Tag Archives: Vulvodynia Treatment

Vulvodynia, burning, labia rawness, inflammation

Vulvodynia . . . unexplained pain of the labia, vulva is a complex disorder characterized by ongoing burning, stinging, irritation and/or rawness. Vulvar vestibulitis is a medical term for redness, inflammation, pain/sensitivity specific to the vaginal opening.

Vulvodynia is a multifactorial chronic pain disorder. Although the condition is common, it is poorly understood, so many girls/women remain un-diagnosed, un-treated or under-treated.

The following articles/medical abstracts provide new insight into vulvodynia; for example the interplay between allergies and chronic pain in vulvodynia, and the link between bacteria/yeast in vulvodynia symptoms. The articles may have unfamiliar medical terminology but the content validates the complex causes and symptoms of vulvodynia.

Helpful Definitions about Vulvar Symptoms
● Hyperalgesia abnormally heightened sensitivity to pain
● Vulvar allodynia painful hypersensitivity to touch
● Hypersensitivity the body responds to a particular substance (called allergens) in an exaggerated fashion, where it does not happen in normal circumstances.
● Hyperinnervation excitation/nerve stimulation of an organ muscle or gland (there are lots of glands around vulva)

J Clin Med Res. 2011 April; 3(2): 59–64.
Measuring Treatment Outcomes in Women With Vulvodynia
Gary Ventolini MD

This is a few paragraphs from Gary Ventolini MD
My opinion, shared by a number of authors, includes the hypothesis that vulvodynia is a pathological alteration at the vaginal vestibule and the vulvovaginal milieu involving the mucosa, subcutaneous tissue, accessory sexual glands with their related circulatory and nervous system.

This alteration is probably due to an insult, inflammation or infection and it is sustained by biological and chemical changes with consequent dysfunction of the vaginal vestibule, Bartholin, and Skene glands secreting function. These changes may be initiated by an insult or preceding infection or inflammation by bacteria, fungi, or virus that results in hypersensitivity leading to pelvic floor muscle dysfunction and recurrent pain

Vulvodynia may have an immune and genetic predisposition component leading to impaired neurological modulation of sensory C-afferent nociceptive processing and pathophysiologically distorted biochemical, immunological and behavioral responses to pain. There may be a potential role of psychosocial factors involved as it is the case like in other chronic pain conditions.

 

PLoS One. 2013 Oct 25
Contact hypersensitivity to oxazolone provokes vulvar mechanical hyperalgesia in mice.
Martinov T, Glenn-Finer R, Burley S, Tonc E, Balsells E, Ashbaugh A, Swanson L, Daughters RS, Chatterjea D.

Abstract
The interplay among pain, allergy and dysregulated inflammation promises to yield significant conceptual advances in immunology and chronic pain. Hapten-mediated contact hypersensitivity reactions are used to model skin allergies in rodents but have not been utilized to study associated changes in pain perception in the affected skin. Here we characterized changes in mechanical hyperalgesia in oxazolone-sensitized female mice challenged with single and repeated labiar skin exposure to oxazolone. Female mice were sensitized with topical oxazolone on their flanks and challenged 1-3 times on the labia.

We then measured mechanical sensitivity of the vulvar region with an electronic pressure meter and evaluated expression of inflammatory genes, leukocyte influx and levels of innervation in the labiar tissue. Oxazolone-sensitized mice developed vulvar mechanical hyperalgesia after a single labiar oxazolone challenge. Hyperalgesia lasted up to 24 hours along with local influx of neutrophils, upregulation of inflammatory cytokine gene expression, and increased density of cutaneous labiar nerve fibers. Three daily oxazolone challenges produced vulvar mechanical hyperalgesic responses and increases in nerve density that were detectable up to 5 days post-challenge even after overt inflammation resolved. This persistent vulvar hyperalgesia is resonant with vulvodynia, an understudied chronic pain condition that is remarkably prevalent in 18-60 year-old women. An elevated risk for vulvodynia has been associated with a history of environmental allergies. Our pre-clinical model can be readily adapted to regimens of chronic exposures and long-term assessment of vulvar pain with and without concurrent inflammation to improve our understanding of mechanisms underlying subsets of vulvodynia and to develop new therapeutics for this condition.

 

Sci Transl Med. 2011 Sep 21
Repeated vulvovaginal fungal infections cause persistent pain in a mouse model of vulvodynia.
Farmer MA, Taylor AM, Bailey AL, Tuttle AH, MacIntyre LC, Milagrosa ZE, Crissman HP, Bennett GJ, Ribeiro-da-Silva A, Binik YM, Mogil JS.

Abstract
Provoked vestibulodynia, the most common form of vulvodynia (unexplained pain of the vulva), is a prevalent, idiopathic pain disorder associated with a history of recurrent candidiasis (yeast infections). It is characterized by vulvar allodynia (painful hypersensitivity to touch) and hyperinnervation. We tested whether repeated, localized exposure of the vulva to a common fungal pathogen can lead to the development of chronic pain.

A subset of female mice subjected to recurrent Candida albicans infection developed mechanical allodynia localized to the vulva. The mice with allodynia also exhibited hyperinnervation with peptidergic nociceptor and sympathetic fibers (as indicated by increased protein gene product 9.5, calcitonin gene-related peptide, and vesicular monoamine transporter 2 immunoreactivity in the vaginal epithelium). Long-lasting behavioral allodynia in a subset of mice was also observed after a single, extended Candida infection, as well as after repeated vulvar (but not hind paw) inflammation induced with zymosan, a mixture of fungal antigens.

The hypersensitivity and hyperinnervation were both present at least 3 weeks after the resolution of infection and inflammation. Our data show that infection can cause persistent pain long after its resolution and that recurrent yeast infection replicates important features of human provoked vulvodynia in the mouse.

 

Dermatol Clin. 2010 Oct;28
Vulvodynia: new concepts and review of the literature.
Groysman V.

Abstract
Vulvodynia is a multifactorial chronic pain disorder that is distressing to the patient and exigent (difficult) to the physician. Although the condition is common, it remains little understood, so patients remain un-diagnosed and un-treated or under treated for many years. Although multiple therapies exist in the treatment of vulvodynia, few randomized controlled clinical trials have been performed. Thus, treatment should be individualized and tailored to a patient’s diagnosis, symptoms, and psychosexual functioning. Patient education is also important and is facilitated by patient brochures providing assurance that vulvodynia is a real disease.

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