Vulvodynia across preconception, pregnancy, and postpartum: a narrative review

Vulvodynia is a common condition affecting reproductive-aged women, with lifetime prevalence estimates ranging from 8% to 28%. However, despite its significant impact on sexual and reproductive health, evidence regarding pregnancy in women with vulvodynia remains scarce.

This review aims to synthesize the available evidence on the bidirectional relationship between vulvodynia and the reproductive continuum-including preconception, pregnancy, childbirth, and the postpartum period-examining both how these stages influence the course of vulvodynia and how vulvodynia affects sexual function, psychological well-being, and obstetric outcomes, across diverse reproductive events, as well as approaches to multidisciplinary management.

A comprehensive literature search was conducted using PubMed, the Cochrane Library, and Google Scholar, using predefined search terms.

Available evidence has not demonstrated a direct impairment of biological fertility in women with vulvodynia, although pain, anxiety, and sexual avoidance may contribute to delayed conception. Symptom evolution during pregnancy is highly variable: while some women experience improvement, others report persistent or worsening pain. Vulvodynia is associated with increased fear of childbirth, challenges with pelvic examinations, and reduced sexual function. Data on delivery outcomes are heterogeneous; although current evidence has not identified a clear contraindication to vaginal birth, some observational studies have reported higher rates of cesarean delivery, often associated with maternal anxiety or maternal request rather than documented obstetric indications. Postpartum symptom trajectories are likewise variable, with some women improving and others experiencing persistent pain, particularly after perineal trauma.

Although evidence is limited, current data highlight the need for individualized follow-up and a multidisciplinary approach for pregnant women with vulvodynia. Further research is required to establish more consistent clinical recommendations.