Vulvodynia

1 - DEFINITION

Vulvodynia is chronic vulvar discomfort, usually a burning sensation, with no identifiable cause [1].This diagnosis is often made after a course of several months or years due to the reluctance of patients to consult a doctor and an unawareness of the disease on the part of health professionals [2]. It has an estimated prevalence of 8% in the general population and it is thought to affect around a quarter of women at some point in their lives [3].

Vulvodynia is part of the group of medically unexplained symptoms (MUS), which means that they are symptoms that are not caused by any identifiable organic disorder (fibromyalgia, interstitial cystitis/painful bladder, irritable bowel syndrome, temporomandibular dysfunction, chronic fatigue syndrome etc.) [4, 5].Fifty per cent of women with vulvodynia are thought to have at least two other MUS [6].Vulvodynia, as with some other MUS, currently tends to be considered to be a disorder of the perception and modulation of pain messages involving central and peripheral nervous system mechanisms that are interwoven in a complex manner [6]_.

There may be genetic factors for a predisposition to this condition [7]and local inflammation (especially inflammation caused by a Candida albicans infection) can play a role in triggering symptoms [8].

An interplay of psychological and environmental factors are involved in vulvodynia. For example, a history of physical, psychological or sexual abuse leads to a four- to sixfold increase in the risk of developing vulvodynia [9, 10].Equally, women affected by vulvodynia more commonly have a history of anxiety, depression and a tendency to catastrophise pain than females without vulvar pain [11]. Finally, several studies have shown that the condition has a psychosexual impact on both the patient and her partner and that this impact can influence the disease course [12, 13].