A Conceptual Model for the Pathophysiology of Vulvar Vestibulitis Syndrome

Division of Advanced Laparoscopy and Pelvic Pain, Department of Obstetrics and Gynecology, and Center for Women's Health Research, University of North Carolina, Chapel Hill, North Carolina 27599-7570, USA.
Obstetrical and Gynecological Survey (Impact Factor: 1.86). 06/2006; 61(6):395-401; quiz 423. DOI: 10.1097/01.ogx.0000219814.40759.38
Source: PubMed


Vulvar vestibulitis syndrome (vestibulitis), the most common type of chronic vulvovaginal pain, impairs the psychologic, physical, and reproductive health of approximately 10% of women at some point in their lives. Research on the pathophysiology of vestibulitis suggests abnormalities in 3 interdependent systems: vestibular mucosa, pelvic floor muscles, and central nervous system pain regulatory pathways. To date, causes and relative contributions of these abnormalities to the development and maintenance of vestibulitis remain poorly understood. Research consistently supports the conceptualization of vestibulitis as a chronic pain disorderg-akin to fibromyalgia, irritable bowel disorder, and temporomandibular disorder (TMD)-that is far more complex than vestibular hypersensitivity alone. Nevertheless, the clinical diagnosis of vestibulitis continues to rely on subjective report of pain during intercourse and vestibular sensitivity on clinical examination after exclusion of other gynecologic disorders. We propose that current diagnostic criteria, which are based on highly subjective patient and clinician measures, are not sufficient to describe and properly classify the heterogeneous clinical presentations of this disorder. To inform clinical care or research, we must be able to objectively characterize women with vestibulitis. This narrative review critically appraises current conceptualization of vestibulitis and presents a context for studying vestibulitis as a chronic pain disorder, emphasizing the need for objective assessment of clinical features.

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Available from: Katherine Eubanks Hartmann, Feb 11, 2014
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    • "Women with vulvodynia commonly have hypertonus of the pelvic floor muscles, decreased contractile strength and MTrPs that may arise from habitual " tensing " or " clenching " as a defensive reaction toward the pain of penetrative attempts[12••, 13, 14]. High tone pelvic floor dysfunction has been postulated to activate vulvar mucosal sensitivity, setting up a vicious cycle of pain and further muscle dysfunction[15]. Symptoms attributed to muscular dysfunction extend beyond pain and often add to the confusion of a therapeutic target. "
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    • "Moreover, women who experience significant psychologic distress are less likely to respond to treatment [4] [14] [15]. Certain psychologic characteristics may precede or be affected by persistent pain [1] [6] [16]. When psychologic distress is measured at 1 point in time (e.g. "
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    ABSTRACT: To examine long-term reports of pain and psychologic correlates of pain in women after vestibulectomy. In a retrospective cross-sectional exploratory study, 37 women who had undergone vestibulectomy between January 1989 and January 2008 completed questionnaires assessing demographic information, self-reported levels of pain, anxiety, somatization, psychologic distress, and sexual function. Eight women reported being completely pain free after surgery. The remaining 29 women reported various levels of pain during intercourse (as measured by the Gracely pain scale) and decreased sexual function (as measured by a sexual functioning questionnaire). Various measures of psychologic distress were associated with average intercourse-related pain, including brief symptom inventory (P=0.002), Pennebaker inventory of limbic languidness (P=0.002), perceived stress scale (P=0.04), and Spielberger trait-anxiety inventory (P=0.01). These same measures of psychological distress were similarly associated with general, unprovoked vaginal pain. The present data suggest that the pathophysiology of localized vulvodynia may be more complex in some women, leading to a suboptimal response to surgical treatment.
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    • "It has been hypothesized that genital pain and inflammation may provoke PFM dysfunctions by (1) destabilizing the PFM, inducing tensions and poor muscle control [20]; (2) triggering a defensive-like reaction toward pain during penetration attempts [33] [34]; (3) intruding the underlying muscle tissues and causing hypersensitivity in the PFM [39]. Others have suggested that PFM dysfunctions may initiate an increase in mucosal sensitivity [40]. It is likely that a vicious cycle involving pain and further muscle dysfunctions is implicated, potentially compounded by the involvement of cognitive, affective, and behavioural factors. "

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