Vulvodynia

Definition

• According to the ISSVD, vulvodynia is vulvar pain lasting at least 3 months without an identifiable cause, although potential contributing factors may be present.
• It is considered an idiopathic pain disorder and is a diagnosis of exclusion.

Classification

• By location, localised (e.g. vestibulodynia), generalised and mixed vulvodynia are distinguished, by trigger, provoked, spontaneous and mixed forms; there are also primary and secondary forms.

Occurrence & epidemiology

Epidemiology

• Population-based studies found a point prevalence of 3–7 % among women of reproductive age; the mean age at onset is about 30 years.

Aetiopathogenesis

Aetiology and risk factors

• The cause is unclear and probably multifactorial; proposed factors include genetic, inflammatory, hormonal, neurological (such as nerve fibre proliferation) and psychosocial factors as well as pelvic floor muscle overactivity.
• Associated factors include other pain conditions such as painful bladder syndrome, fibromyalgia, irritable bowel syndrome and temporomandibular disorder.

Clinical features

• Typical symptoms are burning, irritation and increased sensitivity of varying intensity and location; the pain may be constant or provoked by touch, pressure, intercourse or prolonged sitting.

Diagnosis

• The diagnosis requires systematic exclusion of other, organic causes of vulvar pain; inspection of the vulva is usually normal.
• In the cotton swab test, gentle pressure is exerted at defined points of the vestibule and pain is rated on a scale of 0 to 10; the pelvic floor muscles are also palpated.

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Further reading (selection)

1. StatPearls: Vulvodynia (NCBI Bookshelf)
2. Vulvodynia - A contemporary understanding and practical approach in primary care settings (Malays Fam Physician 2024, PubMed Central)

Cross-references