Vulvodynia . Howard A. Shaw, M.D. Chairman/Director Department of Obstetrics and Gynecology St. Francis Hospital and Medical Center Hartford, CT. Redneck Jacuzzi. Early Descriptions: Hyperaesthesia of the Vulva. 1880
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Howard A. Shaw, M.D.
Department of Obstetrics and Gynecology
St. Francis Hospital and Medical Center
“…excessive sensibility of the nerves supplying the mucous membrane of some portion of the vulva; sometimes…confined to the vestibule…other times to one labium minus…”
Thomas, T.G., Practical Treatise on the Diseases of Women,
Henry C. Lea’s Son & Co., Philadelphia, 1880, pp. 145-147.
“This disease…is characterized by a supersensitiveness of the vulva…No redness or other external manifestation of the disease is visible…When…the examining finger comes in contact with the hyperaesthetic part, the patient complains of pain, which is sometimes so great as to cause her to cry out…Sexual intercourse is equally painful, and becomes in aggravated cases impossible.”
Skene, A.J.C., Diseases of the external organs of generation,
In: Treatise on the Diseases of Women, New York, D. Appleton and Co., 1888, 77-99.
International Society for the Study of
Vulvovaginal Disease (ISSVD)
1983 World Congress
Young, A.W., Azoury, R.S., McKay, M., Pincus, S., Ridley, C.M. and Zerner, J., Burning vulva syndrome: report of ISSVD task force, Journal of Reproductive Medicine 29 (1984) 457.
Subtypes of Vulvodynia:
also known as:
also known as:
Harlow, B.L., Wise, L.A.and Stewart, E.G., Prevalence and predictors of chronic lower
genital tract discomfort, American Journal of Obstetrics and Gynecology, 185 (2001) 545-50.
Harlow, B.L., Project Title: Prevalence and Etiological Predictors of Vulvodynia,
NIH Grant Number: 1R01HD038428-01A1
Pain due to a stimulus that does not normally evoke pain
Increased response to a stimulus that IS normally painful
Symptoms can be constant or intermittent, spontaneous or evoked:
Turner, M.L.C. and Marinoff, S.C., General principles in the diagnosis and
treatment of vulvar diseases, Dermatologic Clinics, 10 (1992) 275-281.
Usually, the skin
abnormalities of lichen
simplex chronicus (aka
eczema, atopic dermatitis,
neurodermatitis) are caused
by rubbing or scratching, as
can be seen from the rubbed
and thickened skin in this
Severe lichen sclerosus
is itchy and it can be
identified by the white
color and easy bruising
and tearing when rubbed,
obviously a cause of
Occasionally, very mild
lichen sclerosus, such as
the faint white spots on
the left side of the photo,
can cause pain.
Lichen planus with
irregular white lines is
classic, and the deep red
areas are painful
Even subtle lichen
planus can hurt, as it
does in this woman who
has mild white
streakiness towards the
posterior fourchette, and
small posterior vestibular
Some topical treatments are very effective, however caution should be used in their application.
Give specific instructions for applying topical treatments for the vulva:
Also known as:
localized vulvar dysesthesia
Diagram from The Vulvodynia Survival Guide, reproduced
with permission of author, Howard I. Glazer, Ph.D.
Friedrich Jr., E.G., Vulvar vestibulitis syndrome,
Journal of Reproductive Medicine, 32 (1987) 110-114.
This patient shows minimal erythema of the left vestibule that may be normal for this patient. However, there is more obvious redness at the opening of the vestibular gland (arrow).
with frequency of intercourse
Vestibular Nerve Fiber Proliferation in Vulvar Vestibulitis Syndrome
Westrom, L.V. and Willen, R., Obstetrics and Gynecology, 91 (1998) 572-576.
Vestibular neural hyperplasia may provide a morphologic explanation of the pain in vulvar vestibulitis syndrome.
Increased Intraepithelial Innervation in Women with Vulvar Vestibulitis Syndrome
Bohm-Starke, N., Hilliges, M., Falconer, C. and Rylander E.,
Gynecologic and Obstetric Investigation, 46 (1998) 256-260.
Nerve supply in the vestibular mucosa in women with VVS and those free of symptoms were studied by PGP 9.5 immunohistochemistry. There was a significant increase in the number of intraepithelial nerve endings in women with VVS indicating an alteration in the nerve supply.
Elevated Tissue Levels of Interleukin-1β and Tumor Necrosis Factor-α in Vulvar Vestibulitis
Foster, D.C. and Hasday, J.D., Obstetrics and Gynecology, 89 (1997) 291-6.
Concentrations of IL-1β and TNF-α were elevated in women with vulvar vestibulitis relative to those in asymptomatic controls. This elevation varied according to anatomic site. Inflammatory cytokine elevation may contribute to the pathophysiology of mucocutaneous hyperalgesia.
Interleukin-1 Receptor Antagonist Gene Polymorphism in Women with Vulvar Vestibulitis
Jeremias, J., Ledger, W.J. and Witkin, S.S., American
Journal of Obstetrics and Gynecology. 182 (2000) 283-5.
Polymorphisms in the gene coding for the interleukin-1 receptor antagonist, a naturally occurring down-regulator of proinflammatory immune response, were studied. The unique distribution of interleukin-1 receptor antagonist alleles among women with VVS suggests that polymorphism in this gene may be a factor influencing susceptibility to this syndrome, severity of symptoms, or both.
Also known as:
generalized vulvar dysesthesia
(as well as other vulvar disorders)
www.nva.org or 301-299-0775
www.issvd.org or 704-814-9493
by Elizabeth Gunter Stewart, MD and Paula Spencer
by Howard I. Glazer, Ph.D. and Gae Rodke, M.D.