Vulvodynia: Definition, Prevalence, Impact, and Pathophysiological Factors

Abstract

Introduction Vulvodynia constitutes a highly prevalent form of chronic genital pain in women, and current information regarding its definition, prevalence, impact, and pathophysiologic factors involved is needed. Aim To update the scientific evidence published in 2010 from the Third International Consultation of Sexual Medicine pertaining to the definition, prevalence, impact, and pathophysiologic factors of women's sexual pain. Methods An expert committee, as part of the Fourth International Consultation of Sexual Medicine, comprised of researchers and clinicians from biological and social science disciplines, reviewed the scientific evidence on the definition, prevalence, impact, and pathophysiologic factors related to chronic genital pain. Main Outcome Measures A review of the definition, prevalence, impact, and pathophysiological factors involved in vulvodynia. Results Vulvodynia is a prevalent and highly impactful genital pain condition. Numerous factors have been implicated in its development and maintenance. Conclusion What is becoming increasingly apparent is that it likely represents the end point of different factors that can differ from patient to patient. Longitudinal research is needed to shed light on risk factors involved in the expression of vulvodynia, as well as in potential subgroups of affected patients, in order to develop an empirically supported treatment algorithm.

Genito-Pelvic Pain/Penetration Disorder (GPPPD): An Overview of Current Terminology, Etiology, and Treatment

“…It may be generalized or localized to a specific area, and provoked by contact or unprovoked (i.e., spontaneous) [4,5]. Vulvodynia is often associated with GPPPD and sexual pain, though not all cases of GPPPD are necessarily caused by vulvodynia [3].…”

“…There are two main subtypes of vulvodynia: provoked vestibulodynia (PVD), characterized by localized provoked pain at the vaginal vestibule (introitus), and generalized vulvodynia (GVD) characterized by unprovoked, diffuse burning pain throughout the entire vulva [4,5]. PVD is thought to be the most common cause of introital dyspareunia, affecting up to 8% of reproductive age women [6,7].…”

“…As specified in the DSM-5 diagnostic criteria, the sexual pain felt in GPPPD cannot be better explained by a medical condition [2]. Similarly, the 2015 Consensus Terminology of Persistent Vulvar Pain and Vulvodynia indicates that vulvodynia must have no clear identifiable cause, otherwise the pain is categorized as persistent vulvar pain [4,5]. Thus, a thorough medical history and exam are essential to rule out potential differential diagnoses that may better explain the woman's pain.…”

“…appropriate [4]. See Table 2 for possible medical causes of dyspareunia which should be ruled out or treated before considering a diagnosis of GPPPD.…”

“…It is this maladaptive pain that is harmful to sexual functioning, especially with increasing involvement of the central nervous system in pain sensitization [3,11]. Thus, GPPPD should be evaluated from a biopsychosocial perspective, and should never be viewed as a purely psychogenic problem [3,4].…”