nerves induces the nervous system to cause a local neuro-inflammatory response to develop in the affected tissues, with macrophage, mast cell, and T-cell responses. […] This local neuro-inflammatory response exacerbates the pain; for example, nerve growth factors secreted from mast cell granules can induce neuroproliferation and sensitization. […] The theory that USL laxity may be the primary trigger of the local neuro-inflammatory response, by mechanical stimulation of the Frankenhauser ganglia and intrapelvic autonomic sensory plexuses leading to the pain syndrome, has significant therapeutic implications. […] The neuro-inflammatory mechanism for vulvodynia raises questions about possible neuro-inflammation in other chronic pelvic pain disorders.

• #14 Vulvodynia: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0401/p1231.html

  Vulvodynia is characterized by chronic discomfort in the vulvar region; the discomfort may range from mild to severe and debilitating. […] Although research is ongoing, little is known about the causes of vulvodynia. Affected women are more likely to have altered contractile characteristics of the pelvic floor musculature; biofeedback therapy designed to address these alterations often results in improved muscle function and decreased vulvar pain. […] Several studies have identified minor immunologic changes in women with vulvodynia, such as altered levels of interleukin-1 and tumor necrosis factor- in vestibular tissue; increased production of interleukin-1 and decreased production of interleukin-1 receptor antagonist by lymphocytes following stimulation; decreased production of interferon; and changes in the gene associated with interleukin-1 receptor antagonist.

• #15 Mechanisms of Vulvodynia Involving Dysregulation of Pro-Resolving Lipids – Research Projects – Falsetta Lab – University of Rochester Medical Center

  https://www.urmc.rochester.edu/labs/falsetta/projects/mechanisms-of-vulvodynia

  Although our work in this area is ongoing, our findings suggest vulvodynia is the product of two hits. The first hit involves exaggerated inflammatory signaling, rendering the vestibule hypersensitive to inflammatory stimuli, such that a womans own natural flora may elicit a response. We are currently focusing on investigating the second hit, involving dysregulation of the resolution machinery.

• #16 Vulval Pain | Pelvic Pain Support Network

  https://www.pelvicpain.org.uk/conditions/vulval-pain/

  Vulval pain may be related to several causes including infections such as candidosis or herpes, skin conditions (dermatosis) and occasionally precancerous or malignant conditions. […] Some data suggest that this pain may arise from persistent inflammatory damage to tissue. Some women may make more chemicals that increase or cause inflammation. […] There is research indicating an increase in the number of nerve fibres in the vulva in women with this condition (Bohm-Starke et al 1998). An increase in the number of nerves could lead to an increased inflammatory response. […] In addition tissue samples from women with this condition have higher levels of substances that cause inflammation (Sloane et al 1999). Biopsies show an increase in the number of mast cells (Bornstein 2001) which could lead to hyperalgesia (excessive sensitivity to a painful stimulus meaning that sufferers feel more pain than normal).

• #17 Provoked vulvodynia: diagnosis of perplexing pain condition – Pelviperineology A Multidisciplinary Pelvic Floor Journal

  https://pelviperineology.org/articles/provoked-vulvodynia-diagnosis-of-perplexing-pain-condition/doi/PPj.2020.39.04.003

  Our group showed that 90% of patients with PV have more than eight mast cells per high power field. […] The exact mechanism by which the instability of the pelvic floor is associated with PV is unclear. […] We documented the involvement of these nerve plexuses in PV, and showed in a randomized, control, crossover study that support of the USLs leads to temporary relief of the PV. […] The first part of the consensus terminology contains a list of recognized causes of vulvar pain, including Candida and bacteriologic vaginal infections, dermatoses, deformities, birth lacerations, and past trauma. […] Diagnosing PV should be conducted according to a structured plan. Diagnosis is based on the understanding of the associated factors of PV as described in the consensus terminology.

• #18 Localized provoked vulvodynia: pathogenesis and pain mechanisms

  https://secure.key4events.com/key4register/AbstractList.aspx?e=612&preview=1&aig=-1&ai=15393

  Localized provoked vulvodynia (LPV) is a subset of vulvodynia, associated with induced pain by touch on vulvar mucosa in the absence of any other recognizable disease. […] The intensity of pain is out of proportion to the applied pressure: very light touch evokes excessively strong pain, a phenomenon defined as allodynia. […] Different vulvovaginal infections, especially recurrent candidiasis, and urinary tract infections are known risk factors for LPV. […] LPV patients, more often than healthy controls, are genetically predisposed to yeast and other vulvo-vaginal infections. […] Animal models and in vitro studies have further produced data of the significance of Candida albicans infection as a pain generator in the vulvar vestibule. […] Studies conducted in cell cultures have shown that fibroblasts originating from vestibular mucosa of LPV patients are more responsive to fungal antigens than those from healthy controls.

• #19 Localized provoked vulvodynia: pathogenesis and pain mechanisms

  https://secure.key4events.com/key4register/AbstractList.aspx?e=612&preview=1&aig=-1&ai=15393

  LPV patients also have a tendency to carry pro-inflammatory allele variants of IL-1beta and IL-1 receptor antagonist genes and show elevated tissue levels of pro-inflammatory cytokines. […] An increased immunoinflammatory response and the neuroinflammatory axis may well be involved in the development of a chronic pain syndrome. […] This further supports the essential role of immune activation in the altered pain sensation of LPV. […] Interplay between activated immune cells and biomodulators of the signaling of sensory neurons could thus be involved in LPV.

• #20 Vulvar Pain: Causes, Treatments, and More

  https://www.healthline.com/health/womens-health/vulvar-pain

  Many women experience pain and discomfort in the vulva at some point in their lives. When the pain is persistent for more than three months and has no apparent cause, its called vulvodynia. […] Vulvar pain isn’t well understood. Vulvar pain is not contagious, nor is it spread through sex. Its also not a sign of cancer. […] Researchers have seen a link between vulvar pain and some conditions and factors in some women, such as the following. […] In one study, mice that were subjected to and treated for yeast infections three times were more likely to encounter vulvar pain than mice without yeast infection. The researchers theorized that the multiple yeast infections increased the production of nerve fibers in the mice. The increased nerve fibers resulted in more vulvar pain. […] Some women are born with genetic differences that cause cells to overreact to inflammation or hormones. That can cause pain when inflammation occurs in the vulvar region. Inflammation causes tissue to swell, fill with more blood, and feel hot and sore.

• #21 Localised provoked vestibulodynia (vulvodynia): assessment and management

  https://www.racgp.org.au/afp/2015/july/localised-provoked-vestibulodynia-vulvodynia-asses

  Vulvodynia is defined by the International Society for the Study of Vulvovaginal Disease (ISSVD) as chronic vulvar discomfort, most often described as burning pain, occurring in the absence of relevant findings or a specific, clinically identifiable, neurologic disorder. It is diagnosed when other causes of vulvar pain have been excluded or when pain persists despite adequate management of these conditions. Vulvodynia is further classified as localised or generalised, and provoked, unprovoked or both. Most chronic vulvar pain falls into two broad groups: localised provoked vestibulodynia (formerly vestibulitis or vulvar vestibular syndrome) and generalised vulvodynia (formerly essential or dysaesthetic vulvodynia). […] Localised provoked vestibulodynia (LPV) is characterised by tenderness to gentle touch or pressure in the vulvar vestibule. There are localised neuroinflammatory changes within the mucosa, including increased concentration of pro-inflammatory peptides and hyperinnervation with C-fibres. These fibres are multimodal sensory fibres that, when stimulated, can result in prolonged burning. In addition, there is hypertonicity of the pelvic floor muscles, resulting in introital narrowing and muscle pain. […] Chronic candidiasis, for example, is frequently implicated in the onset of LPV through the pain-sensitising effect of chronic inflammation and repeated painful sex. It is important, therefore, to look for candidiasis in women with LPV.

• #22 Vulvodynia: Pain Management Strategies

  https://www.mdpi.com/1424-8247/15/12/1514

  Impaired neuroadaptation in patients with longer pain duration Neurophysiology studies have shown that repeated stimulation of a small area results in temporal changes in cortical activity, most notably a reduction in cortical response with extended stimulus duration. […] Autonomic dysfunction In several studies, it has been observed that vulvodynia is often accompanied by autonomic changes, although we are not yet able to determine whether this is the cause or a consequence. […] Hormonal factors The innervation of the female reproductive tract is regulated by gonadal hormone levels. […] Muscle dysfunction Vulvodynia is frequently associated with varying levels of pelvic floor muscle dysfunction, including increased tone and alterations in muscle contractility and control. […] Genetic aspects A genetic hypothesis on vulvodynia was advanced by analyzing familial women with PVD who underwent vestibulectomy.

• #23 Vulvodynia: Current state of the biological science

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5568852/

  It has long been recognized that LVD is often associated with some degree of pelvic floor muscle dysfunction. […] This pelvic floor muscle dysfunction may be the result of a protective reflex to avoid penetration that the woman finds painful or that she fears. […] Compared to other chronic pain conditions, very few animal models have been developed to replicate relevant clinical pain conditions from the urogenital tract. […] Structural and functional magnetic resonance imaging (fMRI) studies have revealed many types of brain differences associated with the development of chronic pain; however, few studies have applied these techniques to study vulvodynia. […] Vulvodynia comprises a poorly defined and understudied heterogeneous group of chronic sexual pain syndromes in women.

• #24 Vulval Pain | Pelvic Pain Support Network

  https://www.pelvicpain.org.uk/conditions/vulval-pain/

  Persistent infections may cause irritated vulvar tissue. […] The management of vulval pain should follow the principles of chronic pain management. […] A combination of medical treatment as well as psychotherapy and physiotherapy appears to be more successful than isolated treatment approaches. […] Those with vulvodynia, either spontaneous or provoked by touch, usually have pelvic floor muscle dysfunction. […] It is crucial to find a physiotherapist who is familiar with taking care of those with vulvodynia. […] A local anaesthetic 5% lidocaine cream was found to have helped some women with vulvodynia in a study by Zolnoun et al (2003). […] Botulinum toxin A injections have been used and a recent study suggests that higher doses than used previously may be effective. […] Surgical removal of the tissue around the opening of the vagina (vestibulectomy) is not generally beneficial in women with provoked vulvodynia (Andrews JC, 2011).

• #25

  https://www.gloshospitals.nhs.uk/your-visit/patient-information-leaflets/vulvodynia/

  Vulvodynia is the medical term used to describe pain in the vulva or female genital area where the skin looks healthy and no cause has been found. This discomfort can be felt during normal touch such as sex, inserting tampons or from clothing. […] We are unsure what the reason is for developing this pain, but current research suggests it is because of a nerve problem. […] In some women the nerve endings become sensitive and interpret normal touch as pain (provoked vulvodynia). […] Some women will have pain that is not triggered by touch (spontaneous or unprovoked vulvodynia). We do not know the exact cause of this pain but some studies have shown links to other chronic pain conditions such as fibromyalgia or irritable bowel syndrome. […] There is strong evidence that physiotherapy, as a first-line treatment, can improve vaginismus and vulvodynia by up to 80%. […] Pain modifying medication can reduce pain signals from your nerves and are given in tablet form. […] Botox injections can be considered if other therapies fail in women with provoked vulvodynia. Up to 70% of women have some benefit and the effects can last up to 3 months.

• #26 Vulvodynia | The Children’s Hospital at Montefiore

  https://www.cham.org/health-library/article?id=bo1196

  Vulvodynia is pain in the vulva that can’t be explained by another health problem, such as an infection or a skin problem. […] Doctors don’t know the exact cause of vulvodynia. But some things that may help cause it include: Swelling of or injury to the nerves of the vulva. Spasms or weakness of the muscles that support the organs of the pelvis. A family history of vulvodynia. […] If a cause for your pain is not found, you may have vulvodynia. […] There are many treatments for vulvodynia, but what works for someone else may not help you. Work with your doctor to find what is best for you. Even though there is no cure, treatment can help you feel better. […] Medicines that are applied to the skin, such as estrogen cream or lidocaine ointment, may help relieve pain. Other medicines that may be used include antidepressants, seizure medicines, and nerve blocks. […] Specific exercises can help you learn how to control and relax your pelvic muscles. Tightness or spasms in these muscles can make vulvar pain worse. […] Cognitive-behavioral therapy allows you to express your emotions and concerns and to learn new ways of coping with vulvar pain.

• #27 What Is Vulvodynia? Causes, Symptoms, and More | Evvy

  https://www.evvy.com/blog/what-is-vulvodynia

  Vulvodynia pain can also be associated with changes in hormone levels from taking birth control pills or entering menopause, for example. […] Because we know so little about vulvodynia its hard to say who is more likely to get it. One study found that people who had poorer sleep quality, other chronic pain conditions, PTSD, a history of vulvodynia, and other urogenital symptoms were more likely to get vulvodynia than people who werent affected by those factors.

• #28 Vulvar Pain (Vulvodynia): Symptoms, Causes and Remedies | Carreras Medical Center

  https://www.toplinemd.com/carreras-medical-center/vulvar-pain-vulvodynia-symptoms-causes-and-remedies/

  Chronic pain conditions: Females experiencing pain in the vaginal area could be two to three times more likely to have conditions such as irritable bowel syndrome or fibromyalgia. Both are inflammatory diseases, so vulvodynia could be linked to inflammation too. […] Hormone therapy: Based on a study, females who have used hormone therapy are more likely to have chronic vulvar pain than those who have not. Another study reports that there is no connection between the use of birth control and vulvar pain. […] Sexual or physical trauma: Pain in the vaginal area could also be caused by sexual abuse, childbirth, or sexual intercourse without adequate vaginal lubrication. Other activities that can put excessive pressure on the vaginal area, such as horseback riding, can also cause harm to this region. If your vagina is throbbing during these activities, stop immediately and get help.

• #29 Vulvar Pain: Causes, Treatments, and More

  https://www.healthline.com/health/womens-health/vulvar-pain

  Vulvar nerve endings can become damaged during childbirth, sexual abuse, or sex without enough vaginal lubrication. Activities that put a lot of pressure on the vaginal region, such as bicycling or horseback riding, can also harm nerve endings and tissue. […] Women with vulvodynia may be 2 to 3 times more likely to have chronic pain conditions like fibromyalgia and irritable bowel syndrome. Both of those are inflammatory diseases, so this type of vulvodynia may be related to inflammation as well. […] Soaps, gels, and feminine deodorant products can cause an allergic reaction in the vulvar region in some women. That can lead to irritation, inflammation, and pain. […] One study found that women with chronic vulvar pain were more likely to have used hormone therapy than those who didn’t have pain. According to another study, there doesn’t appear to be a link between vulvar pain and the use of birth control, however.

• #30 Vulvodynia (vulvar pain): what is it, symptoms and treatment | Top Doctors

  https://www.topdoctors.co.uk/medical-dictionary/vulvodynia-vulvar-pain

  Vulvodynia is pain in the vulva which is persistent and unexplained. The vulva is the female genital area, and it includes the skin surrounding the vaginal opening. […] There is no clear cause for vulvodynia. However, factors that may contribute to vulvar pain include: Hormonal changes, Allergies to feminine hygiene products, Previous vaginal infections, Vulval nerves being injured or irritated, Inflammation, Muscle weakness in the pelvic floor, Some genetic conditions. […] Yes. When oestrogen levels fall, which is a symptom of the menopause and perimenopause, this can cause vaginal dryness which can lead to vulval pain. […] The impact of untreated vulvodynia can mean that you experience a lower quality of life. Vulvodynia can lead to a disturbed sleep and anxiety and depression around sex and body confidence. […] Vulvodynia often goes away by itself, but treatments and lifestyle changes can help to manage symptoms while you have it. A sexual health or gynaecological specialist can provide expert advice if you experience persistent pain or have flare ups.

• #31 Vulvodynia: How to Recognize and Treat this Chronic Pain of the Vulva

  https://mydoctor.kaiserpermanente.org/mas/news/vulvodynia-how-to-recognize-and-treat-this-chronic-pain-of-the-vulva-2012598

  Vulvodynia is pain or discomfort of the vulva that lasts for at least three months. […] There are several different causes and types of vulvodynia. They include: Vaginitis, or inflammation of the vagina. Getting several yeast or bacterial infections can lead to inflammation of the vulvar area. Inflammation causes pain, including painful sexual intercourse. […] Changes in hormone levels and hormone imbalances are the most common reasons for vulvodynia in women in their 20s and older. There is a link, for example, between birth control pills and vulvodynia. The pills can lower the amount of estrogen and testosterone in the vulvar area, leading to dryness and pain. […] Tight pelvic floor muscles can lead to vulvodynia and painful sex. […] Some women are at increased risk of developing vulvodynia, women who have anxiety, depression, repeated vaginal infections, irritable bowel syndrome (IBS), or interstitial cystitis / bladder pain syndrome.

• #32 Vulvar Pain (Vulvodynia): Symptoms, Causes and Remedies | Carreras Medical Center

  https://www.toplinemd.com/carreras-medical-center/vulvar-pain-vulvodynia-symptoms-causes-and-remedies/

  Vulvodynia refers to chronic pain in the outside of a female’s genitals, the vulva. According to patients, this condition is described as a sensation of stinging, rawness, burning, and itching. Vulvodynia can last more than three months and does not have a distinct, identifiable cause like a skin disorder or an infection. Females with vulvodynia can experience sexual dysfunction, and the pain or discomfort may have a negative impact on life quality. […] Although there is no apparent reason for pain in the vaginal area, experts assume that this condition can be caused by various factors. Here are some of the most common factors associated with vulvar pain: Genetic disorders: Some patients are born with specific genetic diseases that may cause the cells to overreact to hormones and inflammation in the body. As a result, these women can experience pain in the vaginal area. The inflammation may also lead to the swelling of the tissue and a sensation of soreness.

• #33 What is vulvodynia?

  https://www.bbc.com/future/article/20180725-the-health-condition-vulvodynia-is-painful-and-misunderstood

  Some research has linked vulvodynia to autoimmune disorders, nerve damage, allergic reactions, chronic yeast infections and even ethnicity, says Stoehr. The risk of getting vulvodynia is also heightened by psychological conditions like depression and anxiety, as well as potentially by childhood events like chronic stress or sexual abuse. […] One recent theory has been that vulvodynia’s symptoms may stem not from the affected part of the body, but in the brain as is the case with other chronic pain disorders. Research has found that sufferers have more grey matter in the areas of their brain that process pain and stress. In other words, the problem may not be in the pelvic area. It may be in how the brain is processing signals from it. […] There is often no identifiable cause, and there is no one-size-fits-all cure.

• #34 Vulvodynia: Causes, Symptoms, Management & Treatment

  https://my.clevelandclinic.org/health/diseases/17878-vulvodynia

  Data suggests that people with vulvodynia are more likely to have higher levels of stress, histories of abuse and certain behavioral health conditions, including: Anxiety, Depression, Post-traumatic stress disorder (PTSD). […] Vulvodynia treatment takes time. Finding the treatment or combination of treatments that bring you pain relief involves trial and error. Treatments that eventually work might not work immediately. […] Unfortunately, vulvodynia isn’t preventable. […] There isn’t enough evidence to predict when (or if) your vulvodynia will ease or resolve on its own.

• #35 Vulvodynia Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/vulvodynia

  Vulvodynia is often a complicated condition. It may take weeks to months to achieve some pain relief. Treatment may not ease all symptoms. A combination of treatments and lifestyle changes may work best to help manage the symptoms of vulvodynia. […] Having this condition can take a physical and emotional toll. It can cause: Depression and anxiety, Problems in personal relations, Sleep problems, Problems with sex.

• #36 Vulvodynia – HealthyWomen

  https://www.healthywomen.org/condition/vulvodynia

  Vulvodynia can cause significant physical, sexual and psychological distress. […] The chronic nature and complexity of vulvodynia often require multiple treatment strategies. […] There is no known cure for vulvodynia. The main goals of treatment are to manage your pain, improve your quality of life (e.g., restore a healthy sex life and reduce anxiety), and prevent the recurrence of symptoms. […] Diagnosis includes a cotton swab test in which the doctor places pressure on different parts of the vulva area to locate the pain and its relative intensity. […] The aim of ongoing research is to determine the causes of vulvodynia and to find more effective ways to identify and treat chronic vulvar pain.

• #37 Vulvodynia: Causes, Symptoms, and Treatments

  https://www.webmd.com/women/vulvodynia

  Possible risk factors for vulvodynia include: Anxiety, Depression, A history of abuse, Posttraumatic stress disorder (PTSD). […] A burning pain is the single most common vulvodynia symptom. Some women describe it as a knife-like pain or like someone poured acid on their skin. […] There’s no one treatment for vulvodynia that works for all women. You may need to try a mix of things for the best results. […] If you have a type of localized vulvodynia called provoked vestibulodynia, your doctor may suggest surgery to remove painful tissue, especially if other options haven’t helped.

• #37 Vulvodynia: Causes, Symptoms, and Treatments

  https://www.webmd.com/women/vulvodynia

  Vulvodynia is a chronic pain condition affecting the vulva (outer female genitals). It usually lasts more than three months, and there’s no known cause. […] Doctors don’t know the cause of most forms of vulvodynia. And there’s no proof that infections, such as sexually transmitted diseases(STDs), lead to vulvodynia. […] Researchers are trying to find the causes. They may include: Nerve injury or irritation, Abnormal response in vulvar cells to an infection or trauma, Genetic factors that cause the vulva to react poorly to chronic inflammation, Hypersensitivity to yeast infections, Muscle spasms, Allergies or irritation to chemicals or other substances, Hormonal changes, A history of sexual abuse, Frequent antibiotic use. […] Those who have vulvodynia may also have another type of pain syndrome, such as: Fibromyalgia, Painful bladder syndrome, Irritable bowel syndrome, Temporomandibular disorder.

• #37

• #38 Etiology, diagnosis, and clinical management of vulvodynia | IJWH

  https://www.dovepress.com/etiology-diagnosis-and-clinical-management-of-vulvodynia-peer-reviewed-fulltext-article-IJWH

  It is often impossible for a woman with vulvodynia and/or her clinician to confidently identify a single biological cause for her pain. […] The chronicity of the pain predictably gives rise to significant problems concerning a womans psychological, sexual, and pelvic floor health. […] The focus of treatment should be on the woman in pain, and not the pain in isolation.

• #39 Vulvodynia – UF Health

  https://ufhealth.org/conditions-and-treatments/vulvodynia

  Vulvodynia is a pain disorder of the vulva. This is the outside area of a woman’s genitals. Vulvodynia causes severe pain, burning, and stinging of the vulva. […] The exact cause of vulvodynia is unknown. Researchers are working to learn more about the condition. Causes may include: […] Irritation or injury to the nerves of the vulva […] Overreaction in the cells of the vulva to infection or injury […] Vulvodynia is diagnosed when all other possible causes have been excluded. […] The goal of the treatment is to reduce pain and relieve symptoms. No one treatment works for all women. You also may need more than one type of treatment to manage your symptoms. […] Vulvodynia is often a complicated disease. It may take weeks to months to achieve some pain relief. Treatment may not ease all symptoms. A combination of treatments and lifestyle changes may work best to help manage the disease.

• #40 Vulvodynia: Pain Management Strategies

  https://www.mdpi.com/1424-8247/15/12/1514

  Psychosocial factors Psychosocial factors must be included among the possible causes of vulvodynia. […] Other comorbidities Finally, the study of comorbidities often associated with vulvodynia contributes to a more complete understanding of the predisposing, precipitating and/or maintaining factors that contribute to vulvar pain.

• #41 Vulvodynia Demystified: Vulvar Pain Causes and Treatments – ETCOA

  https://www.centerofendometriosis.com/blog/vulvodynia-101-metro-detroit-etcoa/

  Vulvodynia occurs when the vulvar tissue becomes highly sensitive. […] Unfortunately, this condition is still defined as unexplained chronic vulvar pain. We dont know exactly what makes some women experience this sensitivity. We do know that it is not caused by active infections, such as a yeast infection, and that it is not a sexually transmitted disease. […] Many women who are diagnosed with endometriosis also experience vulvodynia. When women experience pelvic pain over long periods of time, they may develop pelvic floor muscle spasms and nerve sensitivities. […] Other possible causes include nerve injuries or irritations, high numbers of pain-sensing nerves in the vulva, allergies or sensitive skin, and hormonal changes.

• #42 Generalised vulvodynia

  https://dermnetnz.org/topics/generalised-vulvodynia

  Generalised vulvodynia is one of the most common types of vulvodynia or vulval pain of unknown cause. […] Vulvodynia is defined by the International Society for the Study of Vulvovaginal Diseases (ISSVD) as vulvar pain of at least 3 months duration, without a clearly identifiable cause. […] By definition, the cause of generalised vulvodynia is unknown. Current theories consider generalised vulvodynia is a chronic pain syndrome related to hypersensitive nerves. One or more of the following may have a role to play in the development of this condition. […] Stretched, inflamed nerves in the vulvar area (pudendal nerve entrapment or pudendal neuralgia), spine or related structures […] Trigger points where there are proliferating or sensitised nerve endings in the skin itself […] Previous vulvar skin condition, surgery or childbirth resulting in scarring or another injury […] Hormonal changes causing vulvar dryness, especially during menopause […] Previous inflammatory disorders such as herpes simplex or herpes zoster/shingles infection […] Emotional stress.

• #43

  https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=bo1196

  Vulvodynia is pain in the vulva that can’t be explained by another health problem, such as an infection or a skin problem. […] Doctors don’t know the exact cause of vulvodynia. But some things that may help cause it include: Swelling of or injury to the nerves of the vulva. Spasms or weakness of the muscles that support the organs of the pelvis. A family history of vulvodynia. […] If a cause for your pain is not found, you may have vulvodynia. […] There are many treatments for vulvodynia, but what works for someone else may not help you. Work with your doctor to find what is best for you. Even though there is no cure, treatment can help you feel better. […] Medicines that are applied to the skin, such as estrogen cream or lidocaine ointment, may help relieve pain. Other medicines that may be used include antidepressants, seizure medicines, and nerve blocks.

• #44 Persistent Vulvar Pain | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/09/persistent-vulvar-pain

  Persistent vulvar pain is a complex disorder that frequently is frustrating to the patient and the clinician. […] Vulvar pain can be caused by a specific disorder or it can be idiopathic. Idiopathic vulvar pain is classified as vulvodynia. […] The classification of vulvodynia is based on the site of the pain; whether it is generalized, localized, or mixed; whether it is provoked, spontaneous, or mixed; whether the onset is primary or secondary; and the temporal pattern (whether the pain is intermittent, persistent, constant, immediate, or delayed). […] Proposed etiologies include abnormalities that stem from early fetal development, genetic or immune factors, hormonal factors, inflammation, infection, neuropathic changes, and dietary oxalates. […] Although optimal treatment remains unclear, consider an individualized, multidisciplinary approach to address all physical and emotional aspects possibly attributable to vulvodynia. […] Future research should aim at evaluating a multimodal approach in the treatment of vulvodynia, along with more research on the etiologies of vulvodynia.

• #45 Vulvodynia fact sheet – Melbourne Sexual Health Centre (MSHC)

  https://www.mshc.org.au/sexual-health/sexual-health-fact-sheets/vulvodynia

  Vulvodynia is treated as chronic pain and may be associated with pain conditions affecting other parts of the body. […] Most cases will eventually resolve without treatment, though this can take months or years. […] Neuromodulating medications. Low dose tricyclic antidepressants and the anticonvulsants pregabalin and gabapentin can be very effective, combined with physiotherapy and counselling. These medications adjust pain perception, rather than treat depression. […] Anxiety and depression are common consequences of any chronic painful condition. Pre-existing stressors, fear of the anticipated pain, consequent poor arousal and poor lubrication may worsen the experience of pain.

• #46 Vulvodynia | ACOG

  https://www.acog.org/womens-health/faqs/vulvodynia

  Vulvodynia is likely caused by many factors working together. Some of these factors include the following: […] Damage or irritation of the nerves of the vulva […] Inflammation of the vulva […] Long-term reactions to certain infections […] Certain genetic disorders […] Sensitivity to certain foods […] Dysfunction of the muscles of the pelvic floor […] Conditions that affect nearby muscles or bones. […] Physical therapy is another option for treating vulvodynia. This type of therapy can relax tissues in the pelvic floor and release tension in muscles and joints. […] A nerve block is a type of anesthesia in which an anesthetic drug is injected into the nerves that carry pain signals from the vulva to the spinal cord. This treatment interrupts the pain signals and can provide short-term and sometimes long-term pain relief. Injection of a drug called botulinum toxin A (also known as Botox) has been used to treat vulvodynia. This drug relaxes muscles of the pelvic floor.

• #47

  https://journals.lww.com/pain/fulltext/2024/04000/inflammation,_lipid_dysregulation,_and_transient.11.aspx

  This points to a feed-forward loop where TRPV4 activation enhances inflammation, whereas inflammation increases TRPV4 expression and activity. […] Specialized pro-resolving mediators, especially maresin 1, are highly effective in reducing pain and restoring baseline thresholds, typically within a matter of weeks and often improving the thresholds to above the starting baseline.

• #48 Vulvodynia – Foundation for Female Health Awareness

  https://femalehealthawareness.org/en/vulvodynia/

  Vulvodynia is vulvar discomfort or pain lasting for at least 3 months. […] The exact cause of vulvodynia is unknown. […] Understanding peoples experiences with pain and sexual activity are very important for identifying vulvodynia. […] Vulvodynia treatment is focused on reducing pain and improving quality of life and sexual function. […] For women with vulvar pain at one specific area who do not respond to treatments like medications and therapy, surgery is an option. […] Even after improvement with vulvar pain, many people continue to have issues with sexual function.

• #49 Vulvodynia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430792/

  A comprehensive understanding of the vulva and vulvar vestibule anatomy is crucial for accurately diagnosing and managing vulvodynia. […] The cause of vulvodynia remains unknown, and its treatment continues to be challenging. Management requires an interprofessional treatment approach, with the patient’s report of pain and its severity taken seriously. […] Ongoing research is essential to advancing the treatment of vulvodynia. Continued investigation into its pathophysiology, potential biomarkers, and innovative therapies will aid in developing more targeted, evidence-based approaches to improve patient outcomes and quality of life.

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