Managing Vulvodynia with Central Sensitization: Challenges and Strategies

Abstract

Background: Vulvodynia is defined as a chronic idiopathic vulvar pain condition. This study aimed to investigate the effect of central sensitization on the prognosis of neuromodulator treatment for vulvodynia. Method: A total of 105 patients with vulvodynia who underwent pelvic mapping pain exploration were included and scored according to the Convergence PP Criteria for pelvic pain and central sensitization. The patients were treated according to chronic pelvic pain guidelines, and their response to treatment was evaluated. Results: A total of 35 out 105 patients (33%) with vulvodynia had central sensitization, which was associated with comorbidities, dyspareunia, pain with micturition, and pain with defecation. Dyspareunia and pain with defecation were independent prognostic factors for central sensitization. Patients with central sensitization experienced more pain during intercourse, urination, or defecation, had more comorbidities, and responded worse to treatment. They required more treatment, with a longer response time (over 2 months). Patients with localized vulvodynia were treated with physiotherapy and lidocaine, while patients with generalized vulvodynia were treated with neuromodulators. Amitriptyline was effective in treating patients with generalized spontaneous vulvodynia and dyspareunia. Conclusions: Overall, this study highlights the importance of considering central sensitization in the diagnosis and treatment of vulvodynia and the need for individualized treatment based on the patient’s symptoms and underlying mechanisms. Vulvodynia patients with central sensitization had more pain during intercourse, urination, or defecation, and responded worse to treatment, requiring more time and medication.

Using network analysis to model associations between psychological symptoms, sexual function, and sexual distress in women

“…The intuitive connection between lubrication and pain is consistent with research that vaginal dryness is a primary contributor to pain during penetration ( Sutton et al, 2012 ). It is possible that pain during sex was directly associated with symptoms like nausea and weakness, but not cardiovascular symptoms, because this pain implicates central nervous system sensitization and skeletal muscle tension ( Kaarbø et al, 2023 ; Rubal et al, 2023 ). Additionally, different interoceptive capacities exist for cardiac and gastric sensations, which might explain the importance of some somatic symptoms over others for connecting sexual function and psychological symptoms ( Davey et al, 2021 ).…”

Inflammation, lipid dysregulation, and transient receptor potential cation channel subfamily V member 4 signaling perpetuate chronic vulvar pain

“…50 Vulvodynia is a complex pain syndrome that involves other neuropathic pain features, such as central sensitization, although the origins of LPV remain incompletely understood. 47 , 65 , 83 , 86 , 108 Studying vulvodynia affords the unique opportunity to examine adjacent affected and unaffected sites within the same subject, allowing each patient to serve as their own control. Sadly, LPV destroys the lives of ∼8% to 12% of US women.…”