Vulvar vestibulodynia: strategies to meet the challenge

Vulvodynia is a condition that affects approximately 8% to 12% of women during their lifetimes. Vulvar vestibulodynia (VVD), the most common form of this condition, is characterized by pain with touch at the vulvar vestibule and resulting entryway dyspareunia. Studies suggest a multifactorial etiology; hormonal effects, muscle dysfunction, personality, psychosocial factors, and inflammatory mediators may all play some role in the development of this condition. Both peripheral and central sensitization to pain have been implicated in the development of enhanced pain experienced by women with VVD. Recommendations for the treatment of this condition exist; however, treatments of this condition have not been well studied. Few prospective placebo-controlled trials exist, and many of those that do have failed to show clinically relevant efficacy associated with traditional therapies. New studies into the etiology of this condition, as well as potential new therapies, are emerging, but the optimal approach has yet to be defined. Proper vulvar hygiene is recommended, and traditional therapies such as topical medications and centrally acting oral medications may continue to play a role in treatment. Newer studies elucidating the effects of personality and cognitive factors as well as pelvic floor muscle dysfunction in the development of this condition lend support for the inclusion of cognitive behavioral therapy and physical therapy/surface electromyographic biofeedback in the treatment regimen. Surgery for this condition exists, with success rates of 60% to 90%; however, it is recommended only in cases that have failed to respond to traditional therapy.