Vulvodynia: a modern view on the pathogenetic mechanisms of development and the principles of treatment


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Abstract

The review article covers the definition of vulvodynia, its possible causes, the pathogenetic mechanisms of development, and the specific principles of treatment. The main factors contributing to disease development are comorbidity, other pain syndromes in the history, chronic inflammation, pelvic floor muscle hypertonicity, genetic, neurological factors, and psychosocial problems. Due to the multivariate pathogenesis of vulvodynia in each patient, interdisciplinary and personalized approaches that affect the mechanism of disease development, as well as a search for new specific treatments should be considered as the principles of treatment. These methods are the application of botulinum toxin type A, platelet-rich blood plasma, hyaluronic acid, and placental preparations along with developing physiotherapy treatments.

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About the authors

Kamil’ Rafaehl’evich Bakhtiyarov

I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Email: doctorbah@mail.ru
MD, Professor, Professor of the Department of Obstetrics, Gynecology, and Perinatology of the Faculty of Medicine

Viktoriya Tofikovna Khizhnyakov

I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Email: victorya.05@mail.ru
obstetrician-gynecologist, doctor of ultrasound diagnostics

Sofiya Yuryevna Belogubova

I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Email: belogubovasofla@gmail.com
a 6th year student of the International School «Medicine of the Future» of the Faculty of Medicine

Dar’ya Andreevna Kazakova

I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia

Email: kazakova.daria@gmail.com
a 6th year student of the International School «Medicine of the Future» of the Faculty of Medicine

References

  1. Moyal-Barracco M., Lynch P. 2003 ISSVD terminology and classification vulvodynia: a historical perspective. J. Reprod. Med. 2004; 49(10): 772-7.
  2. Bornstein J., Goldstein A.T., Stockdale C.K., 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(4): 745-51. https://dx.doi.org/10.1097/A0G.0000000000001359.
  3. Harlow B.L., Stewart E.G. A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? J. Am. Med. Womens Assoc. 2003 Spring; 58(2): 82-8.
  4. Harlow B.L., Kunitz C.G., Nguyen R.H.N., Rydell S.A., Turner R.M., MacLehose R.F. Prevalence of symptoms consistent with a diagnosis of vulvodynia: population-based estimates from 2 geographic regions. Am. J. Obstet. Gynecol. 2014; 210(1): 40. e1-40. e8. https://dx.doi.org/10.1016/j. ajog.2013.09.033.
  5. Sadownik L.A., Yong PJ, Smith K.B. Systematic review of treatment outcome measures for vulvodynia. J. Low. Genit. Tract Dis. 2018; 22(3): 251-9. https:// dx.doi.org/10.1097/LGT.0000000000000406.
  6. Al-Safi Z.A., Santoro N. Menopausal hormone therapy and menopausal symptoms. Fertil. Steril. 2014; 101(4): 905-15.
  7. Hersh J.E. Vulvodynia in adolescents: presentation, diagnosis and treatment options. Curr. Opin. Obstet. Gynecol. 2018; 30(5): 293-9. https://dx.doi. org/10.1097/GCO.0000000000000480.
  8. Ponte M, Klemperer E, Sahay A., Chren M.M. Effects of vulvodynia on quality of life. J. Am. Acad. Dermatol. 2009; 60(1): 70-6. https://dx.doi.org/10.1016/j. jaad.2008.06.032.
  9. Reed B.D., Harlow S.D., Sen A., Edwards R.M., Chen D., Haejher H.K. Relationship between vulvodynia and chronic comorbid pain conditions. Obstet. Gynecol. 2012; 120(1): 145-51. https://dx.doi.org/10.1097/ AOG.0b013e31825957cf.
  10. Gardella B, Porru D, Nappi R.E., Dacco M.D., Chiesa A., Spinillo A. Interstitial cystitis is associated with vulvodynia and sexual dysfunction - a case-control study. J. Sex. Med. 2011; 8(6): 1726-34. https://dx.doi.org/10.1111/j.1743-6109.2011.02251.x.
  11. Hartmann E.H., Nelson C. The perceived effectiveness of physical therapy treatment on women complaining of chronic vulvar pain and diagnosed with either vulvar vestibulitis syndrome or dysesthetic vulvodynia. J. Sect. Womens Health. 2001; 25: 13-8.
  12. Kahn B.S., Tatro C., Parsons C.L., Willems J.J. Prevalence of interstitial cystitis in vulvodynia patients detected by bladder potassium sensitivity. J. Sex. Med. 2010;7(2):996-1002. https://dx.doi.org/10.1111/j.1743-6109.2009.01550.x.
  13. Грациоттин А., Мурина Ф. Вульводиния. Пер. с англ. Аполихина И.А., Горбунова Е.А., ред. М.: Практическая медицина; 2015.
  14. Goldstein A.T., Belkin Z.R., KrapjJ.M., Song W., Khera M., Jutrzonka S.L. et al. Polymorphisms of the androgen receptor gene and hormonal contraceptive induced provoked vestibulodynia. J. Sex. Med. 2014; 11(11): 2764-71. https:// dx.doi.org/10.1111/jsm.12668.
  15. Bohm-Starke N. Medical and physical predictors of localized provoked vulvodynia. Acta Obstet. Gynecol. Scand. 2010; 89(12): 1504-10. https://dx.doi. org/10.3109/00016349.2010.528368.
  16. Gerber S., Witkin S.S., Stucki D. Immunological and genetic characterization of women with vulvodynia. J. Med. Life. 2008; 1(4): 432-8.
  17. Tympanidis P., Casula M.A., Yiangou Y., Terenghi G., Dowd P., Anand P. Increased vanilloid receptor VR1 innervation in vulvodynia. Eur. J. Pain. 2004; 8: 129-33.
  18. Farmer M.A., Taylor A.M., Bailey A.L., Tuttle A.H., MacIntyre L.C., Milagrosa Z.E. et al. Repeated vulvovaginal fungal infections cause persistent pain in a mouse model of vulvodynia. Sci. Transl. Med. 2011; 3(101): 101ra91. https://dx.doi.org/10.1126/scitranslmed.3002613.
  19. Morin M., Binik Y.M., Bourbonnais D., Khalije S., Ouellet S., Bergeron S. Heightened pelvic floor muscle tone and altered contractility in women with provoked vestibulodynia. J. Sex. Med. 2017; 14(4): 592-600. https://dx.doi. org/10.1016/j.jsxm.2017.02.012.
  20. Haejjner H.K., Collins M.E., Davis G.D., Edwards L., Foster D.C., Hartmann E.H. et al. The vulvodynia guideline. J. Low. Genit. Tract Dis. 2005; 9: 40Y51.
  21. Stockdale C.K., Lawson H.W. 2013 vulvodynia guideline update. J. Low. Genit. Tract Dis. 2014; 18(2): 93-100. https://dx.doi.org/10.1097/ LGT.0000000000000021.
  22. De Andres J., Sanchis-Lopez N., Asensio-Samper J.M., Fabregat-Cid G., Villanueva-Perez V.L., Monsalve Dolz V. et al. Vulvodynia-an evidence-based literature review and proposed treatment algorithm. Pain Pract. 2016; 16(2): 204-36. https://dx.doi.org/10.1111/ papr.12274.
  23. Leo R.J. A systematic review of the utility of anticonvulsant pharmacotherapy in the treatment of vulvodynia pain. J. Sex. Med. 2013; 10(8): 2000-8.
  24. Jeon Y., Kim Y., Shim B., Yoon H., Park Y., Shim B. et al. A retrospective study of the management of vulvodynia. Korean J. Urol. 2013; 54(1): 48-52. https:// dx.doi.org/10.4111/kju.2013.54.1.48.
  25. Brown C.S., Bachmann G.A., Wan J., Foster D.C. Gabapentin for the treatment of vulvodynia: a randomized controlled trial. Obstet. Gynecol. 2018;131(6): 1000-7. https://dx.doi.org/10.1097/AOG.0000000000002617.
  26. Прилепская В.Н., Костава М.Н., Назарова Н.М., Фофанова И.Ю. Эффективность применения Изопринозина при лечении вульводинии, обусловленной инфекционно-воспалительными процессами. РМЖ. Мать и дитя. 2009; 17(16): 1046-8.
  27. Anbazhagan A., Roberts R. Nonurological uses of botulinum toxin in gynaecology. Obstetrician Gynaecologist. 2008; 10(2): 75-9. https://dx.doi.org/10.1576/ toag.10.2.075.27394.
  28. Abbott J.A., Jarvis S.K., Lyons S.D., Thomson A., Vancaille T.G. Botulinum toxin type a for chronic pain and pelvic floor spasm in women: a randomized controlled trial. Obstet. Gynecol. 2006; 108(4): 915-23. https://dx.doi.org/10.1097/01. AOG.0000237100.29870.cc.
  29. Moga M., Dimienescu O., Balan A., Scarneciu I., Barabas B., Pies L. Therapeutic approaches of botulinum toxin in gynecology. Toxins. 2018; 10(4): 169. https:// dx.doi.org/10.3390/toxins10040169.
  30. Pelletier F., Parratte B., Penz S., Moreno J.P., Aubin F., Humbert P. Efficacy of high doses of Botulinum toxin A for treating provoked vestibulodynia. Br. J. Dermatol. 2011; 164(3): 617-22. https://dx.doi.org/10.1111/j. 1365-2133.2011.10235.x.
  31. Sclajani A.P., McCormick S.A. Induction of dermal collagenesis, angiogenesis, and adipogenesis in human skin by injection of platelet-rich fibrin matrix. Arch. Facial Plast. Surg. 2012; 14(2): 132-6. https://dx.doi.org/10.1001/ archfacial.2011.784.
  32. Englert S.J., Estep T.H., Ellis-Stoll C.C. Autologous platelet gel applications during cardiovascular surgery: effect on wound healing. J. Extra Corpor. Technol. 2005; 37(2): 148-52.
  33. Dhillon R.S., Schwarz E.M., Maloney M.D. Platelet-rich plasma therapy - future or trend? Arthritis Res. Ther. 2012; 14(4): 219. https://dx.doi.org//10.1186/ ar3914.
  34. Martinez-Zapata M.J., Marti-Carvajal A., Sola I. et al. Efficacy and safety of the use of autologous plasma rich in platelets for tissue regeneration: a systematic review. Transfusion. 2009; 49(1): 44-56. https://dx.doi.org/10.1111/j. 1537-2995.2008.01945.x.
  35. Runels C., Melnick H., Debourbon E., Roy L. A pilot study of the effect of localized injections of autologous platelet rich plasma (PRP) for the treatment of female sexual dysfunction. J. Women’s Health Care. 2014;3: 169. https://dx.doi. org/10.4172/2167-0420.1000169.
  36. Hung M., Su T., Lin Y., Huang W., Lin T., Hsu C. et al. Changes in sexual function of women with refractory interstitial cystitis/bladder pain syndrome after intravesical therapy with a hyaluronic acid solution. J. Sex. Med. 2014; 11(9): 2256-63. https://dx.doi.org/10.1111/jsm.12507.
  37. Chen, Junya, Li Geng, Xuehong Song, Hongxia Li, Nicola Giordan, Qinping Liao. Evaluation of the efficacy and safety of hyaluronic acid vaginal gel to ease vaginal dryness: a multicenter, randomized, controlled, open-label, parallel-group, clinical trial. J. Sex. Med. 2013; 10(6): 1575-84.
  38. Couchourel D., Fasola E. Methods and kits for treating vaginal and vulvar vestibule mucosa disorders U.S. Patent No. 9,155,757. Washington, DC: U.S. Patent and Trademark Office; 13 October 2015.
  39. Stockdale C.K., Lawson H.W. 2013 Vulvodynia Guideline Update: Journal ojLower Genital Tract Disease. 2014;18(2):93-100. doi: 10.1097/LGT.0000000000000021 АКУШЕРСТВО И ГИНЕКОЛОГИЯ № 6 /2019 AKUSHERSTVO I GINEKOLOGIYA/OBSTETRICS AND GYNECOLOGY (MOSCOW) № 6 /2019 ОБЗОРЫ
  40. Nunns D., Mandal D., Byrne M., McLelland J., Rani R., Cullimore J. et al. Guidelines for the management of vulvodynia. Br. J. Dermatol. 2010; 162(6): 1180-5.
  41. Goldstein A.T., Pukall C.F., Brown C., Bergeron S., Stein A., Kellogg-Spadt S. Vulvodynia: assessment and treatment. J. Sex. Med. 2016;13(4):572-90. ttps:// dx.doi.org/10.1016/j.jsxm.2016.01.020.
  42. Vieira-Baptista P., Donders G., Margesson L., Edwards L., Haejner H.K., Perez-Lopez F.R. Diagnosis and management of vulvodynia in postmenopausal women. Maturitas. 2018; 108: 84-94. https://dx.doi.org/10.1016/j. jsxm.2016.01.02010.1016/j.maturitas.2017.11.003.
  43. Hartmann D., Strauhal M.J, Nelson C.A. Treatment of women in the United States with localized, provoked vulvodynia: practice survey of women’s health physical therapists. J. Reprod. Med. 2007; 52: 48-52.
  44. Bergeron S., Brown C., Lord M.J., Oala M., Binik Y.M., Khalije S. Physical therapy for vulvar vestibulitis syndrome: a retrospective study. J. Sex Marital Ther. 2002; 28(3): 183-92.
  45. Morin M., Carroll M.S., Bergeron S. Systematic review of the effectiveness of physical therapy modalities in women with provoked vestibulodynia. Sex. Med. Rev. 2017; 5(3): 295-322. https://dx.doi.org/10.1016/j. jsxm.2016.01.02010.1016/j.sxmr.2017.02.003.
  46. Аполихина И.А., Додова Е.Г.,Бородина Е.А., Саидова А.С., Филиппенкова Е.В. Дисфункция тазового дна: современные принципы диагностики и лечения. Эффективная фармакотерапия. 2016; 22: 16-23.
  47. Herzberg U., Gurney J.P. U.S. Patent No. 9,040,035.Washington, DC: U.S. Patent and Trademark Office; 2015. Указ. назв. патента.
  48. Hartmann D., Strauhal M.J, Nelson C.A. Treatment of women in the United States with localized, provoked vulvodynia: practice survey of women’s health physical therapists. J. Reprod. Med. 2007; 52: 48-52.
  49. Bergeron S., Brown C., Lord M.J., Oala M., Binik Y.M., Khalije S. Physical therapy for vulvar vestibulitis syndrome: a retrospective study. J. Sex Marital Ther. 2002; 28(3): 183-92.
  50. Morin M., Carroll M.S., Bergeron S. Systematic review of the effectiveness of physical therapy modalities in women with provoked vestibulodynia. Sex. Med. Rev. 2017; 5(3): 295-322. https://dx.doi.org/10.1016/j. jsxm.2016.01.02010.1016/j.sxmr.2017.02.003.
  51. Аполихина И.А., Додова Е.Г., Бородина Е.А., Саидова А.С., Филиппенкова Е.В. Дисфункция тазового дна: современные принципы диагностики и лечения. Эффективная фармакотерапия. 2016; 22: 16-23.
  52. Herzberg U., Gurney J.P. U.S. Patent No. 9,040,035.Washington, DC: U.S. Patent and Trademark Office; 2015.

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