Clinical manifestations and diagnosis of generalized vulvodynia
- Elizabeth Gunther Stewart, MD
Elizabeth Gunther Stewart, MD
- Assistant Professor
- Harvard Medical School
Vulvar pain syndromes are characterized by unexplained burning or any combination of stinging, irritation, pain, or rawness located anywhere between the mons and the anus and causing physical, sexual, and psychological distress.
The terminology used to describe vulvar pain syndromes has varied over time. The current classification system, which was agreed upon at the 2003 Congress of the International Society for the Study of Vulvovaginal Disease, consists of two major categories [1,2]:
●Vulvar pain related to a specific disorder:
•Infectious (eg, candidiasis, trichomoniasis, herpes simplex virus)
•Inflammatory (eg, lichen simplex chronicus, lichen sclerosus, lichen planus, atrophic vaginitis, immunobullous disorder)
- International Society for the Study of Vulvovaginal Disease, XVII World Congress, jointly sponsored by the American College of Obstetricians and Gynecologists, October 12-16, 2003, Salvador, Brazil.
- Moyal-Barracco M, Lynch PJ. 2003 ISSVD terminology and classification of vulvodynia: a historical perspective. J Reprod Med 2004; 49:772.
- Reed BD, Haefner HK, Edwards L. A survey on diagnosis and treatment of vulvodynia among vulvodynia researchers and members of the International Society for the Study of Vulvovaginal Disease. J Reprod Med 2008; 53:921.
- 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 (1972) 2003; 58:82.
- 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.
- 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.
- Reed BD, Legocki LJ, Plegue MA, et al. Factors associated with vulvodynia incidence. Obstet Gynecol 2014; 123:225.
- Marks TA, Shroyer KR, Markham NE, et al. A clinical, histologic, and DNA study of vulvodynia and its association with human papillomavirus. J Soc Gynecol Investig 1995; 2:57.
- Smith PG. Effects of estrogen on peripheral pain pathways. In Vulvodynia - Toward Understanding a Pain Syndrome, National Institute of Child Health and Human Development, Bethesda, MD, April 14-15, 2003.
- Zoubina EV, Mize AL, Alper RH, Smith PG. Acute and chronic estrogen supplementation decreases uterine sympathetic innervation in ovariectomized adult virgin rats. Histol Histopathol 2001; 16:989.
- Harlow BL, Abenhaim HA, Vitonis AF, Harnack L. Influence of dietary oxalates on the risk of adult-onset vulvodynia. J Reprod Med 2008; 53:171.
- Harlow BL, Vitonis AF, Stewart EG. Influence of oral contraceptive use on the risk of adult-onset vulvodynia. J Reprod Med 2008; 53:102.
- Mogil JS, Grisel JE. Transgenic studies of pain. Pain 1998; 77:107.
- Shir Y, Ratner A, Seltzer Z. Diet can modify autotomy behavior in rats following peripheral neurectomy. Neurosci Lett 1997; 236:71.
- Oaklander AL. The pathology of pain. Neuroscientist 1999; 5:302.
- Graven-Nielsen T, Mense S. The peripheral apparatus of muscle pain: evidence from animal and human studies. Clin J Pain 2001; 17:2.
- Butrick CW. Interstitial cystitis and chronic pelvic pain: new insights in neuropathology, diagnosis, and treatment. Clin Obstet Gynecol 2003; 46:811.
- Butrick CW, Sanford D, Hou Q, Mahnken JD. Chronic pelvic pain syndromes: clinical, urodynamic, and urothelial observations. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20:1047.
- Peters KM, Carrico DJ. Frequency, urgency, and pelvic pain: treating the pelvic floor versus the epithelium. Curr Urol Rep 2006; 7:450.
- Dietz HP. Pelvic floor trauma following vaginal delivery. Curr Opin Obstet Gynecol 2006; 18:528.
- Quinn M. Injuries to the levator ani in unexplained, chronic pelvic pain. J Obstet Gynaecol 2007; 27:828.
- Butrick CW. Pathophysiology of pelvic floor hypertonic disorders. Obstet Gynecol Clin North Am 2009; 36:699.
- Hurtado EA, Appell RA. Management of complications arising from transvaginal mesh kit procedures: a tertiary referral center's experience. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20:11.
- Ustinova EE, Fraser MO, Pezzone MA. Colonic irritation in the rat sensitizes urinary bladder afferents to mechanical and chemical stimuli: an afferent origin of pelvic organ cross-sensitization. Am J Physiol Renal Physiol 2006; 290:F1478.
- www.nva.org/ (Accessed on October 28, 2005).
- Jantos M. Vulvodynia: a psychophysiological profile based on electromyographic assessment. Appl Psychophysiol Biofeedback 2008; 33:29.
- http://www.macses.ucsf.edu/research/allostatic/allostatic.php#allostasis (Accessed on August 18, 2014).
- McEwen BS, Stellar E. Stress and the individual. Mechanisms leading to disease. Arch Intern Med 1993; 153:2093.
- Rodrigues SM, LeDoux JE, Sapolsky RM. The influence of stress hormones on fear circuitry. Annu Rev Neurosci 2009; 32:289.
- Ganzel BL, Morris PA, Wethington E. Allostasis and the human brain: Integrating models of stress from the social and life sciences. Psychol Rev 2010; 117:134.
- Plante AF, Kamm MA. Life events in patients with vulvodynia. BJOG 2008; 115:509.
- Harlow BL, Stewart EG. Adult-onset vulvodynia in relation to childhood violence victimization. Am J Epidemiol 2005; 161:871.
- Schweinhardt P, Kuchinad A, Pukall CF, Bushnell MC. Increased gray matter density in young women with chronic vulvar pain. Pain 2008; 140:411.
- Van Ryckeghem DM, Crombez G, Goubert L, et al. The predictive value of attentional bias towards pain-related information in chronic pain patients: a diary study. Pain 2013; 154:468.
- Arnsten AF. Stress signalling pathways that impair prefrontal cortex structure and function. Nat Rev Neurosci 2009; 10:410.
- Kao A, Binik YM, Amsel R, et al. Biopsychosocial predictors of postmenopausal dyspareunia: the role of steroid hormones, vulvovaginal atrophy, cognitive-emotional factors, and dyadic adjustment. J Sex Med 2012; 9:2066.
- Arnold LD, Bachmann GA, Rosen R, et al. Vulvodynia: characteristics and associations with comorbidities and quality of life. Obstet Gynecol 2006; 107:617.
- Ponte M, Klemperer E, Sahay A, Chren MM. Effects of vulvodynia on quality of life. J Am Acad Dermatol 2009; 60:70.
- Ventolini G, Barhan SM. Vulvodynia. Dermatol Online J 2008; 14:2.
- Bachmann GA, Rosen R, Arnold LD, et al. Chronic vulvar and other gynecologic pain: prevalence and characteristics in a self-reported survey. J Reprod Med 2006; 51:3.
- Wesselmann U, Burnett AL, Heinberg LJ. The urogenital and rectal pain syndromes. Pain 1997; 73:269.
- Bowen AR, Vester A, Marsden L, et al. The role of vulvar skin biopsy in the evaluation of chronic vulvar pain. Am J Obstet Gynecol 2008; 199:467.e1.
- Unger CA, Walters MD. Female clitoral priapism: an over-the-counter option for management. J Sex Med 2014; 11:2354.
- Arntzen BW, de Boer CN. Priapism of the clitoris. BJOG 2006; 113:742.
- Fischer M, Marsch WC. Vulvodynia: an indicator or even an early symptom of vulvar cancer. Cutis 2001; 67:235.