Vulvar pain affecting the vestibule (vestibulodynia) is an enigmatic pain disorder
that greatly affects quality of life and sexual functioning. The most common form
of the disorder (localized provoked vulvodynia) is initiated by genital contact but
is otherwise asymptomatic. Findings on examination are limited to excessive tenderness
of the vestibule with light touch with cotton swab but may also include localized
erythema and pelvic floor muscle tightness and tenderness. This review will summarize
the literature regarding the role of inflammation in the genesis of the disorder.
Some evidence exists for altered histology consisting of increased numbers of mast
cells and nerve endings. Immunological abnormalities that have been reported include
altered cytokines and neurokines. Abnormal inflammatory response and heightened sensitivity
of the vaginal opening has been documented in a murine model of vaginal infection
with Candida albicans. In vitro studies of fibroblasts from the vestibule of affected women with vestibulodynia
demonstrate a proinflammatory response to C albicans that may be important in the initiation of pain. However, thus far none of the findings
have led to adequate treatments.
Keywords
vulvodynia - localized provoked vulvodynia - vestibulodynia - inflammation
