Beyond vulvodynia: from a correct diagnosis to a multidisciplinary care program. A referral center experience

Background Vulvodynia is a chronic pain condition without an identifiable cause. As such, it is a diagnosis of exclusion, and all other causes of vulvar pain should be excluded. Although a standard treatment for vulvodynia has not been established yet, multidisciplinary care programs appear to be effective. Puropose The aim of this retrospective monocentric study was to analyze the prevalence of vulvodynia among women referred to our institution for a suspected diagnosis and to evaluate the efficacy of a multidimensional treatment plan. The primary outcome was the prevalence of vulvodynia following differential diagnosis. Secondary outcomes included: prevalence of the differential diagnoses, symptom resolution rate following treatment, and the relation between persistence of symptoms and (a) patients’ age; (b) coexisting chronic overlapping pain conditions (COPCs).

After having ruled out all other causes of vulvar pain, only 40.1% of women were considered as affected by vulvodynia. The most frequent differential diagnoses included lower genital tract infections (25.3%), vulvar lichen sclerosus (17.6%) and vulvovaginal atrophy (8.2%). Following a multidisciplinary care program, resolution of symptoms was observed in 13.6% cases, improvement in 64.3% and persistence in 21.9%. We did not find a statistically significant association between persistence of symptoms and age > 38 years (OR 2.10; p = 0.30). Women with one or more COPCs other than vulvodynia had a 75% increased risk of not obtaining a resolution of symptoms (OR 1.75; p = 0.44).

A thorough differential diagnosis and a multidisciplinary care program may represent a first way out of the muddle in the management of these patients. Similar content being viewed by others

Corsini-Munt S, Rancourt KM, Dubé JP, Rossi MA, Rosen NO (2017) Vulvodynia: a consideration of clinical and methodological research challenges and recommended solutions. J Pain Res 10. https://doi.org/10.2147/JPR.S126259 Bornstein J, Goldstein AT, Stockdale CK, Bergeron S, Pukall C, Zolnoun D et al (2015) ISSVD, ISSWSH and IPPS consensus terminology and classification of persistent vulvar pain and vulvodynia. Obstet Gynecol 2016:127. https://doi.org/10.1097/AOG.0000000000001359 Bergeron S, Reed BD, Wesselmann U, Bohm-Starke N (2020) Vulvodynia. Nat Rev Dis Primers 6. https://doi.org/10.1038/s41572-020-0164-2 Torres-Cueco R, Nohales-Alfonso F (2021) Vulvodynia—it is time to accept a new understanding from a neurobiological perspective. Int J Environ Res Public Health 18. https://doi.org/10.3390/ijerph18126639 Brotto LA, Yong P, Smith KB, Sadownik LA (2015) Impact of a multidisciplinary vulvodynia program on sexual functioning and Dyspareunia. J Sexual Med 12. https://doi.org/10.1111/jsm.12718 Bohm-Starke N, Ramsay KW, Lytsy P, Nordgren B, Sjöberg I, Moberg K, et al (2022) Treatment of provoked vulvodynia: a systematic review. J Sexual Med 19. https://doi.org/10.1016/j.jsxm.2022.02.008 Santangelo G, Ruggiero G, Murina F, Di Donato V, Perniola G, Palaia I, et al (2023) Vulvodynia: a practical guide in treatment strategies. Int J Gynecol Obstet 163. https://doi.org/10.1002/ijgo.14815 Barnabei VM (2020) Vulvodynia. Clin Obstet Gynecol Bautrant E, Porta O, Murina F, Mühlrad H, Levêque C, Riant T, et al (2019) Provoked vulvar vestibulodynia: epidemiology in Europe, physio-pathology, consensus for first-line treatment and evaluation of second-line treatments. J Gynecol Obstet Hum Reprod 48. https://doi.org/10.1016/j.jogoh.2019.04.011 Cervigni M, Nasta L, Schievano C, Lampropoulou N, Ostardo E (2019) Micronized palmitoylethanolamide-polydatin reduces the painful symptomatology in patients with interstitial cystitis/bladder pain syndrome. Biomed Res Int 2019. https://doi.org/10.1155/2019/9828397 Pendharkar S, Skafte-Holm A, Simsek G, Haahr T (2023) Lactobacilli and their probiotic effects in the vagina of reproductive age women. Microorganisms 11. https://doi.org/10.3390/microorganisms11030636 Backman H, Widenbrant M, Bohm-Starke N, Dahlöf LG (2008) Combined physical and psychosexual therapy for provoked vestibulodynia – an evaluation of a multidisciplinary treatment model. J Sex Res 45. https://doi.org/10.1080/00224490802398365 Centers for Disease Control and Prevention (2006) Expedited partner therapy in the management of sexually transmitted diseases. US Department of Health and Human Services Vieira-Baptista Pedro, Stockdale Colleen K., Sobel Jack (2023) Recommendations for the diagnosis and treatment of vaginitis. Int Soc Study Vulvovaginal Dis Cetera GE, Merli CEM, Facchin F, Barbara G, Caia C, Libutti G, et al (2023) “Time is on my side”. Disease trajectory of vulvodynia: a systematic review with a narrative synthesis. Arch Gynecol Obstet. https://doi.org/10.1007/s00404-023-06984-z Smith KB, Sadownik LA, Dargie E, Albert AYK, Brotto LA (2019) Multidisciplinary treatment for provoked vestibulodynia: treatment trajectories, predictors, and moderators of sexual distress and pain. Clin J Pain 35 As-Sanie S, Black R, Giudice LC, Gray Valbrun T, Gupta J, Jones B, et al (2019) Assessing research gaps and unmet needs in endometriosis. Am J Obstet Gynecol 221. https://doi.org/10.1016/j.ajog.2019.02.033 Orr NL, Huang AJ, Liu YD, Noga H, Bedaiwy MA, Williams C, et al (2023) Association of central sensitization inventory scores with pain outcomes after endometriosis surgery. JAMA Netw Open 6. https://doi.org/10.1001/jamanetworkopen.2023.0780 Raimondo D, Raffone A, Renzulli F, Sanna G, Raspollini A, Bertoldo L et al (2023) Prevalence and risk factors of central sensitization in women with endometriosis. J Minim Invasive Gynecol 30:73-80.e1. https://doi.org/10.1016/j.jmig.2022.10.007 Akeda K, Yamada J, Takegami N, Fujiwara T, Murata K, Kono T et al (2023) Central sensitization as a predictive factor for the surgical outcome in patients with lumbar spinal stenosis: a multicenter prospective study. Eur Spine J. https://doi.org/10.1007/s00586-023-07687-4

The authors are grateful to Mirella Di Martino for her incomparable contribution to the study by treating with physical therapy the patients included in the study. Funding This study was not founded. Author information Authors and Affiliations Contributions Veronica Boero and Giulia Emily Cetera: project development, conceptualization, methodology, investigation, writing—original draft, writing—review and editing. Carlotta Caia: formal analysis, data curation, writing—review and editing. Camilla Erminia Maria Merli, Elisa Pesce and Giada Gramegna: data curation and editing. Giussy Barbara: review and editing. Ermelinda Monti: conceptualization, review. Paolo Vercellini: methodology, review and editing. Corresponding author Ethics declarations Competing interests The authors declare no financial or non-financial conflicts of interest. Ethics approval Local Institutional Review Board approval was obtained (#154_2023, Comitato etico Milano 2). Consent to participate Not applicable. Consent to participation Not applicable. Availability of data and materials On request. Code availability Not applicable. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Boero, V., Cetera, G.E., Caia, C. et al. Beyond vulvodynia: from a correct diagnosis to a multidisciplinary care program. A referral center experience. Arch Gynecol Obstet 310, 1189–1195 (2024). https://doi.org/10.1007/s00404-024-07496-0 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-024-07496-0