Vulvodynia

The prevalence of the disease in populations around the world has not yet been well studied, and when making statistical comparisons, large discrepancies are apparent. However, on the basis of the most recent data, it is estimated that, in general, it affects 8 to 12% of women. This, for example, ranges from 5 to 16%, or up to 6 million women, in the United States of America. Unfortunately, in Poland, as a result of a lack of sufficient studies, exact data on this subject are not available. However, as a result of the complexity of vulvodynia, it is presumed to be a condition that is “underdiagnosed”, and the percentage of sufferers worldwide is supposed to be higher. Importantly, the condition occurs in women of all ethnic groups and ages.

The etiopathogenesis of the disease is not completely understood, and diagnosis is based on the exclusion of other organic causes, which were highlighted in the 2015 consensus

Myofascial dysfunctions involving the pelvic diaphragm are found in women with vulvodynia. These are usually in the form of increased tension, which is termed a hypertonic/overactive/nonrelaxing state and can be a primary or a secondary (trauma, infection, endometriosis) cause of pain. The disorder mainly affects the largest muscle of the pelvic floor, the levator ani, but also spreads to the anterior and/or posterior muscular segments, and can cause dysfunction of the neighboring organs and systems, consequently leading to dysfunction of the bladder, rectum, and even intestines. Accordingly, women with vulvodynia are found to have characteristic comorbidities involving the urinary bladder (overactive or painful organ, or the surrounding area; recurrent or interstitial inflammation), micturition disorders (urgent incontinence; difficulty initiating micturition or thin micturition stream), rectum (hemorrhoids; anal fissure; pruritus ani; pain and problems with defecation), or irritable bowel syndrome. However, it has also been shown that there are clinical cases in which myofascial dysfunctions not only affect the pelvic floor muscles, but also other areas of the body. Women experience pain in the neck and the lumbosacral region, and headaches (including migraines), tension in the temporomandibular joint area, and fibromyalgia are also sometimes observed.

An important group of risk factors, which can have a significant role in the development of pelvic floor dysfunction, are those relating to the psychosocial sphere. Anxiety, depression, catastrophic thinking, and post-traumatic stress often lead to vulvar pain and sexual dysfunction. The reduced effectiveness of analgesic treatment is found in this group of individuals. In addition, women with anxiety disorders have been shown to have as much as a fourfold increased risk of vulvodynia.

According to the World Health Organization’s (WHO) guidelines, chronic pain is a disease entity, and the patient is entitled to receive full therapeutic care.

On the basis of the localization of pain symptoms, vulvodynia is divided into:

A.

Generalized (which involves the entire vulva, and may spread to other areas of the body, such as the abdomen, thighs, or buttocks);

B.

Localized (which involves only part of the vulva)—subtypes:

• Clitorodynia (clitoral pain);

• Westibulodynia (pain in the vaginal vestibule);

• Hemivulvodynia (pain of the middle of the vulva).

C.

Mixed.

The duration and nature of vulvar pain varies among women and can be intermittent, unchanging, continuous, immediate, or delayed, and sensations are completely subjective, being described as itching, burning, stinging, irritation, dryness, abrasion, and hypersensitivity of the vulvar area. The pain can occur without or under the influence of external factors, and forms are distinguished as follows:

A.Spontaneous;

B.Provoked;

C.Mixed.

Dyspareunia, or pain during sexual intercourse, is classified as a provoked form of the disease. Other triggers or situations that cause the provoked form of the disease can be wearing clothing that is too tight, an attempt to apply a tampon, a gynecological examination, and even prolonged sitting.

The etiopathogenesis of the disease makes the therapeutic process complicated and time-consuming hence it is based on several concepts that complement one another. The woman should remain after multidisciplinary care. Studies show that such a therapeutic path yields the best results. Treatment methods include pharmacotherapy, surgical treatment, psychotherapy, sex therapy, and a set of physiotherapeutic methods that now seem to be expanding rapidly with promising results, and are recommended by the American College of Obstetricians and Gynecologists.