Vulvodynia as a somatoform disorder

Chronic vulvar pain can occur either as a result of a recognizable, underlying vulvar disorder or as an idiopathic process known as vulvodynia. It is widely recognized that most patients with vulvodynia have some degree of associated psychosexual distress. Most clinicians currently believe that the long-term presence of pain, arising as a local process involving either the innervation of the vulva or a low-grade inflammatory process of vulvar tissue, is sufficient to explain the development of secondary psychosexual problems. This explanation may be termed the neuropathic hypothesis. Alternatively, a minority of clinicians believes that the reverse is true and that vulvodynia develops as a result of pre-existing psychosexual dysfunction which, due to various precipitating factors, is subsequently expressed as chronic vulvar pain. This explanation may be termed the somatoform hypothesis. This review summarizes the evidence supporting the somatoform hypothesis and concludes that psychosocial factors may be the primary factor responsible for chronic "idiopathic" anogenital pain in both men and women. Moreover, since current treatment for vulvodynia is controversial and only partially effective, the therapeutic implications of a somatoform etiology are of considerable importance.