Description

• Vulvar pain ≥3 months duration, without visible findings, lab abnormalities, or an identifiable neurologic disorder
• Provoked vulvodynia is often described as the sensation that something is blocking the vagina or the vagina is too small for penetration
• Unprovoked vulvodynia is described as constant burning or stinging in the absence of any sexual activity.

Epidemiology

• Can occur at any age but most women diagnosed between age 20 and 40 years (1)
• Nearly half of women opt not to seek treatment (2).
• Women with and without vulvodynia have similar rates of marital satisfaction, but women with vulvodynia have poorer sexual satisfaction.

Incidence

• Annual rate of new onset vulvodynia is 1.8%.
• Lifetime incidence approaches 15%, suggesting nearly 14 million U.S. women will experience vulvar discomfort at some point in their lives (3).
• Provoked vulvodynia is the most common cause of sexual pain in women <30 years old.

Prevalence

• Between 8.3% and 16% (2)
• Latina women are 80% more likely to present with vulvar pain compared with white and black women.

Etiology and Pathophysiology

• Multifactorial with unknown exact cause
• Neuropathically mediation:
  • Neurogenic inflammation sensitizes afferent nerves and transmits impulses to the CNS, whereas reinforcing signals sustain pain loop.
  • Vulvar biopsy specimens show increased neuronal proliferation and branching.
• Pelvic floor pathology:
  • Hypertonic pelvic floor at the superficial muscle layer, weaker vaginal muscle contraction, and decreased relaxation after contraction (3).
• Other contributing factors:
  • Recurrent vulvovaginal candidiasis or other infections
  • Immune-mediated chronic neuroinflammatory process within vulvar tissues
  • Chemical exposure (trichloroacetic acid) or physical trauma
  • Reduced estrogen receptor expression/changes in estrogen concentration
  • CNS etiology, similar to other regional pain syndromes
  • Trauma: episiotomy, forceps delivery, abuse, pelvic floor injury

Risk Factors

• Recurrent vulvovaginal infections, specifically candidiasis (2)
• Hormonal factors: Pain onset or increased severity may be associated with perimenopause/menopause.
• Pelvic floor dysfunction
• Interstitial cystitis/painful bladder syndrome
• Childhood physical or sexual abuse (3)
• Depression and anxiety (2)
• Other neuropathic and chronic pain disorders, including regional pain syndrome

General Prevention

• Wear 100% cotton underwear in the daytime and no underwear to sleep.
• Avoid douching and other vulvar irritants such as perfumes, dyes, and detergents.
• Avoid abrasive activities and tight, synthetic clothing.
• Avoid panty liners.
• Clean the vulva with water only and pat area dry after bathing.
• Avoid use of hair dryers in the vulvar area.

Commonly Associated Conditions

Chronic pain syndromes, chronic cystitis, irritable bowel syndrome, fibromyalgia, migraines, depression, anxiety, endometriosis, low back pain, pelvic floor dysfunction (2)