Abstract
Objective: The pathophysiology of vulvadynia is still unclear. We evaluated the general innervations of the nerves, the sensory neuropeptides in the vestibular area in eighteen women with vulvadynia, aged 20-38. The same individual acted as her own control and biopsies were taken from affected and none affected areas of posterior wall of the vulval vestibule. Quantitative immunohistochemistry was performed, using antisera to the general neuronal marker protein gene product (PGP) 9.5 and to the sensory neuropeptides substance P and calcitonin gene-related peptide (CGRP). Pain and stress assessments were made. Results: The number of PGP 9.5 immunoreactive in the affected areas showed an increase in number (p=0.06) compared to control sites (p=0.40), but the result did not reached to significance. High scores for pain sensation, signs of burnout, emotional and physical symptoms of stress and anxiety were indicated, regardless of time in all women. Conclusions: An increase in PGP 9.5 immunoreactive nerve fibers may be either secondary to nerve sprouting, or may represent neural hyperplasia, which could be applied as an objective diagnostic finding in vulvadynia. Further studies needed for the neuromediator’s roll and inter individual factors for the diagnosis. Vulvodynia seem lead to chronic pain, hence having negative impact on the couple's relationship and the quality of life of women in several ways.
Highlights
Vulvodynia is a heterogeneous, multisystemic and multi-factorial disease in women of fertile age
An increase in protein gene product (PGP) 9.5 immunoreactive nerve fibers may be either secondary to nerve sprouting, or may represent neural hyperplasia, which could be applied as an objective diagnostic finding in vulvadynia
Vulvodynia seem lead to chronic pain, having negative impact on the couple's relationship and the quality of life of women in several ways
Summary
Vulvodynia is a heterogeneous, multisystemic and multi-factorial disease in women of fertile age It is characterized by the sudden onset of a painful burning sensation, hyperalgesia, mechanical allodynia localized to the region of the vulval vestibulus [1,2,3,4]. Sensory cutaneous nerve fibers as well as epidermal and dermal immune cells are capable of producing neuromediators in the skin, which can activate specific receptors on target cells and modulate physiological and pathophysiological effects. In addition these neuromediators have been found to activate a number of cutaneous cells via a signaling cascade
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