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Vulvodynia

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Pain in Women

Abstract

Chronic vulvar pain affects 3–10 % of women with a similar prevalence among white and African-American women [1–4]. Previously termed vulvodynia and vestibulitis, chronic vulvar pain syndromes have been reclassified by the International Society for the Study of Vulvovaginal Disease (ISSVD) as spontaneous or provoked pain with further subtyping based on location, i.e., generalized versus localized (Table 6.1) [5, 6]. Dyspareunia, which affects up to 22 % of women, is an almost universal finding among women with vulvodynia and is classified as primary (present from first attempt at coitus or tampons) to secondary (developing sometime after pain-free intercourse has been established) [7].

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References

  1. Danielsson I, Sjöhom I, Stenlund H, Wikman M. Prevalence and incidence of prolonged and severe dyspareunia in women: results from a population study. Scand J Public Health. 2003;31:113–18.

    Article  PubMed  Google Scholar 

  2. Harlow BL, Stewart EG. A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? J Am Med Womens Assoc. 2003;58: 82–8.

    PubMed  Google Scholar 

  3. Reed BD, Crawford S, Couper M, Cave C, Haefner H. Pain at the vulvar vestibule: a web-based survey. J Low Genit Tract Dis. 2004;8:48–57.

    Article  PubMed  Google Scholar 

  4. Arnold LD, Bachmann GA, Rosen R, Rhoads GG. Assessment of vulvodynia symptoms in a sample of U.S. women: a prevalence survey with a nested case control. Am J Obstet Gynecol. 2007;196:128.e1–6.

    Article  Google Scholar 

  5. Haefner HK, Collins ME, Davis GD, et al. The vulvodynia guideline. J Low Genit Tract Dis. 2005;9:40–51.

    Article  PubMed  Google Scholar 

  6. Gunter J. Vulvodynia: new thoughts on a devastating condition. Obstet Gynecol Surv. 2007;62:812–19.

    Article  PubMed  Google Scholar 

  7. Steege JF, Zolnoun DA. Evaluation and treatment of dyspareunia. Obstet Gynecol. 2009;113: 1124–36.

    PubMed  Google Scholar 

  8. Reed BD, Haefner HK, Harlow SD, Gorenflo DW, Sen A. Reliability and validity of self-reported symptoms for predicting vulvodynia. Obstet Gynecol. 2006;108:906–13.

    Article  PubMed  Google Scholar 

  9. Bergeron S, Binik YM, Khalifé S, Pagidas K, Glazer HI. Vulvar vestibulitis syndrome: reliability of diagnosis and evaluation of current diagnostic criteria. Obstet Gynecol. 2001;98:45–51.

    Article  PubMed  CAS  Google Scholar 

  10. Siddall PJ, Cousins MJ. Neurobiology of pain. Int Anesthesiol Clin. 1997;35:1–26.

    Article  PubMed  CAS  Google Scholar 

  11. Omoigui S. The biochemical origin of pain: the origin of all pain is inflammation and the inflammation response. Part 2 of 3—inflammatory profile of pain syndromes. Med Hypotheses. 2007;69:1169–78.

    Article  PubMed  CAS  Google Scholar 

  12. Gunter J. Neurobiology of chronic pelvic pain. In: Potts J, editor. Genitourinary pain and inflammation. Totowa: Humana Press; 2008. p. 3–17.

    Chapter  Google Scholar 

  13. Kolesnikov Y, El-Maarouf A, Rutishauser U, Pasternak G. Reorganization of dorsal root ganglion neurons following chronic sciatic nerve constriction injury: correlation with morphine and lidocaine analgesia. Eur J Pharmacol. 2007;568(1–3):124–33.

    Article  PubMed  CAS  Google Scholar 

  14. Salter MW. Cellular neuroplasticity mechanisms mediating pain persistence. J Orofac Pain. 2004;18:318–24.

    PubMed  Google Scholar 

  15. Bohm-Starke N, Hilliges M, Brodda-Jansen G, Rylander E, Torebjörk E. Psychophysical evidence of nociceptor sensitization in vulvar vestibulitis syndrome. Pain. 2001;94:177–83.

    Article  PubMed  CAS  Google Scholar 

  16. Tympanidis P, Terenghi G, Dowd P. Increased innervation of the vulvar vestibule in patients with vulvodynia. Br J Dermatol. 2003;148:1021–7.

    Article  PubMed  CAS  Google Scholar 

  17. Bornstein J, Goldschmid N, Sabo E. Hyperinnervation and mast cell activation may be used as histopathologic diagnostic criteria for vulvar vestibulitis. Gynecol Obstet Invest. 2004;58:171–8.

    Article  PubMed  Google Scholar 

  18. Halperin R, Zehavi S, Vaknin Z, Ben-Ami I, Pansky M, Schneider D. The major histopathologic characteristics in the vulvar vestibulitis syndrome. Gynecol Obstet Invest. 2005;59:75–9.

    Article  PubMed  Google Scholar 

  19. Tympanidis P, Casula MA, Yiangou Y, et al. Increased vanilloid receptor VR1 innervation in vulvodynia. Eur J Pain. 2004;8:129–33.

    Article  PubMed  CAS  Google Scholar 

  20. Bornstein J, Cohen Y, Zarfati D, Sela S, Ophir E. Involvement of heparanase in the pathogenesis of localized vulvodynia. Int J Gynecol Pathol. 2008;27:136–41.

    Article  PubMed  Google Scholar 

  21. Zolnoun D, Hartmann K, Lamvu G, et al. A conceptual model for the pathophysiology of vulvar vestibulitis syndrome. Obstet Gynecol Surv. 2006;61:395–401.

    Article  PubMed  Google Scholar 

  22. Foster DC, Sazenski TM, Stodgell CJ. Impact of genetic variation in interleukin-1 receptor genes on vulvar vestibulitis syndrome. J Reprod Med. 2004;49:503–9.

    PubMed  CAS  Google Scholar 

  23. Gerber S, Bongiovanni AM, Ledger WJ, et al. Defective regulation of the proinflammatory immune response in women with vulvar vestibulitis syndrome. Am J Obstet Gynecol. 2002;186:696–700.

    Article  PubMed  Google Scholar 

  24. Gerber S, Bongiovanni AM, Ledger WJ, et al. Interleukin-1β gene polymorphisms in women with vulvar vestibulitis syndrome. Eur J Obstet Gynecol Reprod Biol. 2003;107:74–7.

    Article  PubMed  CAS  Google Scholar 

  25. Meyer RA, Ringkamp M, Campbell JN, Raja SN. Peripheral mechanisms of cutaneous nociception, chapter 1. In: McMahon SB, Koltzenburg M, editors. Wall and Melzack’s textbook of pain. 5th ed. Amsterdam: Elsevier; 2006. p. 1.

    Google Scholar 

  26. Devor M. Sodium channels and mechanisms of neuropathic pain. J Pain. 2006;7(1S):S3–12.

    PubMed  CAS  Google Scholar 

  27. Heavner JE, Willis DJ. Pain pathways: anatomy and physiology, chapter 10. In: Raj PP, editor. Pain medicine. St. Louis: Mosby; 2003. p. 10–5.

    Google Scholar 

  28. Chen H, Lamer TJ, Rho R, Marshall KA, Sitzman BT, Ghazi SM, Brewer RP. Contemporary management of neuropathic pain for the primary care physician. Mayo Clin Proc. 2004;79:1533–45.

    Article  PubMed  Google Scholar 

  29. Nyirjesy P, Peyton C, Weitz MV, Mathew L, Culhane JF. Causes of chronic vaginitis: analysis of a prospective database of affected women. Obstet Gynecol. 2006;108:1185–91.

    Article  PubMed  Google Scholar 

  30. Harlow BL, He W, Nguyen RH. Allergic reactions and the risk of vulvodynia. Ann Epidemiol. 2009;19:771–7.

    Article  PubMed  Google Scholar 

  31. De Knott R, McCormick HM, Do TS, et al. Cutaneous hypersensitivity to Candida albicans in idiopathic vulvodynia. Contact Dermatitis. 2005;53:214–18.

    Article  Google Scholar 

  32. Granot M, Friedman M, Yarnitsky D, et al. Enhancement of the perception of systemic pain in women with vulvar vestibulitis. Br J Obstet Gynecol. 2002;109:863–6.

    Article  Google Scholar 

  33. Granot M, Friedman M. Primary and secondary vulvar vestibulitis syndrome: systemic pain perception and psychophysical characteristics. Am J Obstet Gynecol. 2004;191:138–42.

    Article  PubMed  Google Scholar 

  34. Foster DC, Dworkin RH, Wood RW. Effects of intradermal foot and forearm capsaicin injections in normal and vulvodynia-affected women. Pain. 2005;117:128–36.

    Article  PubMed  CAS  Google Scholar 

  35. Kahn BS, Tatro C, Parsons CL, Willems JJ. Prevalence of interstitial cystitis in vulvodynia patients detected by bladder potassium sensitivity. J Sex Med. 2010;7(2 Pt 2):996–1002.

    Article  PubMed  Google Scholar 

  36. Arnold JD, Bachman GS, Rosen R, et al. Vulvodynia: characteristics and associations with comorbidities and quality of life. Obstet Gynecol. 2006;107:617–24.

    Article  PubMed  Google Scholar 

  37. Parsons CL, Dell J, Stanford EJ, et al. The prevalence of interstitial cystitis in gynecologic patients with pelvic pain, as detected by intravesical potassium sensitivity. Am J Obstet Gynecol. 2002;187:1395–400.

    Article  PubMed  Google Scholar 

  38. Clemens JQ, Meenan RT, O’Keefe Rosetti MC, et al. Prevalence of interstitial cystitis symptoms in a managed care population. J Urol. 2005;174:576–80.

    Article  PubMed  Google Scholar 

  39. Mertz HR. Irritable bowel syndrome. N Eng J Med. 2003;349:2136–46.

    Article  CAS  Google Scholar 

  40. Engman M, Lindehammar H, Wijma B. Surface electromyography diagnostics in women with or without vulvar vestibulitis and in asymptomatic women. J Psychosom Obstet Gynecol. 2004;25:281–94.

    Article  Google Scholar 

  41. Vodusek DB. Anatomy and neurocontrol of the pelvic floor. Digestion. 2004;69:87–92.

    Article  PubMed  Google Scholar 

  42. Rogers RM. Basic pelvic neuroanatomy. In: Steege JF, Metzger DA, Levy BS, editors. Chronic pelvic pain: an integrated approach. Philadelphia: WB Saunders; 1998. p. 31–58.

    Google Scholar 

  43. Barber MD, Bremer RE, Thor KB, Dolber PC, Kuehl TJ, Coates KW. Innervation of the female levator ani muscles. Am J Obstet Gynecol. 2002;187:64.

    Article  PubMed  Google Scholar 

  44. Robinson DR, Gebhart GF. Inside information—the unique features of visceral sensation. Mol Interv. 2008;8:242–53.

    Article  PubMed  CAS  Google Scholar 

  45. Jänig W, Haput-Schade P, Kohler W. Afferent innervation of the colon: the neurophysiologic basis for visceral sensitization and pain. In: Mayer EA, Raybould HE, editors. Basic and clinical aspects of chronic abdominal pain: pain research and clinical management. Amsterdam: Elsevier Sciences; 1993. p. 71–86.

    Google Scholar 

  46. Doggweiler R, Jasmin L, Schmidt RA. Neurogenically mediated cystitis in rats: an animal model. J Urol. 1998;160:1551–6.

    Article  PubMed  CAS  Google Scholar 

  47. Jasmin L, Janni G, Ohara PT, Rabkin SD. CNS induced neurogenic cystitis is associated with mast cell degranulation in the rat. J Urol. 2000;164(3 Pt 1):852–5.

    PubMed  CAS  Google Scholar 

  48. Wesselman U. Neurogenic inflammation and chronic pelvic pain. World J Urol. 2001;19:180–5.

    Article  Google Scholar 

  49. Berkley KJ, Hubscher CH, Wall PD. Neuronal responses to stimulation of the cervix, uterus, colon, and skin in the rat spinal cord. J Neurophysiol. 1993;69:545–56.

    PubMed  CAS  Google Scholar 

  50. Winnard KP, Bmitrieva N, Berkley KJ. Cross-organ interactions between reproductive, gastrointestinal, and urinary tracts: modulation by estrous stage and involvement of the hypogastric nerve. Am J Physiol Regul Integr Comp Physiol. 2006;291:R1592–601.

    Article  PubMed  CAS  Google Scholar 

  51. Wesselman U, Lai J. Mechanisms of referred visceral pain: uterine inflammation in the adult virgin rat results in neurogenic plasma extravasation in the skin. Pain. 1997;73:309–17.

    Article  Google Scholar 

  52. Reissing ED, Brown C, Lord MJ, Binik YM, Khalifé S. Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome. J Psychosom Obstet Gynecol. 2005;26:107–13.

    Article  CAS  Google Scholar 

  53. Pukall CF, Strigo IA, Binik YM, et al. Neural correlates of painful genital touch in women with vulvar vestibulitis syndrome. Pain. 2005;115:118–22.

    Article  PubMed  Google Scholar 

  54.  

    Google Scholar 

  55. Gordon AS, Panahlan-Jand M, McComb F, et al. characteristics of women with vulvar pain disorders: a web-based survey. J Sex Martial Ther. 2003;29 Suppl 1:45–58.

    Google Scholar 

  56. Whitten C, Cristobal K. Chronic pain is a chronic condition not just a symptom. Permanente J. 2005;9:43–51.

    Google Scholar 

  57. Manchikanti L, Fellows B, Pampati V, Beyer C, Damron K, Barnhill RC. Comparison of the psychological status of chronic pain patients and the general population. Pain Physician. 2002;5:40–8.

    PubMed  Google Scholar 

  58. Banks SM, Kerns RD. Explaining the high rates of depression in chronic pain: a diathesis-stress framework. Psychol Bull. 1996;119:95–110.

    Article  Google Scholar 

  59. Sadownik LA. Clinical correlates of vulvodynia patients. A prospective study of 300 patients. J Reprod Med. 2000;45:679–84.

    PubMed  CAS  Google Scholar 

  60. Reed BD, Haefner HK, Punch MR, Roth RS, Gorenflo DW, Gillespie BW. Psychosocial and sexual functioning in women with vulvodynia and chronic pelvic pain. A comparative evaluation. J Reprod Med. 2000;45:624–32.

    PubMed  CAS  Google Scholar 

  61. Landry T, Bergeron S. Biopsychosocial factors associated with dyspareunia in a community sample of adolescent girls. Arch Sex Behav. 2011;40(5):877–89.

    Article  PubMed  Google Scholar 

  62. Delgado PL. Common pathways of pain and depression. J Clin Psychiatry. 2004;65 Suppl 12:16–9.

    PubMed  Google Scholar 

  63. Obata K, Noguchi K. BDNF in sensory neurons and chronic pain. Neurosci Res. 2006;55:1–10.

    Article  PubMed  CAS  Google Scholar 

  64. McEwan BS. Plasticity of the hippocampus: adaptation to chronic stress and allostatic load. Ann N Y Acad Sci. 2001;933:265–77.

    Article  Google Scholar 

  65. Arnow B, Hunker EM, Blasey CM, et al. Comorbid depression, chronic pain, and disability in primary care. Psychosom Med. 2006;68:262–8.

    Article  PubMed  Google Scholar 

  66. Harlow BL, Gunther Stewart E. Adult-onset vulvodynia in relation to childhood violence victimization. Am J Epidemiol. 2005;161:871–80.

    Article  PubMed  Google Scholar 

  67. Dalton VK, Haefner HK, Reed BD, Senapati S, Cook A. Victimization in patients with vulvar dysesthesia/vestibulodynia. Is there an increased prevalence? J Reprod Med. 2002;47:829–34.

    PubMed  Google Scholar 

  68. Kawamura N, Kim Y, Asukai N. Suppression of cellular immunity in men with past history of posttraumatic stress disorder. Am J Psychiatry. 2001;158:484–6.

    Article  PubMed  CAS  Google Scholar 

  69. Meaney MJ. Maternal care, gene expression, and the transmission of individual differences in stress reactivity across generations. Annu Rev Neurosci. 2001;24:1161–92.

    Article  PubMed  CAS  Google Scholar 

  70. Bjorling DE, Wang ZY. Estrogen and neuroinflammation. Urology. 2001;6 Suppl 1:40–6.

    Article  Google Scholar 

  71. Ting AY, Blacklock AD, Smith PG. Estrogen regulates vaginal sensory and autonomic nerve density in the rat. Biol Reprod. 2004;71:1397–404.

    Article  PubMed  CAS  Google Scholar 

  72. Unruh AM. Gender variations in the clinical pain experience. Pain. 1996;65:123–76.

    Article  PubMed  CAS  Google Scholar 

  73. Kushner L, Moldwin RM. Efficiency of questionnaires used to screen for interstitial cystitis. J Urol. 2006;176:587–92.

    Article  PubMed  Google Scholar 

  74. Drossman DA, Dumitrascu DL. Rome III: new standard for functional gastrointestinal disorders. J Gastrointestin Liver Dis. 2006;15(3):237–41.

    PubMed  Google Scholar 

  75. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.

    Article  PubMed  CAS  Google Scholar 

  76. Davidson JR, Feltner DE, Dugar A. Management of generalized anxiety disorder in primary care: identifying the challenges and unmet needs. Prim Care Companion J Clin Psychiatry. 2010;12(2): e1–e13.

    Google Scholar 

  77. Gunter J. Chronic pelvic pain: an integrated approach to diagnosis and treatment. Obstet Gynecol Surv. 2003;58:615–23.

    Article  PubMed  Google Scholar 

  78. Ferage MA, Miller KW, Ledger WJ. Determining the cause of vulvovaginal symptoms. Obstet Gynecol Surv. 2008;63:445–64.

    Article  Google Scholar 

  79. Gunter J. Chronic pelvic pain: the myofascial component. Female Patient. 2004;29:9–16.

    Google Scholar 

  80. Butrick CW. Pelvic floor hypertonic disorders: identification and management. Obstet Gynecol Clin North Am. 2009;36:707–22.

    Article  PubMed  Google Scholar 

  81. Labat JJ, Riant T, Robert R, Amarenco G, Lefaucheur JP, Rigaud J. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol Urodyn. 2008;27(4):306–10.

    Article  PubMed  Google Scholar 

  82. Metts JF. Vulvodynia and vulvar vestibulitis: challenges in diagnosis and management. Am Fam Physician. 1999;59(6):1547–60.

    Article  PubMed  Google Scholar 

  83.  

    Google Scholar 

  84. Solomons CC, Melmed MH, Heitler SM. Calcium citrate for vulvar vestibulitis. A case report. J Reprod Med. 1991;36:879–82.

    PubMed  CAS  Google Scholar 

  85. Harlow BL, Abenhaim HA, Vitonis AF, Harnack L. Influence of dietary oxalates on the risk of adult-onset vulvodynia. J Reprod Med. 2008;53:171–8.

    PubMed  Google Scholar 

  86. Baggish MS, Sze EH, Johnson R. Urinary oxalate excretion and its role in vulvar pain syndrome. Am J Obstet Gynecol. 1997;177:507–11.

    Article  PubMed  CAS  Google Scholar 

  87. Foster DC, Kotok MB, Huang L, et al. Oral desipramine and topical lidocaine for vulvodynia: a randomized controlled trial. Obstet Gynecol. 2010;116:583–93.

    Article  PubMed  CAS  Google Scholar 

  88. Nickel JC. Interstitial cystitis: characterization and management of an enigmatic urologic syndrome. Rev Urol. 2002;4(3):112–21.

    PubMed  Google Scholar 

  89. Drisko J, Bischoff B, Hall M, McCallum R. Treating irritable bowel syndrome with a food elimination diet followed by food challenge and probiotics. J Am Coll Nutr. 2006;25(6): 514–22.

    PubMed  Google Scholar 

  90. Nyirjesy P, Sobel JD, Weitz MV, Leaman DJ, Small MJ, Gelone SP. Cromolyn cream for recalcitrant idiopathic vulvar vestibulitis: results of a placebo controlled trial. Sex Transm Infect. 2001;77(1):53–7.

    Article  PubMed  CAS  Google Scholar 

  91. Goldstein AT, Marinoff ST, Haefner HK. Vulvodynia treatment strategies. Clin Obstet Gynecol. 2005;48:769–85.

    Article  PubMed  Google Scholar 

  92. Zolnoun DA, Hartmann KE, Steege JF. Overnight 5% lidocaine ointment for treatment of vulvar vestibulitis. Obstet Gynecol. 2003;102(1):84–7.

    Article  PubMed  CAS  Google Scholar 

  93. Danielsson I, Torstensson T, Brodda-Jansen G, Bohm-Starke N. EMG biofeedback versus topical lidocaine gel: a randomized study for the treatment of women with vulvar vestibulitis. Acta Obstet Gynecol Scand. 2006;85:1360–7.

    Article  PubMed  Google Scholar 

  94. Boardman LA, Cooper AS, Blais LR, Raker CA. Topical gabapentin in the treatment of localized and generalized vulvodynia. Obstet Gynecol. 2008;112:579–85.

    Article  PubMed  Google Scholar 

  95. Nyirjesy P, Lev-Sagie A, Mathew L, Culhane JF. Topical amitriptyline-baclofen cream for the treatment of provoked vestibulodynia. J Low Genit Tract Dis. 2009;13:230–6.

    Article  Google Scholar 

  96. Murina F, Radici G, Bianco V. Capsaicin and the treatment of vulvar vestibulitis syndrome: a valuable alternative. MedGenMed. 2004;6:48–56.

    PubMed  Google Scholar 

  97. Updike GM, Wiesenfeld HC. Insight into treatment of vulvar pain: a survey of clinicians. Am J Obstet Gynecol. 2005;193:1404–9.

    Article  PubMed  Google Scholar 

  98. Brown CS, Wan J, Bachmann G, Rosen R. Self-management, amitriptyline, and amitriptyline plus triamcinolone in the management of vulvodynia. J Womens Health (Larchmt). 2009;18:163–9.

    Article  Google Scholar 

  99. Nyirjesy P, Sbel J, Witz MV, Small MJ, Gelone SP. Cromolyn cream, for recalcitrant idiopathic vulvar vestibulitis: results of a placebo controlled study. Sex Transm Infect. 2001;77:53–77.

    Article  PubMed  CAS  Google Scholar 

  100. Hi G, Rodke G, Swenlonis C, Hertz R, Young AW. Treatment of vulvar vestibulitis syndrome with electromyographic feedback of pelvic floor musculature. J Reprod Med. 1996;40:283–90.

    Google Scholar 

  101. Bergeron S, Binik YM, Klalifé S, Pagidas K, Glazer HI, Meana M, Amsel R. A randomized comparison of group cognitive behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain. 2001;91:297–306.

    Article  PubMed  CAS  Google Scholar 

  102. McKay E, Kaufman RH, Doctor U, Berkova Z, Glazer H, Redko V. Treating vulvar vestibulitis with electromyographic biofeedback of pelvic floor musculature. J Reprod Med. 2001;46:337–42.

    PubMed  CAS  Google Scholar 

  103. Bergeron S, Klalifé S, Glazer HI, Meana M, Binik Y. Surgical and behavioral treatments for vestibulodynia: two-and-one-half-year follow-up and predictors of outcome. Obstet Gynecol. 2008;111:159–66.

    Article  PubMed  Google Scholar 

  104. Reed BD, Haefner HK, Edwrads L. A survey on diagnosis and treatment of vulvodynia researchers and members of the International Society for the Study of Vulvar Disease. J Reprod Med. 2008;53:921–9.

    PubMed  Google Scholar 

  105. Hartmann D, Starauhal MJ, Nelson CA. Treatment of women in the United States with localized, provoked vestibulodynia practice survey of women’s health physical therapists. J Reprod Med. 2007;52:48–52.

    PubMed  Google Scholar 

  106. Backman H, Widenbrant M, Bohm-Starke N, Dahlof LG. Combined physical and psychosexual therapy for provoked vestibulodynia- an evaluation of a multidisciplinary treatment model. J Sex Res. 2008;45:378–85.

    Article  PubMed  Google Scholar 

  107. Goldfinger C, Pukall CF, Gentilcore-Saulnier E, McLean L, Chamberlain S. A prospective study of pelvic floor physical therapy: pain and psychosexual outcomes in provoked vestibulodynia. J Sex Med. 2009;6:1955–68.

    Article  PubMed  Google Scholar 

  108. Forth HL, Cramp MC, Dreschsler WI. Does physiotherapy treatment improve the self-reported pain levels and quality of life of women with vulvodynia? A pilot study. J Obstet Gynaecol. 2009;29:423–9.

    Article  PubMed  CAS  Google Scholar 

  109. Hartmann EH, Nelson C. The perceived effectiveness of physical therapy treatment on women complaining of chronic vulvar pain and diagnosed with either vulvar vestibulitis syndrome or dysesthetic vulvodynia. J Sect Womens Health. 2001;25:13–8.

    Google Scholar 

  110. Reed BD, Caron AM, Gorenflo DW, Haefner HK. Treatment of vulvodynia with tricyclic antidepressants: efficacy and associated factors. J Low Genit Tract Dis. 2006;10:245–51.

    Article  PubMed  Google Scholar 

  111. Munday PE. Response to treatment in dysaesthetic vulvodynia. J Obstet Gynaecol. 2001;6:610–13.

    Article  Google Scholar 

  112. Reed BD, Caron AM, Gorenflo DW, et al. Treatment of vulvodynia with tricyclic antidepressants: efficacy and associated factors. J Low Genit Tract Dis. 2006;10:245–51.

    Article  PubMed  Google Scholar 

  113. McKay M. Dysesthetic (“essential”) vulvodynia: treatment with amitriptyline. J Reprod Med. 1993;38:9–13.

    PubMed  CAS  Google Scholar 

  114. Harris G, Horowitz B, Borigida A. Evaluation of gabapentin in the treatment of generalized vulvodynia, unprovoked. J Reprod Med. 2007;52:103–6.

    PubMed  CAS  Google Scholar 

  115. Ben-Davod B, Friedman M. Gabapentin therapy for vulvodynia. Anesth Anal. 1999;89:1459–60.

    Google Scholar 

  116. Meltzer-Brody SE, Zolnoun D, Steege JF, Rinaldi KL, Leserman J. Open-label trial of lamotrigine focusing on efficacy in vulvodynia. J Reprod Med. 2009;54:171–8.

    PubMed  CAS  Google Scholar 

  117. Jerome L. Pregabalin-induced remission in a 62-year-old woman with a 20-year history of vulvodynia. Pain Res Manag. 2007;12:212–14.

    PubMed  Google Scholar 

  118. Tinetti ME. Preventing falls in elderly persons. N Engl J Med. 2003;348:42–9.

    Article  PubMed  Google Scholar 

  119. Petersen CD, Giraldi A, Lundvall L, Kristensen E. Botulinum toxin type A—a novel treatment for provoked vestibulodynia? Results from a randomized, placebo-controlled, double blinded study. J Sex Med. 2009;6:2523–37.

    Article  PubMed  CAS  Google Scholar 

  120. American Society Anesthesiologists Task Force. Practice guidelines for chronic pain management. Anesthesiology. 2010;112:8120–33.

    Google Scholar 

  121. Segal D, Tifheret H, Lazar S. Submucous infiltration of betamethasone and lidocaine in the treatment of vulvar vestibulitis. Eur J Obstet Gynecol Reprod Biol. 2003;26(107):105–6.

    Article  Google Scholar 

  122. Murina F, Tassan P, Roberti P, Bianco V. Treatment of vulvar vestibulitis with submucous infiltrations of methylprednisolone and lidocaine: an alternative approach. J Reprod Med. 2001;46:713–16.

    PubMed  CAS  Google Scholar 

  123. Dede M, Yenen MC, Yilmaz A, Baser I. Successful treatment of persistent vulvodynia with submucous infiltration of betamethasone and lidocaine. Eur J Obstet Gynecol Reprod Biol. 2006;124:258–9.

    Article  PubMed  Google Scholar 

  124. Yoon H, Chung WS, Shim BS. Botulinum toxin A for the management of vulvodynia. Int J Impot Res. 2007;19:84–7.

    Article  PubMed  CAS  Google Scholar 

  125. Gunter J, Brewer A, Tawfik O. Botulinum toxin A for vulvodynia: a case report. J Pain. 2004;5:238–40.

    Article  PubMed  Google Scholar 

  126. Gerber S, Bongiovanni AM, Ledger WJ, Witkin SS. A deficiency in interferon-alpha production in women with vulvar vestibulitis. Am J Obstet Gynecol. 2002;186:361–4.

    Article  PubMed  CAS  Google Scholar 

  127. Kent HL, Wisniewski PM. Interferon for vulvar vestibulitis. J Reprod Med. 1990;35:1138–40.

    PubMed  CAS  Google Scholar 

  128. Marinoff SC, Turner ML, Hirsch RP, Richard G. Intralesional alpha interferon. Cost-effective therapy for vulvar vestibulitis syndrome. J Reprod Med. 1993;38:19–24.

    PubMed  CAS  Google Scholar 

  129. Calvillo O, Skaribas IM, Rockett C. Computed tomography-guided pudendal nerve block. A new diagnostic approach to long-term anoperineal pain: a report of two cases. Reg Anesth Pain Med. 2000;25:420–3.

    PubMed  CAS  Google Scholar 

  130. Stav K, Dwyer PL, Roberts F, Roberts L. Pudendal neuralgia: fact or fiction? Obstet Gynecol Surv. 2009;64:190–9.

    Article  PubMed  Google Scholar 

  131. Toshniwal GR, Dureja GP, Prashanth SM. Transsacrococcygeal approach to ganglion impar block for management of chronic perineal pain: a prospective observational study. Pain Physician. 2007;10:661–6.

    PubMed  Google Scholar 

  132. Goldstein AT, Klingman D, Christopher K, Johnson C, Marinoff SC. Surgical treatment of vulvar vestibulitis syndrome: outcome assessment derived from a postoperative questionnaire. J Sex Med. 2006;3:923–31.

    Article  PubMed  Google Scholar 

  133. Eva LJ, Narain S, Orakwue CO, Luesley DM. Is modified vestibulectomy for localized provoked vulvodynia and effective long-term treatment? A follow-up study. J Reprod Med. 2008;53:435–40.

    PubMed  Google Scholar 

  134. Bohm-Starke N, Rylander EJ. Surgery for localized, provoked vestibulodynia: a long-term follow-up study. J Reprod Med. 2008;53(2):83–9.

    PubMed  Google Scholar 

  135. Trutnovsky G, Law C, Simpson JM, Mindel A. Use of complementary therapies in a sexual health clinic setting. Int J STD AIDS. 2001;12:307–9.

    Article  PubMed  CAS  Google Scholar 

  136. Curran S, Brotto LA, Fisher H, Knudson G, Cohen T. The ACIV study: acupuncture treatment in provoked vestibulodynia. J Sex Med. 2010;7:981–95.

    Article  PubMed  Google Scholar 

  137. Powell J, Wojnarowska F. Acupuncture for vulvodynia. J R Soc Med. 1999;92:579–81.

    PubMed  CAS  Google Scholar 

  138. Brotto LA, Sadownik L, Thompson S. Impact of educational seminars on women with vestibulodynia. J Obstet Gynaecol Can. 2010;32:132–8.

    PubMed  Google Scholar 

  139. Jensen JT, Wilder K, Car K, et al. Quality of life and sexual function after evaluation and treatment at a referral center for vulvovaginal disorders. Am J Obstet Gynecol. 2003;188:1629–37.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Kaiser Permanente, Center for Pelvic Pain, 2238 Geary Blvd., San Francisco, CA, 94115, USA

    Jennifer Gunter M.D.

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  1. Jennifer Gunter M.D.
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  1. Spaulding Rehabiliation Hospital, Nashua Street 125, Boston, 02114, Massachusetts, USA

    Allison Bailey

  2. , Departments of Anesthesia, Neurology, Cr, Beth Israel Deaconness Medical Center, H, One Brookline Place, Suite 105, Brookline, 02445-7294, USA

    Carolyn Bernstein

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Gunter, J. (2013). Vulvodynia. In: Bailey, A., Bernstein, C. (eds) Pain in Women. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-7113-5_6

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