Localized Provoked Vulvodynia-An Ignored Vulvar Pain Syndrome.

Jorma Paavonen,David A Eschenbach

doi:10.3389/fcimb.2021.678961

Abstract

Localized provoked vulvodynia (LPV) causes dyspareunia among reproductive aged women. We review the pathogenesis of LPV and suggest that LPV is an inflammatory pain syndrome of the vestibular mucosa triggered by microbial antigens in a susceptible host. Tissue inflammation and hyperinnervation are characteristic findings which explain symptoms and clinical signs. Education of health care providers of LPV is important since this condition is common, often unrecognized, and patients often become frustrated users of health care. Research is needed on the antigen triggers of the syndrome. Randomized clinical trials are needed to evaluate treatment modalities.

Highlights

Localized provoked vulvodynia (LPV) is defined as vulvar pain induced by touching the vulvar vestibular epithelium that has lasted a minimum of 3 months, in the absence of another recognizable vulvar disease (American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice and American Society for Colposcopy and Cervical Pathology (ASCCP), 2016; Bornstein et al, 2016)
The clinical diagnostic test is known as the Q-tip test and is performed using a simple cotton swab gently touching the vestibular epithelium (Figure 1) (American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice and American Society for Colposcopy and Cervical Pathology (ASCCP), 2016; Bornstein et al, 2016)
Case-series and case reports have demonstrated efficacy, botulinum toxin is not recommended as first-line treatment for LPV, pending more robust scientific support (Goldstein et al, 2016)

Summary

INTRODUCTION

Localized provoked vulvodynia (LPV) is defined as vulvar pain induced by touching the vulvar vestibular epithelium that has lasted a minimum of 3 months, in the absence of another recognizable vulvar disease (American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice and American Society for Colposcopy and Cervical Pathology (ASCCP), 2016; Bornstein et al, 2016). The dyspareunia associated with LPV causes sexual dysfunction, and severely impacts sexual, mental and social health. The prevalence of LPV varies between 8 and 18% in population based studies (Harlow et al, 2014). The term localized provoked vulvodynia (LPV) has been universally accepted and holds priority over the former term vulvar vestibulitis syndrome (Bornstein et al, 2016)

Localized Provoked Vulvodynia

Treatment modality

Findings

CONCLUSIONS