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Vulvodynia

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Aesthetic and Regenerative Gynecology
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Abstract

Vulvar pain is a complex disorder of varied etiologies. Vulvodynia refers to chronic vulvar pain without specific identifiable cause and may have many associated factors. It carries significant negative effect on woman’s health, self-esteem, relationships and quality of life. As vulvodynia is a diagnosis of exclusion, it is imperative to exclude all treatable causes before assigning vulvodynia as the cause of vulvar pain. In the absence of specific tests, clinical assessment is of utmost importance to find the cause of vulvar pain. Treatment should be holistic and focus not only on the primary site of pain but also on its subsequent impact on the patients’ lifestyle and sexual functioning. There is no strong evidence of benefit of a particular treatment intervention over the others. It is important to individualize the treatment plan as disease course is chronic with fluctuating symptoms and presentation is varied. Usually, various treatment modalities including medical treatments, psychotherapy, physiotherapy and dietary advice are combined because different treatment strategies tackle different facets of chronic vulval and sexual pain.

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References

  1. Bornstein J, Goldstein AT, Stockdale CK, et al. 2015 ISSVD, ISSWSH and IPPS consensus terminology and classification of persistent vulvar pain and vulvodynia. Obstet Gynecol. 2016;127(4):745–51.

    Article  PubMed  Google Scholar 

  2. 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.

    Google Scholar 

  3. Siddall PJ, Cousins MJ. Persistent pain as a disease entity: implications for clinical management. Anesth Analg. 2004;99:510–20.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wesslemann U, Boham A, Foster D. Vulvodynia: current state of the biological science. Pain. 2014;155:1696–701.

    Article  Google Scholar 

  6. Henzell H, Berzins K. Localised provoked vestibulodynia (vulvodynia). Assessment and Management. 2015;44(7):460–6.

    Google Scholar 

  7. American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice; American Society for Colposcopy and Cervical Pathology (ASCCP). Committee opinion no 673: persistent vulvar pain. Obstet Gynecol. 2016;128(3):e78–84.

    Article  Google Scholar 

  8. Labat JJ, Riant T, Robert R, et al. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol Urodyn. 2008;27:306–10.

    Article  PubMed  Google Scholar 

  9. Haefner HK. Critique of new gynecologic surgical procedures: surgery for vulvar vestibulitis. Clin Obstet Gynecol. 2000;43(3):689–700.

    Article  CAS  PubMed  Google Scholar 

  10. Haefner HK, Collins ME, Davis GD, Edwards L, Foster DC, Hartmann ED, et al. The vulvodynia guideline. J Low Genit Tract Dis. 2005;9:40–51.

    Article  PubMed  Google Scholar 

  11. Lewis FM, Harrington CI. Use of magnetic resonance imaging in vulvodynia. J Reprod Med. 1997;42:169.

    CAS  PubMed  Google Scholar 

  12. Schover LR, Youngs DD, Cannata RN. Psychosexual aspects of the evaluation and management of vulval vestibulitis. Am J Obstet Gynaecol. 1991;167:630–6.

    Article  Google Scholar 

  13. Stewart D, Reicher A, Gerulath AH, Boydall K. Vulvodynia and psychological distress. Obstet Gynaecol. 1994;84:587–90.

    CAS  Google Scholar 

  14. Andrews JC. Vulvodynia: an evidence-based approach to medical management. JCOM. 2010;17:225–38.

    Google Scholar 

  15. Laudry T, Bergeron S, Dupuis MJ, Desrochers G. The treatment of provoked vestibulodynia: a critical review. Clin J Pain. 2008;24:155–71.

    Article  Google Scholar 

  16. Mandal D, Nunns D, Byrne M, et al. Guidelines for the management of vulvodynia. Br J Dermatol. 2010;162:1180–5.

    Article  PubMed  Google Scholar 

  17. Munday P, Buchan A, Ravenhill G, et al. A qualitative study of women with vulvodynia: II. Response to a multidisciplinary approach to management. J Reprod Med. 2007;52:19–22.

    PubMed  Google Scholar 

  18. Masheb RM, Kerns RD, Lozano C, et al. A randomized clinical trial for women with vulvodynia: cognitive-behavioral therapy vs. supportive psychotherapy. Pain. 2009;141:31–40.

    Article  PubMed  Google Scholar 

  19. Zolnoun DA, Hartmann KE, Steege JF. Overnight 5% lidocaine ointment for treatment of vulvar vestibulitis. Obstet Gynecol. 2003;102(1):84–7.

    CAS  PubMed  Google Scholar 

  20. Foster DC, Kotok MB, Huang LS, et al. Oral desipramine and topical lidocaine for vulvodynia: a randomized controlled trial. Obstet Gynecol. 2010;116(3):583–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Bohm-Starke N, Brodda-Jansen G, Linder J, Danielsson I. The result of treatment on vestibular and general pain thresholds in women with provoked vestibulodynia. Clin J Pain. 2007;23:598.

    Article  PubMed  Google Scholar 

  22. Goldstein AT, Pukall CF, Brown C, et al. Vulvodynia: assessment and treatment. J Sex Med. 2016;13:572.

    Article  PubMed  Google Scholar 

  23. Burrows LJ, Goldstein AT. The treatment of vestibulodynia with topical estradiol and testosterone. Sex Med. 2013;1:30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Nyirjesy P, Sobel JD, Weitz MV, Leaman DJ, Small MJ, Gelone SP. Cromolyn cream for recalcitrant idiopathic vulvar vestibulitis: results of a placebo controlled study. Sex Transm Infect. 2001;77(1):53–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Baron R. Capsaicin and nociception: from basic mechanisms to novel drugs. Lancet. 2000;356:785.

    Article  CAS  PubMed  Google Scholar 

  26. Sansone RA, Sansone LA. Pain, pain, go away: antidepressants and pain management. Psychiatry (Edgmont). 2008;5:16.

    Google Scholar 

  27. 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.

    Article  PubMed  Google Scholar 

  28. Bates CM, Timmins DJ. Vulvodynia--new and more effective approaches to therapy. Int J STD AIDS. 2002;13:210.

    Article  CAS  PubMed  Google Scholar 

  29. Harris G, Horowitz B, Borgida A. Evaluation of gabapentin in the treatment of generalized vulvodynia, unprovoked. J Reprod Med. 2007;52:103.

    CAS  PubMed  Google Scholar 

  30. Reed BD, Haefner HK, Cantor L. Vulvar dysesthesia (vulvodynia). A follow-up study. J Reprod Med. 2003;48:409.

    PubMed  Google Scholar 

  31. Brown CS, Bachmann GA, Wan J, et al. Gabapentin for the treatment of vulvodynia: a randomized controlled trial. Obstet Gynecol. 2018;131:1000.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Pagano R, Wong S. Use of amitriptyline cream in the management of entry dyspareunia due to provoked vestibulodynia. J Low Genit Tract Dis. 2012;16:394.

    Article  PubMed  Google Scholar 

  33. Brown C, Bachmann G, Foster D, et al. Milnacipran in provoked vestibulodynia: efficacy and predictors of treatment success. J Low Genit Tract Dis. 2015;19:140.

    Article  PubMed  Google Scholar 

  34. Snyder DS, Unanue ER. Corticosteroids inhibit murine macrophage Ia expression and interleukin 1 production. J Immunol. 1982;129:1803.

    CAS  PubMed  Google Scholar 

  35. Dede M, Yenen MC, Yilmaz A, Baser I. Successful treatment of persistent vulvodynia with submucous infiltration of betamethasone and lidocaine. Eur J Obstet Gynecol Reprod Biol. 2006;124:258–9.

    Article  PubMed  Google Scholar 

  36. Murina F, Tassan P, Roberti P, Bianco V. Treatment of vulvar vestibulitis with submucous infiltrations of methylprednisolone and lidocaine. An alternative approach J Reprod Med. 2001;46:713.

    CAS  PubMed  Google Scholar 

  37. Cui M, Khanijou S, Rubino J, Aoki KR. Subcutaneous administration of botulinum toxin a reduces formalin-induced pain. Pain. 2004;107:125.

    Article  CAS  PubMed  Google Scholar 

  38. Beal BR, Wallace MS. An overview of pharmacologic management of chronic pain. Med Clin North Am. 2016;100:65–79.

    Article  PubMed  Google Scholar 

  39. Pelletier F, Parratte B, Penz S, et al. Efficacy of high doses of botulinum toxin a for treating provoked vestibulodynia. Br J Dermatol. 2011;164:617.

    CAS  PubMed  Google Scholar 

  40. Dykstra DD, Presthus J. Botulinum toxin type a for the treatment of provoked vestibulodynia: an open-label, pilot study. J Reprod Med. 2006;51:467.

    CAS  PubMed  Google Scholar 

  41. Petersen CD, Giraldi A, Lundvall L, Kristensen E. Botulinum toxin type A-a novel treatment for provoked vestibulodynia? Results from a randomized, placebo controlled, double blinded study. J Sex Med. 2009;6:2523.

    Article  CAS  PubMed  Google Scholar 

  42. Hartmann D. Chronic vulvar pain from a physical therapy perspective. Dermatol Ther. 2010;23:505–13.

    Article  PubMed  Google Scholar 

  43. Goldfinger C, Pukall CF, Gentilcore-Saulnier E, et al. A prospective study of pelvic floor physical therapy: pain and psychosexual outcomes in provoked vestibulodynia. J Sex Med. 2009;6:1955–68.

    Article  PubMed  Google Scholar 

  44. Murina F, Bianco V, Radici G, et al. Transcutaneous electrical nerve stimulation to treat vestibulodynia: a randomised controlled trial. Br J Obstet Gynaecol. 2008;115:1165–70.

    Article  CAS  Google Scholar 

  45. Bergeron S, Brown C, Lord MJ, et al. Physical therapy for vulvar vestibulitis syndrome: a retrospective study. J Sex Marital Ther. 2002;28:183–92.

    Article  PubMed  Google Scholar 

  46. FitzGerald MP, Kotarinos R. Rehabilitation of the short pelvic floor. II: treatment of the patient with the short pelvic floor. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14:269.

    Article  CAS  PubMed  Google Scholar 

  47. 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.

    CAS  PubMed  Google Scholar 

  48. Murina F, Bernorio R, Palmiotto R. The use of amielle vaginal trainers as adjuvant in the treatment of vestibulodynia: an observational multicentric study. Medscape J Med. 2008;10:23.

    PubMed  PubMed Central  Google Scholar 

  49. Khandker M, Brady SS, Vitonis AF, et al. The influence of depression and anxiety on risk of adult onset vulvodynia. J Womens Health (Larchmt). 2011;20:1445.

    Article  Google Scholar 

  50. Bergeron S, Khalifé S, Dupuis MJ, McDuff P. A randomized clinical trial comparing group cognitive-behavioral therapy and a topical steroid for women with dyspareunia. J Consult Clin Psychol. 2016;84:259.

    Article  PubMed  Google Scholar 

  51. Goldfinger C, Pukall CF, Thibault-Gagnon S, et al. Effectiveness of cognitive-Behavioral therapy and physical therapy for provoked Vestibulodynia: a randomized pilot study. J Sex Med. 2016;13:88.

    Article  PubMed  Google Scholar 

  52. Corsini-Munt S, Bergeron S, Rosen NO, et al. Feasibility and preliminary effectiveness of a novel cognitive-behavioral couple therapy for provoked vestibulodynia: a pilot study. J Sex Med. 2014;11:2515.

    Article  PubMed  Google Scholar 

  53. Brotto LA, Bergeron S, Zdaniuk B, Basson R. Mindfulness and cognitive behavior therapy for provoked vestibulodynia: mediators of treatment outcome and long-term effects. J Consult Clin Psychol. 2020;88:48.

    Article  PubMed  Google Scholar 

  54. Wu C, Goldstein A, Klebanoff JS, Moawad GN. Surgical management of neuroproliferative-associated vestibulodynia: a tutorial on vestibulectomy with vaginal advancement flap. Am J Obstet Gynecol. 2019;221:525.e1.

    Article  Google Scholar 

  55. Tommola P, Unkila-Kallio L, Paavonen J. Surgical treatment of vulvar vestibulitis: a review. Acta Obstet Gynecol Scand. 2010;89:1385–95.

    Article  PubMed  Google Scholar 

  56. Kehoe S, Leusley D. An evaluation of modified vestibulectomy in the treatment of vulvar vestibulitis: preliminary results. Acta Obstet Gynecol Scand. 1996;75:676–7.

    Article  CAS  PubMed  Google Scholar 

  57. Bergeron S, Binik YM, Khalife’ S, et al. A randomized comparison of group cognitive behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain. 2001;91:297–306.

    Article  PubMed  Google Scholar 

  58. Leclair CM, Goetsch MF, Lee KK, et al. KTP-nd: Yag laser therapy for the treatment of vestibulodynia, a follow up study. J Repro Med. 2007;52:53–8.

    Google Scholar 

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Bagga, R., Singla, R. (2022). Vulvodynia. In: Jindal, P., Malhotra, N., Joshi, S. (eds) Aesthetic and Regenerative Gynecology. Springer, Singapore. https://doi.org/10.1007/978-981-16-1743-0_24

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  • DOI: https://doi.org/10.1007/978-981-16-1743-0_24

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