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Localized provoked vulvodynia (LPV), also called vulvar vestibulitis or provoked vestibulodynia, is a major cause of dyspareunia that severely impacts sexual health. At the tissue level, lymphocytic inflammation and hyperinnervation are characteristic pathological features, explaining the main symptoms and signs. A recent experimental animal study suggests that the histopathological findings of LPV may be due to mucosal CD4 Th17 immune responses to microbial antigens. We hypothesize that LPV is an immune-mediated inflammatory disease and challenge the concept of LPV as a chronic pain syndrome of unknown cause. Since most treatment modalities currently used in LPV are no better than placebo, we therefore warrant future research investigating the possible presence of CD4 Th17 cells and IL17 cytokine in affected tissues together with treatment trials that include inhibitors of the IL17 pathway. [ABSTRACT FROM AUTHOR]

Vulvodynia is a chronic pain condition that affects the vulvar area, often resulting in significant discomfort and a reduced quality of life. Current treatments for vulvodynia are limited, and there is a need for more effective therapeutic options. Acmella oleracea, known for its spilanthol content, and Boswellia serrata, rich in boswellic acids, have been explored for their potential analgesic properties in pain management. In this study, vulvodynia-like symptoms were induced in female mice using Complete Freund's adjuvant (CFA). After the induction of symptoms, the mice were treated with a combination of Acmella oleracea and Boswellia serrata extracts (AO + BS). Behavioral pain assessments were conducted to monitor the effects of the treatment. Additionally, biochemical and functional evaluations were performed to measure spinal microgliosis and neuronal overexcitation. The combination of Acmella oleracea and Boswellia serrata (AO + BS) resulted in a significant reduction of vulvar hypersensitivity in mice. Besides alleviating pain, AO + BS therapy also reduced spinal microgliosis and neuronal overexcitation in mice with vulvodynia. The findings suggest that the AO + BS combination has the potential to alleviate vulvodynia associated pain through mechanisms involving the reduction of spinal microgliosis and neuronal overexcitation. These results point to the therapeutic promise of these plant extracts for chronic pain conditions like vulvodynia. The combination of Acmella oleracea and Boswellia serrata shows potential as a treatment for vulvodynia. However, further studies are needed to explore the underlying mechanisms and to optimize the dosage for clinical use. [ABSTRACT FROM AUTHOR]

Background and Objective: TRIV is a new and promising technique based on the fact that Vulva can be divided into three circular zones based on anatomy, embryology, and histology- Outer, Middle, and Inner ring. The Vulvoscopy Index and N-S-P scheme are objective tools to improve the systematization of vulvoscopy findings and to simplify information management using TRIV. Methods: Hundred women with vulvar complaints (Cases) and 100 asymptomatic women (Controls) underwent TRIV and findings were documented as per N-S-P Scheme and Vulvoscopy Index. Biopsy was taken from specific lesions. Vulvar disorders were categorized into 5 categories based on histology and clinical findings—Vulvodynia, Impaired vulvar skin, Vulvar dermatosis, pre-malignant lesions of the vulva, and others. Results: According to N-S-P scheme most common formulas were- N–N-N for Normal vulva, P-P-P for vulvar dermatoses, and N-S–N for Impaired Vulvar skin. The mean Vulvoscopy index was 4.33 ± 0.52 for Impaired vulvar skin, 6.11 ± 2.87 for vulvodynia, 24 ± 6.04 for pre-malignant lesions of vulva, and 25.17 ± 4.31 for vulvar dermatosis. The sensitivity, specificity, and diagnostic accuracy of the Vulvoscopy Index for detecting vulvar disorders were 100%, 96.51%, and 98.50%, respectively. The positive and negative predictive values were 0.97 and 1.00, respectively. Conclusion: The Vulvoscopy Index is a significant predictor for vulvar disorders. N-S-P scheme helps in the objective and systematic documentation of TRIV findings, which allows monitoring of the vulvar changes. TRIV can be used for preventing early stages of vulvar dermatosis which is a risk factor for vulvar malignancy. [ABSTRACT FROM AUTHOR]

Purpose of Review: This review examines laser therapy for bladder pain syndrome/interstitial cystitis (BPS/IC) and vulvodynia, focusing on efficacy, mechanisms, and common pathophysiological pathways. Recent Findings: Studies show promising results for non-ablative Er:YAG and Nd:YAG lasers in treating vulvodynia and associated conditions in BPS/IC patients. Ho:YAG laser demonstrates potential for Hunner's lesions. Histological improvements and symptom relief have been reported. Research highlights shared pathophysiological mechanisms between BPS/IC and vulvodynia, including mast cell involvement, neurogenic inflammation, and central sensitization. Furthermore, machine learning-based clustering analysis has identified novel subtypes of BPS/IC. Summary: Laser therapy shows potential in managing BPS/IC and vulvodynia, with evidence suggesting common underlying mechanisms. Larger, long-term studies are needed to establish efficacy, safety, and optimal protocols, as well as to further elucidate shared pathophysiological pathways. The author proposes developing personalized medicine approaches using regular clustering analysis and artificial intelligence, which may lead to adaptive treatment strategies based on patients' changing symptom profiles. [ABSTRACT FROM AUTHOR]

Genito-pelvic pain/penetration disorder is a relatively new term encompassing both dyspareunia (recurrent pain with intercourse) and vaginismus (involuntary contraction of the pelvic floor with attempted penetration). Symptoms are often multifactorial. Thus, a detailed history and sensitive patient-centered examination are essential to identify and treat the underlying cause(s). Additional laboratory or imaging studies are not routinely indicated but may be helpful to rule out infectious etiologies or evaluate pelvic organ pathology in cases of deep dyspareunia. Treatment may include patient education about the condition, avoidance or modifications of irritants or triggers, use of vaginal lubricants and moisturizers, hormone therapy, pelvic floor physical therapy, and psychosocial interventions as indicated. Vulvodynia is a separate but related condition and is a diagnosis of exclusion. It is defined as vulvar pain for at least 3 months without another clearly identifiable cause. High-quality studies on the treatment of vulvodynia are limited. However, pelvic floor physical therapy and psychosocial interventions such as cognitive behavior therapy have the most consistent evidence of benefit. [ABSTRACT FROM AUTHOR]

Guided by the revelation risk model, we conducted an online experiment (N = 400) to assess five strategies (i.e. initiate, response, third-person disclosure, humor, evidence) used to hypothetically disclose two types of sexual dysfunction (SD) – vulvovaginal pain (VVP) and erectile dysfunction (ED) – in romantic relationships of six months or less. Results indicated that relationship investment varied depending on the SD disclosed, such that participants who imagined that their partner disclosed ED were less invested than those who imagined that their partner disclosed VVP. Results also indicated that intention to continue the relationship varied depending on the SD disclosed and strategy used, such that participants who imagined that their partner disclosed VVP were most likely to intend to continue their relationship when their partner responded to a reference to their SD, whereas participants who imagined that their partner disclosed ED were most likely to intend to continue their relationship when their partner left behind evidence of their SD. Theoretical and practical insights that advance our understanding of disclosing SD in newly established romantic relationships and disclosure theorizing are offered. [ABSTRACT FROM AUTHOR]

Background: Vestibulodynia (VBD) represents a summation and overlapping of trigger factors (infections, hormonal disturbances, allergies, genetic aspects, psychological vulnerability, and others) with broad individual variability. As there are no standard treatment options for VBD, the disease is still in need of appropriate therapeutic tools. Objectives: A prospective observational trial was performed to confirm the efficacy of a topical gel containing a spermidine–hyaluronate complex (UBIGEL donna™) as either a stand-alone or companion treatment through a multicenter study on a large sample population. Methods: For women with VBD (n = 154), the treatment consisted of approximately two months (4 + 4 weeks) of applications according to the posology of UBIGEL. Evaluation of symptoms was performed on relevant clinical endpoints: dyspareunia and vulvovaginal pain/burning by a visual scale (VAS); vestibular trophism by a vestibular trophic health (VeTH) score; vulvoscopy through a cotton swab test; and the level of hypertonic pelvic floor by a physical graded assessment of levator ani hypertonus. Results: A total of 154 patients treated with UBIGEL donna™ showed significant improvements across all five evaluated parameters, including pain, dyspareunia, swab test results, muscle hypertonicity, and vestibular trophism. Pain and dyspareunia scores decreased by 46.5% and 33.5%, respectively, while significant improvements were also observed in the other parameters (p < 0.0001). These improvements were consistent across various stratifications, including age and disease duration. Conclusions: The findings of the present study suggest that UBIGEL donna™ is effective in alleviating pain and dyspareunia, as well as reducing vestibular hypersensitivity in women with VBD. Although UBIGEL donna™ alone cannot serve as a comprehensive substitute for all recommended therapies, we suggest that multimodal therapy strategies may be crucial for attaining substantial improvement in any aspect of the condition. [ABSTRACT FROM AUTHOR]

Lipschütz ulcer (LU) is a condition known for painful vulvar ulcers, typically affecting young women and often linked to infectious agents. Recent reports have indicated a potential connection between LU and COVID‐19 vaccination, particularly after the second or booster doses. This study presents a case of LU following the first dose of tozinameran in a young woman who had a previous SARS‐CoV‐2 infection and investigates similar cases globally. An 18‐year‐old woman experienced vulvar pain and ulcers 2‐days after her initial COVID‐19 vaccine dose. After ruling out infections through serological tests, a diagnosis of LU was made, and her symptoms resolved after 10 days. A literature search and VigiBase® analysis revealed 11 cases of LU following COVID‐19 vaccination, and 519 vulvovaginal ulcer cases associated with these vaccines were identified in Vigibase®, with a median onset of 2 days. Most LU cases occurred after the second dose or booster shots. The primary hypothesis for this association is a type 3 hypersensitivity reaction mediated by immune complexes, possibly triggered by prior exposure, as many cases occurred after the second dose. Interestingly, the presented case suggests that prior COVID‐19 infection could serve as sensitization. In conclusion, this study highlights the potential occurrence of LU after the initial COVID‐19 vaccine dose in young patients with prior COVID‐19 infection. While the risk of recurrence after subsequent vaccinations or infections remains uncertain, the benefits of vaccination outweigh the risks. Clinicians and patients should be aware of this potential issue to make informed decisions regarding vaccination. [ABSTRACT FROM AUTHOR]

Background : Chronic overlapping pain conditions (COPCs), pain-related conditions that frequently occur together, may occur in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and could impact illness severity. This study aimed to identify comorbid COPCs in patients with ME/CFS and evaluate their impact on illness severity. Methods: We used data from 923 participants in the Multi-Site Clinical Assessment of ME/CFS study, conducted in seven U.S. specialty clinics between 2012 and 2020, who completed the baseline assessment (595 ME/CFS and 328 healthy controls (HC)). COPCs included chronic low back pain (cLBP), chronic migraine/headache (cMHA), fibromyalgia (FM), interstitial cystitis/irritable bladder (IC/IB), irritable bowel syndrome (IBS), temporomandibular disorder (TMD). Illness severity was assessed through questionnaires measuring symptoms and functioning. Multivariate analysis of variance and analysis of covariance models were used for analyses. Log-binomial regression analyses were used to compute prevalence of COPCs and prevalence ratios (PR) between groups with 95% confidence intervals. Both unadjusted and adjusted results with age and sex are presented. Results : 76% of participants with ME/CFS had at least one COPCs compared to 17.4% of HC. Among ME/CFS participants, cMHA was most prevalent (48.1%), followed by FM (45.0%), cLBP (33.1%), and IBS (31.6%). All individual COPCs, except TMD, were significantly more frequent in females than males. The unadjusted PR (ME/CFS compared to HC) was highest for FM [147.74 (95% confidence interval (CI) = 20.83-1047.75], followed by cLBP [39.45 (12.73-122.27)], and IC/IB [13.78 (1.88-101.24)]. The significance and order did not change after age and sex adjustment. The COPC comorbidities of cLBP and FM each had a significant impact on most health measures, particularly in pain attributes (Cohen's d effect size 0.8 or larger). While the impact of COPC comorbidities on non-pain attributes and quality of life measures was less pronounced than that on pain, statistically significant differences between ME/CFS participants with and without COPCs were still evident. Conclusions: More than 75% of ME/CFS participants had one or more COPCs. Multiple COPCs further exacerbated illness severity, especially among females with ME/CFS. Assessment and management of COPCs may help improve the health and quality of life for patients with ME/CFS. [ABSTRACT FROM AUTHOR]

Background: Vulvodynia is a chronic pain syndrome characterized by persistent vulvar pain, occurring without clinically identifiable disorders. Central sensitization (CS) is suggested to play a role in the pathophysiology of vulvodynia, as for other nociplastic pain conditions. Aim: This study delves into the complex interplay between psychosocial factors and CS burden in women with vulvodynia, aiming to identify potential predictors (temperament, personality traits, childhood adverse events, defense mechanisms, and mental pain) and understand their impact on quality of life (QoL). Methods: A cohort-based cross-sectional web survey of 357 women with vulvodynia. Outcomes: Outcomes included 8 self-report measures to assess the Central Sensitization Inventory (CSI) and psychological variables, including sensory processing sensitivity, traumatic experiences, personality traits, defense mechanisms, and mental pain. Results: Hierarchical multiple regression analyses were conducted in study 1, revealing that the following predicted higher CSI scores in women with vulvodynia: higher emotional overexcitability, decreased low sensory threshold, increased bodily threat experiences, elevated psychoticism, greater use of immature and neurotic defense mechanisms, and heightened mental pain. The final regression model identified the following as the strongest predictors of CS: low sensory threshold (β = 0.316), bodily threat experiences (β = 0.145), neurotic defenses (β = 0.210), and mental pain (β = 0.269). In study 2, the model presented interactions among these psychological factors in predicting CSI values explaining 48.9% of the variance in CS, 30.3% in psychological QoL, and 57.1% in physical QoL. Clinical Translation: This model opens discussion for tailored psychological interventions aimed to improve overall QoL in women with vulvodynia. Strengths and Limitations: Strengths of the study include innovative insights into the interplay between psychological variables and the construct of CS and quality of life. As a limitation, the research was conducted as a cross-sectional study with self-reported measures. Conclusion: The study calls for comprehensive assessments that consider physical and mental aspects, paving the way for holistic health care approaches in the management of vulvodynia. [ABSTRACT FROM AUTHOR]

Introduction: Vulvodynia is a common and complex pain syndrome with a negative impact on quality of life and sexual health. Physical therapy is still an underexplored treatment for vulvodynia. Women's experiences of their physical therapy treatment might shed light on meaningful aspects and essential keys to facilitate change. Purpose: To explore and describe women's experiences of physical therapy treatment for vulvodynia. Methods: A qualitative interview study, using qualitative content analysis. Fourteen women with a median age of 28 years and a median pain duration of 6.5 years participated. Digital interviews were conducted using a semi-structured interview guide with open-ended questions. Results: One theme, four categories and thirteen sub-categories were developed in the analysis. The theme, "Trying to become friends with your vulva," illuminate how the women approached and reconnected to their bodies in physical therapy. The treatment increased their awareness and provided explanations for their symptoms. Four categories described aspects of the theme: 1) untapped resources in a complex healthcare; 2) a matter of trust; 3) a guide to understanding your body; and 4) a new way forward but not the whole solution. Conclusion: Women with vulvodynia perceive physical therapy as a promising and yet unknown approach. Physical therapy treatment gives the opportunity to reconnect with the body and vulva in a new way, and to manage pain and muscle tension as part of a multidisciplinary treatment. [ABSTRACT FROM AUTHOR]

Background: Vulvodynia (VVD) is a debilitating chronic vulvar pain significantly affecting patients' quality of life. Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic and complex illness characterized by an unpleasant sensation related to the filling of the bladder and it strongly impacts patients' lives. The exact mechanisms of the two syndromes remain unknown, but there is an overlap between suspected pathophysiologies. Objective: To present an overview of the current research on the association between VVD and IC/BPS. Search Strategy: A systematic search of three electronic databases was conducted. Studies examining the correlation between VVD and IC/BPS with male and female patients aged over 18 years were included. Selection Criteria: Studies assessing the coexistence of VVD and IC/BPS were included. Reviews, letters to the editor, conference abstracts, book chapters, guidelines, Cochrane reviews, and expert opinions were excluded. Data Collection and Analysis: Two reviewers screened the studies for eligibility. Eligible studies were screened for quality. Main Results: A total of 13 studies were included in the final review. Among them, 11 presented a positive association between the two syndromes. The studies highlighted that VVD and IC/BPS share common comorbidities and possibly etiopathogenic pathways. Conclusion: VVD and IC/BPS are both complex and multifactorial syndromes. This review highlights an association between them, but additional studies on the topic should be conducted for a more precise conclusion. Synopsis: Vulvodynia and interstitial cystitis are both chronic pelvic pain conditions that often coexist. They are characterized by a similar etiopathogenetic pathway and common comorbidities. [ABSTRACT FROM AUTHOR]

Background: Vulvodynia impacts up to 8% of women by age 40, and these women may have a more compromised immune system than women with no vulvar pain history. Aim: Given that psychiatric morbidity is associated with vulvodynia and is known to activate immune inflammatory pathways in the brain and systemically, we sought to determine whether the association between psychiatric morbidity and vulvar pain was independent of or dependent upon the presence of immune-related conditions. Methods: Women born in Sweden between 1973 and 1996 with localized provoked vulvodynia (N76.3) and/or vaginismus (N94.2 or F52.5) diagnosed between 2001 and 2018 were matched to two women from the same birth year with no vulvar pain. International Statistical Classification of Diseases and Related Health Problems (ICD-9 or -10 codes) were used to identify women with a history of depression, anxiety, attempted suicide, neurotic disorders, stress-related disorders, behavioral syndromes, personality disorders, psychotic disorders, or chemical dependencies, as well as a spectrum of immune-related conditions. The Swedish National Prescribed Drug Register was used to identify women with filled prescriptions of antidepressants or anxiolytics. Outcomes: Vulvodynia, vaginismus, or both were outcomes assessed in relation to psychiatric morbidity. Results: Women with vulvodynia, vaginismus, or both, relative to those without vulvar pain, had adjusted odds ratios between 1.4 and 2.3, with CIs highly compatible with harmful effects. When we assessed women with and those without a lifetime history of immune-related conditions separately, we also observed elevated odds ratios in both groups for mood, anxiety, and neurotic and stress disorders. Clinical implications: Documenting psychiatric impairment as a cause or consequence of vulvodynia is critical in clinical practice because psychiatric conditions may impact treatment efficacy. Strengths and Limitations: Strengths of this study include a data source that represents the entire population of women in Sweden that is known to be highly accurate because Sweden provides universal healthcare. Limitations include difficulty in making an accurate assessment of temporality between psychiatric morbidity and the first onset of vulvar pain. In addition, because Swedish registry data have limited information on lifestyle, behavioral, and anthropomorphic factors such as smoking, diet, physical activity, and obesity, these conditions could not be assessed as confounders of psychiatric morbidity and vulvar pain. Conclusions: Immune pathways by which women with psychiatric conditions increase their risk of vulvar pain could be independent from other immune pathways. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: Women with vulvovaginal or genital pain more commonly experience interstitial cystitis/bladder pain syndrome (IC/BPS) and urinary tract infections. However, the relationship between genital pain and bladder health is lacking. Methods: Women in the Prevention of Lower Urinary Tract Symptoms Consortium's RISE FOR HEALTH population-based study answered questions about bladder health globally, and across nine bladder health domains of holding, efficacy, social–occupation, physical activity, intimacy, travel, emotion, perception, and freedom. Bladder function was assessed across six indices including urinary frequency, sensation, continence, comfort, emptying, and dysbiosis (e.g., urinary tract infections). Participants were grouped by no pain beyond transitory events (i.e., minor headaches, toothaches, or sprains), nongenital-related pain only, and any genital pain using a validated pain diagram. Mean adjusted scores and indices were compared using general linear modelling. Results: Of 1,973 eligible women, 250 (12.7%) reported genital pain, 609 (30.9%) reported nongenital pain only, and 1,114 (56.5%) reported no pain. Women with any genital pain had lower (worse) adjusted mean scores across all bladder health scales (BHS; BHS global adjusted mean 47.5; 95% CI 40.8–54.1), compared with those with nongenital pain only (53.7; 95% CI 47.6–59.8), and no pain (59.3; 95% CI 53.3–65.4). Similarly, adjusted mean total Bladder Functional Index scores were lower for those with genital pain (63.1; 95% CI 58.4–67.9) compared with nongenital pain (72.1; 95% CI 67.7–76.5) and no pain (77.4; 95% CI 73.0–81.8). Conclusions: Heightened awareness of the relationship between genital pain and bladder health should prompt clinicians caring for women with genital pain to assess bladder health and function. [ABSTRACT FROM AUTHOR]

Introduction: Vulvodynia is a painful and constant vulvar discomfort. This condition is often described as a searing or stinging sensation, with an increased awareness of pain (hyperalgesia) and pain sensitivity (allodynia). Objective: To determine the effects of botulinum toxin A treatment on pain, resting vaginal pressure, and female sexual distress scale among vulvodynia patients. Patients and methods: A quasi-experimental study was performed on 40 patients with vulvodynia. The assessment was done 3 months after botulinum toxin injection by visual analog scale, vaginal pressure at rest, and female sexual distress scale. Results: The findings revealed that the effect of treatment was turned out to be significantly effective (P <0.05) in reducing pain and measured using visual analog scale where the values at baseline were 8.25±3.41, which reduced to 4.37±2.12 after 3 months of intervention. In addition to that female sexual distress scale also shown a significant reduction after 3 months of treatment. The improvement was noticed with a mean difference of mean differnce=8.21±3.58 (P <0.05, 95% confidence interval). Furthermore, it was shown that botulinum toxin A therapy significantly decreased resting vaginal pressure. Conclusion: Botulinum toxin type A therapy is a potential alternative for treating female vulvodynia. [ABSTRACT FROM AUTHOR]

Background: Genital pain treatment regimens range from local or systemic pharmacological to non-pharmacological, manual and psychosexual therapies with poor to moderate evidence for their efficiency. The aim of this study was to evaluate the subjective therapeutic response (genital pain relief) of different treatment modalities for vulvodynia and the most prevalent other vulvar pathologies, chronic vulvar eczema and lichen sclerosus by means of a cross-sectional survey. Material and Methods: A questionnaire-based cohort study that included 128 vulvodynia, 116 eczema and 79 lichen sclerosus patients was used. All patients attended the vulvar clinic at the University Hospital of Zurich. The patients who had been treated were surveyed from January to October 2022, using a customized online questionnaire consisting of 37 questions on symptoms and treatment outcomes for guideline-recommended treatment modalities. The study was approved by the Cantonal Ethics Review Board of Zurich. Results: Altogether, 41 patients with vulvodynia, 37 with vulvar eczema and 23 with lichen sclerosus returned the questionnaire. The three groups were similar regarding pain characteristics and comorbidities. All three patient groups reported having benefited from non-pharmacological treatment (improvement rate vulvodynia 54%; eczema 51%; lichen sclerosus 58%), from topical (55%; 55%; 75%) and from locally invasive (46%; 66%; 50%) treatments. Overall, there was no significant difference in subjective treatment outcome between non-pharmacological, locally invasive, and topical treatments for vulvodynia, eczema, and lichen sclerosus. However, the use of oral medication was reported to be significantly less effective (p-value 0.050). Conclusion: In conclusion, we found that in the patients' perception, topical, invasive and non-pharmacological treatments, but not oral medications, are helpful for genital pain relief in women with vulvodynia, vulvar eczema, and lichen sclerosus. Therefore, we recommend an escalating therapy approach with first-line non-pharmacological treatments together with topical therapies. [ABSTRACT FROM AUTHOR]

Background: Vulvodynia is a chronic pain condition without an identifiable cause. As such, it is a diagnosis of exclusion, and all other causes of vulvar pain should be excluded. Although a standard treatment for vulvodynia has not been established yet, multidisciplinary care programs appear to be effective. Puropose: The aim of this retrospective monocentric study was to analyze the prevalence of vulvodynia among women referred to our institution for a suspected diagnosis and to evaluate the efficacy of a multidimensional treatment plan. The primary outcome was the prevalence of vulvodynia following differential diagnosis. Secondary outcomes included: prevalence of the differential diagnoses, symptom resolution rate following treatment, and the relation between persistence of symptoms and (a) patients' age; (b) coexisting chronic overlapping pain conditions (COPCs). Results: After having ruled out all other causes of vulvar pain, only 40.1% of women were considered as affected by vulvodynia. The most frequent differential diagnoses included lower genital tract infections (25.3%), vulvar lichen sclerosus (17.6%) and vulvovaginal atrophy (8.2%). Following a multidisciplinary care program, resolution of symptoms was observed in 13.6% cases, improvement in 64.3% and persistence in 21.9%. We did not find a statistically significant association between persistence of symptoms and age > 38 years (OR 2.10; p = 0.30). Women with one or more COPCs other than vulvodynia had a 75% increased risk of not obtaining a resolution of symptoms (OR 1.75; p = 0.44). Conclusion: A thorough differential diagnosis and a multidisciplinary care program may represent a first way out of the muddle in the management of these patients. [ABSTRACT FROM AUTHOR]

(1) Background: Vulvodynia is characterized by vulvar pain for at least three months and may have related variables, one of these being pelvic floor hypertonus. The purpose of this study was to compare the therapeutic effectiveness of two weekly sessions of pelvic floor rehabilitation and 5 mg of vaginal diazepam daily vs. pelvic floor rehabilitation alone in individuals with vulvodynia. (2) Methods: A single-center, not-blind, randomized study enrolled 20 vulvodynic patients: A total of 10 were treated with dual therapy (intravaginal diazepam and pelvic floor rehabilitation), and 10 were treated with only pelvic floor rehabilitation. All of them underwent a pelvic floor ultrasound examination and VAS pain and Marinoff scale assessments before the beginning of therapy as well as three and six months later. (3) Results: The elevator plate angle ranged from 8.2 to 9.55 (p = 0.0005), hiatal area diameter ranged from 1.277 to 1.482 (p = 0.0002), levator symphysis distance ranged from 3.88 to 4.098 (p = 0.006), anorectal angle ranged from 121.9 to 125.49 (p = 0.006), Marinoff scale ranged from 2.3 to 1.4 (p = 0.009), and VAS scale ranged from 5.8 to 2.8 (p < 0.001). (4) Conclusions: This pilot study demonstrates that the suggested treatment improves the hypertonicity of the pelvic floor, as measured by ultrasound parameters, correlating with a reduction in symptomatology. [ABSTRACT FROM AUTHOR]

Localized provoked vulvodynia (LPV), also called vulvar vestibulitis or provoked vestibulodynia, is a major cause of dyspareunia that severely impacts sexual health. At the tissue level, lymphocytic inflammation and hyperinnervation are characteristic pathological features, explaining the main symptoms and signs. A recent experimental animal study suggests that the histopathological findings of LPV may be due to mucosal CD4 Th17 immune responses to microbial antigens. We hypothesize that LPV is an immune-mediated inflammatory disease and challenge the concept of LPV as a chronic pain syndrome of unknown cause. Since most treatment modalities currently used in LPV are no better than placebo, we therefore warrant future research investigating the possible presence of CD4 Th17 cells and IL17 cytokine in affected tissues together with treatment trials that include inhibitors of the IL17 pathway.

Vulvodynia is a chronic pain condition that affects the vulvar area, often resulting in significant discomfort and a reduced quality of life. Current treatments for vulvodynia are limited, and there is a need for more effective therapeutic options. Acmella oleracea, known for its spilanthol content, and Boswellia serrata, rich in boswellic acids, have been explored for their potential analgesic properties in pain management. In this study, vulvodynia-like symptoms were induced in female mice using Complete Freund’s adjuvant (CFA). After the induction of symptoms, the mice were treated with a combination of Acmella oleracea and Boswellia serrata extracts (AO + BS). Behavioral pain assessments were conducted to monitor the effects of the treatment. Additionally, biochemical and functional evaluations were performed to measure spinal microgliosis and neuronal overexcitation. The combination of Acmella oleracea and Boswellia serrata (AO + BS) resulted in a significant reduction of vulvar hypersensitivity in mice. Besides alleviating pain, AO + BS therapy also reduced spinal microgliosis and neuronal overexcitation in mice with vulvodynia. The findings suggest that the AO + BS combination has the potential to alleviate vulvodynia associated pain through mechanisms involving the reduction of spinal microgliosis and neuronal overexcitation. These results point to the therapeutic promise of these plant extracts for chronic pain conditions like vulvodynia. The combination of Acmella oleracea and Boswellia serrata shows potential as a treatment for vulvodynia. However, further studies are needed to explore the underlying mechanisms and to optimize the dosage for clinical use.

Ahinoam Lev-Sagie,1 Nosaiba Rayan-Gharra,2 Hadas Allouche-Kam,3 Michal Granot2 1Faculty of Medicine, Hebrew University of Jerusalem, Clalit Health Organization, Jerusalem, Israel; 2Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; 3Department of Obstetrics and Gynecology, Hadassah Mount Scopus-Hebrew University Medical Center, Jerusalem, IsraelCorrespondence: Ahinoam Lev-Sagie, MD Faculty of Medicine,Hebrew University of Jerusalem, Israel, and Vulvovaginal Disorders Clinic, Clalit Health Organization, Jerusalem, Israel, Tel +972-52-5223933, Fax +972-74-7405516, Email levsagie@netvision.net.ilPurpose: A diagnostic algorithm was recently suggested to address the underlying mechanisms of provoked-vestibulodynia (PVD). It delineates four subgroups (Hormonal-associated, Augmented-anterior, Hymenal-associated and Hypertonicity-associated), each manifesting a distinctive vulvar pain-hypersensitivity regarding location (circumferential vs posterior-only vestibulodynia) and pain characteristics. We aimed to explore the significance of various experimentally induced vulvar pain measures in the manifestation of pain hypersensitivity in each subgroup.Methods: Women with PVD (n = 113) and 43 controls reported pain intensity provoked during vaginal penetration and tampon insertion. Vestibular tenderness (anterior and posterior) was assessed by Q-tip test, and pressure stimulation delivered to the puborectalis assessed muscle tenderness. Pain thresholds were measured using a vulvar-algesiometer. These measures were compared between patients and controls and among the PVD subgroups. Correlations between the clinical and experimentally induced-pain measures were assessed. Finally, to address whether the association between experimentally induced-pain measures and dyspareunia severity is mediated by hypertonicity, the conditional indirect effect was analyzed in each subgroup.Results: Compared to controls, augmented vulvar pain-hypersensitivity and hypertonicity were observed among patients (p < 0.001). ANOVA revealed no subgroup differences in dyspareunia severity. Nevertheless, some experimentally induced-pain measures were differently correlated with dyspareunia intensity in each subgroup, allowing discrimination of subgroups according to the unique findings of vulvar pain-hypersensitivity. The degree of pelvic floor muscle-hypertonicity mediated the association between vulvar pain-hypersensitivity and dyspareunia severity, emphasizing the key role of hypertonicity in distinguishing between subgroups.Conclusion: The findings offer more evidence of variations among PVD subtypes, demonstrating that insertional dyspareunia may originate from dissimilar alterations in the mucosal and muscular tissues. The results also emphasize the significance of utilizing a wide battery of tests to capture different experimentally induced-pain measures, revealing the unique patterns of vulvar pain-hypersensitivity in each subgroup.Keywords: vulvodynia, provoked vestibulodynia, insertional dyspareunia, experimentally induced pain measures, subgroups

Vulvodynia is a chronic vulvar pain condition that can be challenging to treat and often requires multi-modal interventions for symptom management. Low-dose naltrexone (LDN) is a reversible competitive antagonist at opioid receptors and may have utility in treating chronic pain conditions. In a specialty gynecology clinic at an academic medical center, patients with poorly controlled vulvodynia who had failed standard treatments were offered LDN as an adjunct pain treatment. This case series describes the experience of three patients with chronic vulvodynia who added LDN to their treatment regimen. All patients reported subjective improvement in their symptoms without side-effects. Additional research is needed on the efficacy of LDN for chronic pelvic pain conditions such as vulvodynia as well as the long-term safety profile of such use.

Primary provoked vestibulodynia (PVD) is marked by the onset of symptoms at first provoking vulvar contact, whereas secondary PVD refers to symptom onset after some period of painless vulvar contact. Different pathophysiological processes are believed to be involved in the development and maintenance of primary PVD and secondary PVD. The primary aim of this study was to test the hypotheses that the resting state functional connectivity of the brain and brain stem regions differs between these subtypes. Deep clinical phenotyping and resting state brain imaging were obtained in a large sample of a women with primary PVD (n = 46), those with secondary PVD (n = 68), and healthy control women (n = 94). The general linear model was used to test for differences in region-to-region resting state functional connectivity and psychosocial and symptom assessments. Direct statistical comparisons by onset type indicated that women with secondary PVD have increased dorsal attention-somatomotor network connectivity, whereas women with primary PVD predominantly show increased intrinsic resting state connectivity within the brain stem and the default mode network. Furthermore, compared with women with primary PVD, those with secondary PVD reported greater incidence of early life sexual abuse, greater pain catastrophizing, greater 24-hour symptom unpleasantness, and less sexual satisfaction. The findings suggest that women with secondary PVD show greater evidence for central amplification of sensory signals, whereas women with primary PVD have alterations in brain stem circuitry responsible for the processing and modulation of ascending and descending peripheral signals.

Vulvodynia, a long-term genital pain disorder with a high lifetime prevalence, profoundly impacts both the affected women and their partners. However, the experiences of these partners have been under-researched. Using Braun and Clarke’s thematic analysis, this qualitative study explored the experiences of male partners of women with vulvodynia. In individual interviews with seven men (20–32 years), four themes were identified: “Trying to be a good and caring partner,” “Fear of sexual and emotional rejection,” “Feelings of insecurity and being misled,” and “Keeping up the façade.” Despite efforts to support their partners, the men often faced rejection, leading to insecurities about their attractiveness, the relationship’s future, and their ability to conform to social expectations. They coped by concealing insecurities from their partners and overemphasizing traditional masculinity among peers. We discuss these results using sexual script theory, suggesting that gendered sexual scripts play a significant role in relationships with vulvodynia, with prevailing cultural assumptions regarding masculinity challenging men’s ability to be simultaneously caring and sexual. As a result, the men found themselves negotiating two contrasting ideals associated with masculine behavior: those of good caregiver and assertive, virile sexual partner. Our research suggests that male partners of women with vulvodynia tend to be left alone to deal with the resulting ambivalence and distress. Supporting these men could benefit both parties in managing vulvodynia. [ABSTRACT FROM AUTHOR]