Vulvar Pain and Vulvodynia
Vulvar pain is an enigma. Its etiology, pathophysiology, and treatment have not yet been elucidated. The most perplexing presentation is pain during intercourse, sometimes prevents the possibility to have intercourse. Around the enigma of vulvar pain, myt
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Jacob Bornstein
54.1 Introduction Vulvar pain is an enigma. Its etiology, pathophysiology, and treatment have not yet been elucidated. The most perplexing presentation is pain during intercourse, sometimes prevents the possibility to have intercourse. Around the enigma of vulvar pain, myths about its causes and treatments emerged. Most of these treatment myths have not been proven to be effective. Consequently, they also lead to unnecessary treatments and despair on the side of the patients. In 2015, an evidence-based consensus terminology has been introduced by the scientific organizations dealing with vulvar disease (“2015 terminology”) [1], giving clear definition and understanding of vulvar pain. Consequently, a new paradigm to the treatment of vulvar pain can now be formed [2], making it an etiology-based.
Electronic Supplementary Material The online version of this chapter (doi:10.1007/978-3-319-61621-6_54) contains supplementary material, which is available to authorized users. J. Bornstein (*) Department of Obstetrics and Gynecology Galilee Medical Center, Bar-Ilan University Faculty of Medicine, Nahariya, Israel
54.2 “Vulvar Pain,” “Vulvodynia,” or “Dyspareunia”? Why are we talking about “vulvar pain,” although the most common and disturbing presenting symptom is introital pain during intercourse, i.e., superficial dyspareunia? Dyspareunia is one of the most common complaints associated with sexual dysfunction. There are several reasons to that. One is the attempt of the ISSVD to broaden the terminology so that it involves pain in general and not only pain during intercourse. An additional reason is to move away from the limited psycho-sexual connotation of “dyspareunia” that prevailed years ago. Here again, the significance of the 2015 consensus terminology of “persistent vulvar pain and vulvodynia” [1] is depicted (Table 54.1). That terminology has been created by three international societies: the ISSVD, the International Society for The Study of Women’s Sexual Health (ISSWSH), and the International Pelvic Pain Society (IPPS). The 2015 terminology divides “persistent vulvar pain” into two categories: vulvar pain that its cause is known (e.g., inflammatory, neoplastic, traumatic, infection-related, neurologic, traumatic, iatrogenic, and hormonal) and “vulvodynia.”. The new definition of vulvodynia is “vulvar pain of at least three months’ duration, without clear identifiable cause, which may have potential associated factors.” The 2015 terminology further characterizes vulvodynia based on location (vestibulodynia, cliterodynia, generalized, mixed), provocation (upon contact
© Springer International Publishing AG, part of Springer Nature 2019 J. Bornstein (ed.), Vulvar Disease, https://doi.org/10.1007/978-3-319-61621-6_54
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J. Bornstein
344 Table 54.1 2015 Consensus terminology and classification of persistent vulvar pain and vulvodynia
Table 54.2 2015 Consensus terminology and classification of persistent vulvar pain and vulvodynia
A. Vulvar pain caused by a specific disordera • I
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