VULVAR PAIN SYNDROME: VULVODYNIA
Jenniffer Voelkl Guevara
July 20th 2017
Current ICS Definition:
Recent definition for generalized vulvar pain syndrome refers to a vulvar pain syndrome where the pain/burning cannot be consistently and precisely localized by point-pressure ‘‘mapping’’ via probing with a cotton-tipped applicator or similar instrument. Tenderness is diffuse and may affect all locations of the vulva (1).
Previously, Abrahams et al (2002) described the term vulval pain as “felt in and around the external genitalia” (2); and Haylen et al (2010) defined the same term as “a complaint of pain felt in and around the vulva” (3).
Historical Perspective:
The following table describes the history, findings and evolution of the term (4)
1800´s: Described as “excessive sensitivity” or “hyperesthesia”.1889: Skene described a condition of “hyperesthesia” which mimics the modern syndrome in his classic The Treatise on the disease of Women”.
1891: Thomas and Munde used the term “Excessive sensitivity” upon their writings, A Practical Treatise on the Diseases of Women.
1928: Kelly describes“exquisitely sensitive deep red spots in the mucosa of the hymeneal ring as a source of dyspareunia”.
1942: Hunt, describes for the first time minor vestibular gland, but without association with vulvar pain syndrome.
1976: Pellisse and Hewitt reintroduce the syndrome in the literature as “erythematous vulvitis in plaques”.
1983: Vulvodynia was defined by the International Society for the Study of Vulvar Disease (ISSVD) as chronic vulvar discomfort, especially characterized by the patient´s complaint of burning, stinging, irritation and/or rawness.
1987: Friedrich reported 86 patients with consistent vulvar signs and symptoms and subsequently introduced the term “vulvar vestibulitis syndrome” as the standard term and description for this disorder.
1988: Pyka reveals a chronic inflammatory response without evidence of direct glandular inflammation.
In 1987 Frierich and the International Society for the Study of Vulvovaginal Disease ISSVD stablishedestablished a new definition in 1987 as follows:
“ Severe pain on vestibular touch, tenderness to pressure localized to the vulvar vestibule, and physical findings confined to vulvar erythema.” (5)
Until 2004, the Society’s have maintained Friedrich’s definition of vulvar vestibulitis syndrome (vestibulodynia) as “vulvar discomfort, most often described as burning pain, occurring in the absence of visible findings or a specific, clinically identifiable, neurologic disorder” and since this date they suggest to apply the term “Vulvodynia”.
Moreover, Vulvodynia was classified as either “localized” or “generalized,” that can be either “provoked” or “unprovoked,” or that can be “mixed,” as any combination of the above. Pain may be associated with both sexual (e.g., intercourse) and nonsexual activities (e.g.,tampon insertion). The term “Vulvar vestibulitis syndrome” was determined to be less descriptive of the disorder and was replaced by “localized provoked vulvodynia,” which refers to pain only at the vulvar vestibule (“localized”) caused by contact (“provoked”).
The descriptor and up to this date accepted term was “vestibulodynia.” In addition to being classified according to pain location and means of pain provocation, vestibulodynia can be considered either primary (i.e., pain with first attempted tampon use and/or intercourse) or secondary (i.e., development of vulvar pain following previously painless tampon use and/or intercourse). (6)
Lately, the 2015 Consensus terminology and classification of persistent vulvar pain from the from the International Society for the Study of Vulvovaginal Disease (ISSVD), the International Society for the Study of Women's Sexual Health (ISSWSH), and the International Pelvic Pain Society (IPPS) defined and classified vulvar pain as follows (7)
References:
1. Doggweiler R, Whitmore KE, Meijlink JM, Drake MJ, Frawley H, Nordling J, et al. A standard for terminology in chronic pelvic pain syndromes: A report from the chronic pelvic pain working group of the international continence society. Neurourol Urodyn [Internet]. 2016 Aug 26 [cited 2016 Oct 16]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/27564065
2. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: Report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37–49.
3. Haylen BT, Ridder D. An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction. Neurourol Urodyn. 2009;28(5):395–9.
4. Baggish MS, Miklos JR. Vulvar Pain Syndrome: A Review. Obstet Gynecol Surv [Internet]. 1995;50(8):618–627. Available from: http://journals.lww.com/obgynsurvey/Fulltext/1995/08000/Vulvar_Pain_Syndrome__A_Review.23.aspx
5. Stone-Godena T. Vulvar Pain Syndromes: Vestibulodynia. J Midwifery Women’s Heal. 2006;51(6):502–9.
6. Hartmann D. Chronic vulvar pain from a physical therapy perspective. Dermatol Ther. 2010;23(5):505–13.
7. Bornstein J, Goldstein A, Coady D. Consensus terminology and classification of persistent vulvar pain. From Int Soc Study Vulvovaginal Dis (ISSVD), Int Soc Study Women’s Sex Heal (ISSWSH), Int Pelvic Pain Soc. 2015;