Vulvodynia

Odyne was the "Greek goddess of pain." Therefore, the term vulvodynia literally means "vulvar pain." Vulvodynia is currently defined as "vulvar discomfort, most often described as burning pain, occurring in the absence of relevant visible findings or a specific, clinically identifiable disease". This classification acknowledges that vulvar pain may be attributable to diagnosable and treatable disorders such as infections (yeast, trichomonas), dermatologic disorders (lichen sclerosus, lichen planus, plasma cell vulvitis), hormonal (atrophic vulvovaginitis) and neurologic disorders (pudendal neuralgia, pudendal nerve entrapment, and post-herpetic neuralgia.) However, these definable causes of vulvar pain are not defined as vulvodynia.   Therefore, while many women are referred to us with the diagnosis of "vulvodynia," we at the FCVVD only rarely assign this diagnosis because we are very skilled in the diagnosis of the specific diseases that cause vulvar pain.   

It is estimated that 1.3 % of women have vulvodynia.  In 2002, a sample of women were invited to participate in a web-based survey and 94.5% responded. A history of pain of vulvar pain was reported by 28 %, with 7.8% reporting pain within the past six months, 3 % reporting pain that lasted three or more months, and 1.7% reporting pain lasting three or more months that occurred within the past six months. The authors concluded that as many as 14 million women in the United States may experience chronic vulvar pain during their lifetime.  Thus, even if only a small percentage of these women have true vulvodynia, the number of women with the problem is enormous. Unfortunately, at least 30% will suffer without seeking medical care.

The cause of vulvodynia remains elusive, but it most likely occurs from a variety of sources and represents many different disease processes.  Possible causes include abnormalities of embryologic development, genetic and/or immunologic factors, hormonal factors, peripheral and central neuropathy (nerve damage), allergic reactions, tightness of the muscles of the pelvic floor, and nerve entrapment. In essence, it is likely that there are many different diseases that yield similar symptoms and cause "vulvodynia."


It is also very important to know what does not cause vulvodynia. In the past decade many of the earlier theories regarding the etiology vulvodynia have been called into question. Recent studies have shown that HPV (human papilloma virus) does not play a significant role in vulvodynia.    In addition, the early hypothesis of increased urinary oxalate has also been refuted. Lastly, despite the fact that many women with vulvodynia report a past history of candidiasis, its role as a causative agent of vulvodynia is also uncertain largely because of the inaccuracy of self diagnosis.

While many clinicians believe that vulvodynia only occurs directly as a result of psychological or sexual dysfunction, this viewpoint is rejected by most patients and by us.  However, almost all agree that the presence of chronic pain, such as with vulvodynia, can have profound psychosocial ramifications.