Vulval Pain Syndrome: Vulvodynia

Vular pain syndrome - Vulvodynia

Editors: Jane Meijlink, Jenniffer Voelkl Guevara

Last Updated: June 2018

Current ICS definition (1)

Female genital pain is defined as pain perceived in the pelvis, pelvic organs, the vagina and/or the female external genitals (2,3) • Vagina (Vulva, Vestibule, and Clitoris) o Pain in the vagina or the external genital organs (vulva, which includes the labia, clitoris and entrance to the vagina) (2) • Generalized vulvar pain syndrome (4) o Diffuse vulvar pain perceived to be in the vestibule or beyond. o Dyspareunia. o Provocation of pain with touch, pressure or friction (3,5) • Localized vulvar pain syndrome: Pain is usually provoked with touch, pressure, or friction; example: tight clothing, bicycle riding, tampon use, sexual activity (4) o Vestibular pain syndrome: Pain localized to one or more portions of the vulvar vestibule (3,5)

History

Derived from Standardisation of Terminology of LUT function (6) • Vulval pain is felt in and around the external genitalia. • Vulval pain syndrome is the occurrence of persistent or recurrent episodic vulval pain, which is either related to the micturition cycle or associated with symptoms suggestive of urinary tract or sexual dysfunction. There is no proven infection or other obvious pathology. (The ICS suggests that the term vulvodynia (vulva – pain) should not be used, as it leads to confusion between single symptom and a syndrome). Derived from Haylen et al (2010) (7) • Vulval pain: Complaint of pain felt in and around the vulva (6)

Other definitions

1983: Vulvodynia was defined by the International Society for the Study of Vulvar Disease (ISSVD) as chronic vulvar discomfort, especially characterized by the patient´s complaint of burning, stinging, irritation and/or rawness (3)

1987: Friedrich reported 86 patients with consistent vulvar signs and symptoms and subsequently introduced the term “vulvar vestibulitis syndrome” as the standard term and description for this disorder (8)

2015: The Consensus terminology and classification of persistent vulvar pain from the from the International Society for the Study of Vulvovaginal Disease (ISSVD), the International Society for the Study of Women's Sexual Health (ISSWSH), and the International Pelvic Pain Society (IPPS) defined and classified vulvar pain as: “Vulvar pain of at least 3 months duration, without clear identifiable cause, which may have potential associated factors Localized (e.g. vestibulodynia, clitorodynia) or Generalized or Mixed (Localized and Generalized)” (3).

Descriptors: • Provoked (e.g. insertional, contact) or Spontaneous or Mixed (Provoked and • Spontaneous) • Onset (primary or secondary) • Temporal pattern (intermittent, persistent, constant, immediate, delayed)

Controversy

Despite the introduction of the term vulval pain (syndrome) some years ago, both professional and patient organisations continue to use the traditional term vulvodynia even though it is not recommended by the latest ICS Standardization of terms.

References:

  1. Doggweiler R, Whitmore KE, Meijlink JM, Drake MJ, Frawley H, Nordling J, et al. A standard for terminology in chronic pelvic pain syndromes: A report from the chronic pelvic pain working group of the international continence society. Neurourol Urodyn [Internet]. 2016 Aug 26 [cited 2016 Oct 16]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/27564065
  2. Engeler DS, Baranowski AP, Dinis-Oliveira P, et al. The 2013 EAU guidelines on chronic pelvic pain: Is management of chronic pelvic pain a habit, a philosophy, or a science? 10 years of development. Eur Urol 2013;64:431–9.
  3. Bornstein J,Goldstein A, CoadyD. 2015 consensus terminology andclassification of persistent vulvarpain. 2015.Available from http://www.issvd.org/resources/terminology
  4. Merskey H, Bogduk N, International Association for the Study of Pain. Task force on taxonomy. Classification of chronic pain: Descriptions of chronic pain syndromes and definitions of pain terms. 2nd ed. Seattle: IASP Press; 1994.
  5. Baranowski AP, Berger R, Buffington T, et al. International Association for the Study of Pain (IASP) Classification of Chronic Pain. Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms, Second Edition (Revised 2011). Cited 21/09/2014. Available from: http://www.iasppain.org/files/Content
  6. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: Report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37–49.
  7. Haylen BT, Ridder D. An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction. Neurourol Urodyn. 2009; 28(5):395–9. Neurourol. Urodynam. 29:4–20, 2010
  8. Stone-Godena T. Vulvar Pain Syndromes: Vestibulodynia. J Midwifery Women’s Heal. 2006;51(6):502–9.
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