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Chapter 29 - Vulvodynia

from Section 6 - Vulva and Vagina

Published online by Cambridge University Press:  24 November 2021

By
Leonardo Micheletti ,
Mario Preti  and
Gianluigi Radici
Edited by
Tahir Mahmood ,
Charles Savona-Ventura ,
Ioannis Messinis  and
Sambit Mukhopadhyay
Tahir Mahmood
Affiliation:
Victoria Hospital, Kirkcaldy
Charles Savona-Ventura
Affiliation:
University of Malta, Malta
Ioannis Messinis
Affiliation:
University of Thessaly, Greece
Sambit Mukhopadhyay
Affiliation:
Norfolk & Norwich University Hospital, UK
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Summary

Vulvodynia is a persistent, idiopathic, and multifactorial vulval pain. It presents a challenge to healthcare providers, mainly because it is a complex syndrome that requires interdisciplinary skills, especially in the neurobiological and algological fields, to avoid incorrect pathogenetic interpretations, inaccurate diagnosis and inadequate treatment.

From a neurobiological perspective, vulvodynia is a dysfunctional vulval pain caused by abnormal function of the nervous system itself, not related to a specific vulval disorder responsible for inflammatory pain, or a neural lesion responsible for neuropathic pain.

Provoked vestibulodynia is the most prevalent subtype of vulvodynia, followed by spontaneous generalized vulvodynia. The primary diagnostic goal is to determine whether the woman suffers from vulvodynia as dysfunctional pain opposed to inflammatory or neuropathic pain.

Treatment of vulvodynia requires an individually tailored and multimodal therapeutic approach, that includes counselling, psychological therapy, medical treatment, and physiotherapy. Surgery can be proposed only as a last resort in provoked vestibulodynia.

Keywords

vulval painvulvodyniafunctional pain syndromevestibulodyniamultimodal therapycounsellingpsychological treatment
Type
Chapter
Information
The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
Gynaecology
 , pp. 237 - 246
Publisher: Cambridge University Press
Print publication year: 2021

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References

Bornstein, J, Goldstein, AT, Stockdale, CK, et al. 2015 ISSVD, ISSWSH, and IPPS consensus terminology and classification of persistent vulval pain and vulvodynia. J Low Genit Tract Dis 2016;20:126–130.CrossRefGoogle ScholarPubMed
Bornstein, J, Preti, M, Simon, JA, et al. Descriptors of vulvodynia: a multisocietal definition consensus (International Society for the Study of Vulvovaginal Disease, the International Society for the Study of Women Sexual Health, and the International Pelvic Pain Society). J Low Genit Tract Dis 2019;23:161–163.Google Scholar
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Micheletti, L, Radici, G, Lynch, PJ. Provoked vestibulodynia: inflammatory, neuropathic or dysfunctional pain? A neurobiological perspective. J Obstet Gynaecol 2014;34:285–288.CrossRefGoogle ScholarPubMed
Micheletti, L, Radici, G, Lynch, PJ. Is the 2003 ISSVD terminology and classification of vulvodynia up-to-date? A neurobiological perspective. J Obstet Gynaecol 2015;35:788–792.CrossRefGoogle ScholarPubMed
Haanpää, M, Attal, N, Backonja, M, et al. NeuPSIG guidelines on neuropathic pain assessment. Pain 2011;152:14–27.CrossRefGoogle ScholarPubMed
Stockdale, CK, Lawson, HW. 2013 vulvodynia guideline update. J Low Genit Tract Dis 2014;18:93–100.CrossRefGoogle ScholarPubMed

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