Vulvodynia as a pain syndrome associated with the pelvic floor muscles dysfunction
More details
Hide details
Oddział Kliniczny Chorób Wewnętrznych, Angiologii i Medycyny Fizykalnej Katedry Chorób Wewnętrznych Wydziału Lekarskiego z Oddziałem Lekarsko-Dentystycznym w Zabrzu Śląskiego Uniwersytetu Medycznego w Katowicach oraz Ośrodek Diagnostyki i Terapii Laserowej
Instytut Wychowania Fizycznego i Turystyki Akademii im. Jana Długosza w Częstochowie
Gabinety Terpa w Lublinie
Jarosław Pasek   

Oddział Kliniczny Chorób Wewnętrznych, Angiologii i Medycyny Fizykalnej Katedry Chorób Wewnętrznych Wydziału Lekarskiego z Oddziałem Lekarsko-Dentystycznym w Zabrzu Śląskiego Uniwersytetu Medycznego w Katowicach oraz Ośrodek Diagnostyki i Terapii Laserowej, ul. Batorego 15, 41-902 Bytom, tel. +48 505 014 331
Ann. Acad. Med. Siles. 2015;69:49–53
Vulvodynia is a chronic pain syndrome occurring in 5–13% of women. It persists at least 3–6 months. The symptoms may affect the vulva, vagina, anus and even the buttocks, of different intensification and location. The pain can also be continuous or intermittent, poorly localized by the patient (unprovoked vulvodynia), can occur in response to touching (provoked vulvodynia) and may be associated with sexual activity (dyspareunia). Vulvodynia is a rarely diagnosed condition because of the low knowledge of health care providers, unexplained etiology and the difficulties in distinguishing it from other vulvovaginal pathologies. There are many factors producing vulvar symptoms, but in 80% of vulvodynia women, pelvic floor muscle instability or hyperactivity are found primarily or secondarily (Overactive Pelvic Floor Muscle Dysfunction). These are two potential mechanisms of sensitization and pain caused by pelvic floor muscle overactivity: hypoxia and trigger points in muscle, fascia and ligament tissue. The exclusion of vulvovaginal diseases (e.g. sexually transmitted diseses), dermatological, neurological disorders, orthopedic and rheumatologic or oncologic conditions, even allergic reactions, is crucial for diagnosis because vulvodynia is diagnosed from exclusion. In this work the etiology, classification and the most common vulvodynia method treatment were introduced.
Mandal D. Guidelines for the management of vulvodynia. Br. J. Dermatol. 2010; 162: 1180–1185.
Słobodzian J. Sposoby diagnozowania przyczyn oraz leczenie bólów krocza i spojenia łonowego. Przegląd literatury, wnioski z własnej praktyki terapeutycznej. Doniesienia własne. Terapia Manualna w Modelu Holistycznym 2001; 1: 38–46.
Haefner H.K. Report of the International Society for the Study of Vulvovaginal Disease terminology and classification of vulvodynia. J. Low. Genit. Tract Dis. 2007; 11: 48–49.
Fall M., Baranowski A.P., Elneil S. EAU guidelines on chronic pelvic pain. Eur. Urol. 2010; 57: 35–48.
Bornstein J., Zarfati D., Goldik Z. Vulvar vestibulitis: physical or psychosexual problem? Obstet. Gyneacol. 1999; 93: 876–880.
Nickel J.C., Shoskes D. Phenotypic approach to the management of the chronic prostatitis/chronic pelvic pain syndrome. BJU Int. 2010; 106: 1252–1263.
Lundqvist E.N., Hofer P.A., Olofsson J.I. Is vulvar vestibulitis an inflammatory condition? A comparison of histological findings in affected and healthy women. Acta. Derm. Venereol. 1997; 77: 319–322.
White G., Jantos M., Glazer H. Establishing the diagnosis of vulvar vestibulitis. J. Reprod. Med. 1997; 42: 157–161.
Friedrich E.G. Therapeutic studies on vulvar vestibulitis. J. Reprod. Med. 1988; 33: 514–517.
Coulson C., Crowley T. Current thoughts on psychosexual disorders in women. Obstet. Gynaecol. 2007; 9: 217–222.
Merskey H., Bogduk N. Klasyfikacja bólu przewlekłego. Wydawnictwo Rehabilitacja Medyczna, Kraków 1999.
Anothaisintawee T., Attia J., Nickel J.C. Management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and network meta-analysis. JAMA 2011; 305: 78–86.
Jantos M. Electromyography and Myofascial Therapy in Pelvic Floor Disorders. Pelvic Floor Disorders. Springer-Verlag Italia 2010.
Labat J.J., Riant T., Robert R. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol Urodyn. 2008; 27: 306–310.
Chaitow L., Lovegrove J.R. Chronic Pelvic Pain and Dysfunction, practical physical medicine. London 2009.
Thiele G.H. Coccygodynia and pain in the superior gluteal region. JAMA 2002; 109: 1271–1275.
Stewart D., Reicher A., Gerulath AH. Vulvodynia and psychological distress. Obstet Gynaecol. 1994; 84: 587–590.
Bergeron S., Binik Y.M., Khalifé S. A randomized comparison of group cognitive behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain 2001; 91: 297–306.
Murina F., Bianco V., Radici G. Transcutaneous electrical nerve stimulation to treat vestibulodynia: a randomised controlled trial. Br. J. Obstet. Gynaecol. 2008; 115: 1165–1670.
Goldfinger C., Pukall C.F., Gentilcore-Saulnier E. A prospective study of pelvic floor physical therapy: pain and psychosexual outcomes in provoked vestibulodynia. J. Sex. Med. 2009; 6: 1955–1968.
Oyama I.A., Rejba A., Lukban J.C. Modified Thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction. Urology. 2004; 64: 862–866.
Bergeron S., Brown C., Lord M.J. Physical therapy for vulvar vestibulitis syndrome: a retrospective study. J. Sex. Marital. Ther. 2002; 28: 183–192.
Glazer H.I. Treatment of vulval vestibulitis syndrome with electromyographic biofeedback of pelvic floor musculature. J. Reprod. Med. 1995; 40: 283–290.
Pasek J., Pasek T., Sieroń A. Fizjoterapia na oddziałach położniczo-ginekologicznych. Post. Rehabil. 2008; 4: 41–46.
Strauss A.C., Dimitrakov J.D. New treatments for chronic prostatitis/chronic pelvic pain syndrome. Nat. Rev. Urol. 2010; 7: 127–135.
McKay M. Dysesthetic (‘essential’) vulvodynia. Treatment with amitriptyline. J. Reprod. Med. 1993; 38: 9–13.
Ben-David B., Friedman M. Gabapentin therapy for vulvodynia. Anesth. Analg. 1999; 89: 1459–1460.
Dede M., Yenen M.C., Yilmaz A. Successful treatment of persistent vulvodynia with submucous infiltration of betamethasone and lidocaine. Eur. J. Obstet. Gynecol. Reprod. Biol. 2006; 124: 258–259.
Yoon H., Chung W.S., Shim B.S. Botulinum toxin A for the management of vulvodynia. Int. J. Impot. Res. 2007; 19: 84–87.
Petersen C.D., Giraldi A., Lundvall L. Botulinum toxin type A – a novel treatment for provoked vestibulodynia? Results from a randomized, placebo controlled, double blinded study. J. Sex. Med. 2009; 6: 2523–2537.
Powell J., Wojnarowska F. Acupuncture for vulvodynia. J. R. Soc. Med. 1999; 92: 579–581.
Sieroń A., Pasek J., Mucha R. Pole magnetyczne i energia światła w medycynie i rehabilitacji – magnetoledoterapia. Balneol. Pol. 2007; 49: 1–7.
Pasek J., Opara J., Pasek T. Znaczenie badań nad jakością życia w rehabilitacji. Fizjoterapia 2007; 15: 3–8.