Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Bladder Dysfunction Reports
Published in: Current Bladder Dysfunction Reports 3/2016

01-09-2016 | Inflammatory/Infectious Bladder Disorders (MS Mourad, Section Editor)

Vulvodynia: Current Etiology, Diagnosis, and Treatment

Authors: Manuel Di Biase, Valerio Iacovelli, Ervin Kocjancic

Published in: Current Bladder Dysfunction Reports | Issue 3/2016

Login to get access

Abstract

Purpose of review

We aim to summarize and broaden the knowledge regarding diagnosis and treatment options of vulvodynia. This review also aims to describe epidemiology, presumed etiopathology, and the future directions of treating vulvodynia in order to add to understand to whether the disorders should be distinguished or combined.

Recent findings

Vulvodynia is an extremely common genital pain syndrome. Although common, most practitioners are uncomfortable with the diagnosis and management of these women’s pain.

Summary

This was a review of all relevant studies with no language restrictions. The following databases were widely searched from inception to the end of March 2016 for published and unpublished research evidence: MEDLINE, EMBASE, ISI Web of Science (WoS), including Science Citation Index, and the Conference Proceedings Citation Index-Science; Scopus; The Cochrane Library including the Cochrane Systematic Reviews Database (CDSR), Cochrane Controlled Trials Register (CCRT), and ClinicalTrials.gov database. The most recent uro-gynecological guidelines were searched. Existing reviews were also checked for eligible studies. Full search terms were a combination of the following: (provoked, localized) vulvodynia, vestibulodynia, vulvar vestibulitis syndrome, vulval vestibulitis, clitorodynia, hemivulvodynia, vaginismus, (superficial) dyspareunia, sexual dysfunction, and pain. We searched the medical literature relating to the etiology, diagnosis, and treatment of vulvodynia. Although many treatment options are available, no treatment is effective for all patients, thus the need to individualize management. Further studies are needed to better understand the etiopathogenesis and the optimal treatment.
Literature
1.••
Bornstein J, Goldstein AT, Stockdale CK, Bergeron S, Pukall C, Zolnoun D, et al. 2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia. J Sex Med. 2016;13(4):607–12. The importance of this paper is related to the general consensus on terminology and classification of vulvodynia.CrossRefPubMed
2.
Goetsch MF. Vulvar vestibulitis: prevalence and historic features in a general gynecologic practice population. Am J Obstet Gynecol. 1991;164:1609–14.CrossRefPubMed
3.
Skene AJC. Treatise on the disease of women. New York: Appleton; 1889.
4.
Kelly HA. Gynecology. New York: Appleton; 1928.
5.
Friedrich Jr EG. Vulvar vestibulitis syndrome. J Reprod Med. 1987;32:110–4.PubMed
6.
Reed BD, Harlow SD, Sen A, Legocki LJ, Edwards RM, Arato N, et al. Prevalence and demographic characteristics of vulvodynia in a population-based sample. Am J Obstet Gynecol. 2012;206(170):e1–9.CrossRefPubMed
7.
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.PubMed
8.
Reed BD, Crawford S, Couper M, Cave C, Haefner HK. Pain at the vulvar vestibule: a web-based survey. J Low Genit Tract Dis. 2004;8:48–57.CrossRefPubMed
9.
Reed BD, Haefner HK, Harlow SD, Gorenflo DW, Sen A. Reliability and validity of self-reported symptoms for predicting vulvodynia. Obstet Gynecol. 2006;108:906–13.CrossRefPubMed
10.
Reed BD. Vulvodynia: diagnosis and management. Am Fam Physician. 2006;73:1231–8.PubMed
11.
Stephens-Shields AJ, Clemens JQ, Jemielita T, Farrar J, Sutcliffe S, Hou X, Landis JR. MAPP research network. Symptom variability and early symptom regression in the MAPP study, a prospective study of urologic chronic pelvic pain syndrome. J Urol. 2016. 10.​1016/​j.​juro.​2016.​04.​070.
12.
Brotto LA, Sadownik LA, Thomson S, et al. A comparison of demographic and psychosexual characteristics of women with primary versus secondary provoked vestibulodynia. Clin J Pain. 2014;30:428–35.PubMed
13.
14.
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(4):601–8.CrossRefPubMed
15.
De Andres J, Sanchis-Lopez N, Asensio-Samper JM, Fabregat-Cid G, Villanueva-Perez VL, Monsalve Dolz V, et al. Vulvodynia—an evidence-based literature review and proposed treatment algorithm. Pain Pract. 2016;16(2):204–36.CrossRefPubMed
16.
Reed BD, Harlow SD, Sen A, Edwards RM, Chen D, Haefner HK. Relationship between vulvodynia and chronic comorbid pain conditions. Obstet Gynecol. 2012;120:145–51.CrossRefPubMedPubMedCentral
17.
Babula O, Danielsson I, Sjoberg I, et al. Altered distribution of mannose-binding lectin alleles at exon I codon 54 in women with vulvar vestibulitis syndrome. Am J Obstet Gynecol. 2004;191:762.CrossRefPubMed
18.
Lev-Sagie A, Prus D, Linhares IM, et al. Polymorphism in a gene coding for the inflammasome component NALP3 and recurrent vulvovaginal candidiasis in women with vulvar vestibulitis syndrome. Am J Obstet Gynecol. 2009;200:303.e1.CrossRef
19.
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.PubMed
20.
Gerber S, Bongiovanni AM, Ledger WJ, et al. Interleukin-1b gene polymorphism in women with vulvar vestibulitis syndrome. Eur J Obstet Gynecol Reprod Biol. 2003;107:74.CrossRefPubMed
21.
Goldstein AT, Belkin ZR, Krapf JM, et al. Polymorphisms of the androgen receptor gene and hormonal contraceptive induced provoked vestibulodynia. J Sex Med. 2014;11:2764.CrossRefPubMed
22.•
Pukall CF, Goldstein AT, Bergeron S, Foster D, Stein A, Kellogg-Spadt S, et al. Vulvodynia: definition, prevalence, impact, and pathophysiological factors. J Sex Med. 2016;13(3):291–304. This paper is useful to understand all the aspects of vulvodynia.CrossRefPubMed
23.
Bouchard C, Brisson J, Fortier M, et al. Use of oral contraceptive pills and vulvar vestibulitis: a case-control study. Am J Epidemiol. 2002;156:254.CrossRefPubMed
24.
Harlow BL, Vitonis AF, Stewart EG. Influence of oral contraceptive use on the risk of adult-onset vulvodynia. J Reprod Med. 2008;53:102.PubMed
25.
26.
Arnold LD, Bachmann GA, Rosen R, et al. Vulvodynia: characteristics and associations with comorbidities and quality of life. Obstet Gynecol. 2006;107:617.CrossRefPubMedPubMedCentral
27.
28.
Foster DC, Woodruff JD. Case-control study of vulvar vestibulitis syndrome. J Womens Health. 1995;4:677–80.CrossRef
29.
Pyka RE, Wilkinson EJ, Friedrich EG, Croker BP. The histopathology of vulvar vestibulitis syndrome. Int J Gynecol Pathol. 1988;7:249–57.CrossRefPubMed
30.
31.
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(3):171–8.CrossRefPubMed
32.
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.CrossRefPubMed
33.
Halperin R, Zehavi S, Vaknin Z, et al. The major histopathologic characteristics in the vulvar vestibulitis syndrome. Gynecol Obstet Invest. 2005;59:75.CrossRefPubMed
34.
Foster DC, Hasday JD. Elevated tissue levels of interleukin-1b and tumor necrosis factor-a in vulvar vestibulitis. Obstet Gynecol. 1997;89:291.CrossRefPubMed
35.
Bohm-Starke N, Falconer C, Rylander E, et al. The expression of cyclooxygenase 2 and inducible nitric oxide synthase indicates no active inflammation in vulvar vestibulitis. Acta Obstet Gynecol Scand. 2001;80:638.CrossRefPubMed
36.
37.
Gerber S, Bongiovanni AM, Ledger WJ, et al. Defective regulation of the proinflammatory immune response in women with vulvar vestibulitis syndrome. Am J Obstet Gynecol. 2002;186:696.CrossRefPubMed
38.
Weiss JM. Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol. 2001;166:2226.CrossRefPubMed
39.
Fitzgerald MP, Payne CK, Lukacz ES, et al. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol. 2012;187:2113.CrossRefPubMedPubMedCentral
40.
Hilton S, Vandyken C. The puzzle of pelvic pain—a rehabilitation framework for balancing tissue dysfunction and central sensitization, I: pain physiology and evaluation for the physical therapist. J Womens Health Phys Ther. 2011;35:103.CrossRef
41.
Morin M, Bergeron S, Khalifé S, et al. Morphometry of the pelvic floor muscles in women with and without provoked vestibulodynia using 4D ultrasound. J Sex Med. 2014;11:776–85.CrossRefPubMed
42.
Pukall CF, Strigo IA, Binik YM, et al. Neural correlates of painful genital touch in women with vulvar vestibulitis syndrome. Pain. 2005;115:118.CrossRefPubMed
43.
Pukall CF, Binik YM, Khalifé S, et al. Vestibular tactile and pain thresholds in women with vulvar vestibulitis syndrome. Pain. 2002;96:163–75.CrossRefPubMed
44.
Westrom LV, Willen R. Vestibular nerve fiber proliferation in vulvar vestibulitis syndrome. Obstet Gynecol. 1998;91:572–6.PubMed
45.
Bohm-Starke N, Hilliges M, Falconer C, et al. Increased intraepithelial innervation in women with vulvar vestibulitis syndrome. Gynecol Obstet Invest. 1998;46:256.CrossRefPubMed
46.
Bohm-Starke N, Hilliges M, Falconer C, Rylander E. Neurochemical characterization of the vestibular nerves in women with vulvar vestibulitis syndrome. Gynecol Obstet Invest. 1999;48:270–5.CrossRefPubMed
47.
Bohm-Starke N, Hilliges M, Brodda-Jansen G, et al. Psychophysical evidence of nociceptor sensitization in vulvar vestibulitis syndrome. Pain. 2001;94:177–83.CrossRefPubMed
48.
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.CrossRefPubMed
49.
Desrochers G, Bergeron S, Landry T, Jodoin M. Do psychosexual factors play a role in the etiology of provoked vestibulodynia? A critical review. J Sex Marital Ther. 2008;34:198–226.CrossRefPubMed
50.
Marinoff SC, Turner MLC. Vulvar vestibulitis syndrome. Dermatol Clin. 1992;10:435–44.PubMed
51.
Bergeron S, Binik YM, Khalifé S, Pagidas K, Glazer HI. Vulvar vestibulitis syndrome: reliability of diagnosis and evaluation of current diagnostic criteria. Obstet Gynecol. 2001;98(1):45–51. V29.PubMed
52.
Brotto LA, Yong P, Smith KB, Sadownik LA. Impact of a multidisciplinary vulvodynia program on sexual functioning and dyspareunia. J Sex Med. 2015;12(1):238–47.CrossRefPubMed
53.
Goldstein AT, Pukall CF, Brown C, Bergeron S, Stein A, Kellogg-Spadt S. Vulvodynia: assessment and treatment. J Sex Med. 2016;13(4):572–90.CrossRefPubMed
54.
55.
Reisman Y. Sexual dysfunctions in chronic pelvic pain: in the EFS and ESSM syllabus of clinical sexology. Amsterdam: Medix Publishers; 2013.
56.
57.
Masheb RM, Lozano-Blanco C, Kohorn EI, Minkin MJ, Kerns RD. Assessing sexual function and dyspareunia with the Female Sexual Function Index (FSFI) in women with vulvodynia. J Sex Marital Ther. 2004;30(5):315–24.CrossRefPubMed
58.
Henzell H, Berzins K. Localised provoked vestibulodynia (vulvodynia):assessment and management. Aust Fam Physician. 2015;44(7):460–6.PubMed
59.
Bortolami A, Vanti C, Banchelli F, Guccione AA, Pillastrini P. Relationship between female pelvic floor dysfunction and sexual dysfunction: an observational study. J Sex Med. 2015;12(5):1233–41.CrossRefPubMed
60.
Gentilcore-Saulnier E, McLean L, Goldfinger C, Pukall CF, Chamberlain S. Pelvic floor muscle assessment outcomes in women with and without provoked vestibulodynia and the impact of a physical therapy program. J Sex Med. 2010;7(2 Pt 2):1003–22.CrossRefPubMed
61.
Næss I, Bø K. Pelvic floor muscle function in women with provoked vestibulodynia and asymptomatic controls. Int Urogynecol J. 2015;26(10):1467–73.CrossRefPubMed
62.
Reissing ED, Brown C, Lord MJ, Binik YM, Khalifé S. Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome. J Psychosom Obstet Gynaecol. 2005;26(2):107–13.CrossRefPubMed
63.
Hasenbring MI, Hallner D, Rusu AC. Fear-avoidance- and endurance-related responses to pain: development and validation of the Avoidance-Endurance Questionnaire (AEQ). Eur J Pain. 2009;13(6):620–8.CrossRefPubMed
64.
Pukall CF, Binik YM, Khalifè S. A new instrument for pain assessment in vulvar vestibulits syndrome. J Sex Marit Ther. 2004;30:69–78.CrossRef
65.
Foster DC et al. The tampon test for vulvodynia treatment outcomes research: reliability, construct validity, and responsiveness. Obstet Gynecol. 2009;113(4):825–32.CrossRefPubMedPubMedCentral
66.
Harlow BL, Wise LA, Stewart EG. Prevalence and predictors of chronic lower genital tract discomfort. Am J Obstet Gynecol. 2001;185(3):545–50.CrossRefPubMed
67.
Goetsch MF, Morgan TK, Korcheva VB, Li H, Peters D, Leclair CM. Histologic and receptor analysis of primary and secondary vestibulodynia and controls: a prospective study. Am J Obstet Gynecol. 2010;202:614.CrossRefPubMed
68.
Flanagan E, Herron KA, O’Driscoll C, Williams AC. Psychological treatment for vaginal pain: does etiology matter? A systematic review and meta-analysis. J Sex Med. 2015;12(1):3–16.CrossRefPubMed
69.•
Stockdale CK, Lawson HW. 2013 vulvodynia guideline update. J Low Genit Tract Dis. 2014;18(2):93–100. This is the latest guideline on vulvodynia.CrossRefPubMed
70.
Petersen CD, Giraldi A, Lundvall L, Kristensen E. Botulinum toxin tipe A—a novel treatment for provoked vestibulodynia? Results from a randomized, placebo controlled, double blinded study. J Sex Med. 2009;6:2523–37.CrossRefPubMed
71.
Murina F, Tassan P, Roberti P, et al. Treatment of vulvar vestibulitis with submucous infiltrations of methylprednisolone and lidocaine. An alternative approach. J Reprod Med. 2001;46(8):713e6.
72.
Kent HL, Wisniewski PM. Interferon for vulvar vestibulitis. J Reprod Med. 1990;35:1138–40.PubMed
73.
Farajun Y, Zarfati D, Abramov L, et al. Enoxaparin treatment for vulvodynia: a randomized controlled trial. Obstet Gynecol. 2012;120(3):565e72.CrossRef
74.
Foster DC, Kotok MB, Huang LS, et al. Oral desipramine and topical lidocaine for vulvodynia: a randomized controlled trial. Obstet Gynecol. 2010;116:583–93.CrossRefPubMed
75.
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.CrossRefPubMed
76.
Leo RJ. A systematic review of the utility of anticonvulsant pharmacotherapy in the treatment of vulvodynia pain. J Sex Med. 2013;10:2000–8.CrossRefPubMed
77.
Murina F, Bianco V, Radici G, Felice R, Di Martino M, Nicolini U. Transcutaneous electrical nerve stimulation to treat vestibulodynia: a randomised controlled trial. BJOG. 2008;115:1165–70.CrossRefPubMed
78.
79.
Eppsteiner E, Boardman L, Stockdale CK. Vulvodynia. Best Pract Res Clin Obstet Gynaecol. 2014;28(7):1000–12.CrossRefPubMed
80.
Tommola P, Unkila-Kallio L, Paavonen J. Surgical treatment of vulvar vestibulitis: a review. Acta Obstet Gynecol Scand. 2010;89:1385–95.CrossRefPubMed
81.
Bornstein J, Zarfati D, Goldik Z, Abramovici H. Perineoplasty compared with vestibuloplasty for severe vulvar vestibulitis. Br J Obstet Gynaecol. 1995;102:652–5.CrossRefPubMed
82.
Nyirjesy P, Sobel JD, Weitz MV, et al. Cromolyn cream for recalcitrant idiopathic vulvar vestibulitis: results of a placebo controlled study. Sex Transm Infect. 2001;77(1):53e7.CrossRef
83.
Steinberg AC, OyamaI A, Rejba AE, et al. Capsaicin for the treatment of vulvar vestibulitis. Am J Obstet Gynecol. 2005;192(5):1549e53.CrossRef
84.
Walsh KE, Berman JR, Berman LA, et al. Safety and efficacy of topical nitroglycerin for treatment of vulvar pain in women with vulvodynia: a pilot study. J Gend Specif Med. 2002;5(4):21e7.
85.
Carrico DJ, Peters KM. Vaginal diazepam use with urogenital pain/pelvic floor dysfunction: serum diazepam levels and efficacy data. Urol Nurs. 2011;31(5):279e84. 299.
86.
Boardman LA, Cooper AS, Blais LR, et al. Topical gabapentin in the treatment of localized and generalized vulvodynia. Obstet Gynecol. 2008;112(3):579e85.CrossRef
87.
Nyirjesy P, Lev-Sagie A, Mathew L, et al. Topical amitriptyline-baclofen cream for the treatment of provoked vestibulodynia. J Low Genit Tract Dis. 2009;13(4):230e6.CrossRef
88.
Burrows LJ, Goldstsein AT. The treatment of vestibulodynia with topical estradiol and testosterone. J Sex Med. 2013;1(1):30e3.
89.
Donders GG, Bellen G. Cream with cutaneous fibroblast lysate for the treatment of provoked vestibulodynia: a double-blind randomized placebo-controlled crossover study. J Low Genit Tract Dis. 2012;16(4):427e36.CrossRef
Metadata
Title
Vulvodynia: Current Etiology, Diagnosis, and Treatment
Authors
Manuel Di Biase
Valerio Iacovelli
Ervin Kocjancic
Publication date
01-09-2016
Publisher
Springer US
Published in
Current Bladder Dysfunction Reports / Issue 3/2016
Print ISSN: 1931-7212
Electronic ISSN: 1931-7220
DOI
https://doi.org/10.1007/s11884-016-0381-4

Other articles of this Issue 3/2016

Current Bladder Dysfunction Reports 3/2016 Go to the issue

Pediatric Bladder Dysfunction (SJ Hodges, Section Editor)

Pediatric Bladder Reconstruction

Inflammatory/Infectious Bladder Disorders (MS Mourad, Section Editor)

Diagnosis and Management of Male Genital Lichen Sclerosus

Pediatric Bladder Dysfunction (SJ Hodges, Section Editor)

Modified O’Regan Protocol for Overactive Bladder

Pediatric Bladder Dysfunction (SJ Hodges, Section Editor)

Sacral Neuromodulation for Bladder Dysfunction in Children: Indications, Results and Complications

Post-Prostatectomy and Acquired Voiding Dysfunction (V Tse, Section Editor)

Ketamine-Associated Uropathy: From Presentation to Management

Pediatric Bladder Dysfunction (SJ Hodges, Section Editor)

Management of Bladder Diverticula in the Pediatric Population