VULVODYNIA AS A CHRONIC VULVAR PAIN DISORDER: A NARRATIVE REVIEW OF PATHOPHYSIOLOGY, DIAGNOSIS, AND MANAGEMENT

Agnieszka Dobrowolska; Adam Skrobarczyk; Zuzanna Drewniak; Marta Rząsa; Karolina Rycman; Martyna Sternik; Kamil Wendrychowicz; Filip Wróbel

doi:10.31435/ijitss.2(50).2026.5312

Authors

Agnieszka Dobrowolska Provincial Hospital in Zgierz them. M. Sklodowska-Curie, ul. Parzeczewska 35, 95-100 Zgierz, Poland https://orcid.org/0009-0000-5645-7518
Adam Skrobarczyk 4th Military Clinical Hospital with Polyclinic in Wroclaw, Rudolfa Weigla 5, 50-981 Wroclaw, Poland https://orcid.org/0009-0006-6391-2666
Zuzanna Drewniak Praski Hospital in Warsaw, aleja Solidarności 67, 03-401 Warszawa, Poland https://orcid.org/0009-0006-0426-4312
Marta Rząsa Provincial Hospital in Zgierz them. M. Sklodowska-Curie, ul. Parzeczewska 35, 95-100 Zgierz, Poland https://orcid.org/0009-0000-6817-6940
Karolina Rycman Clinical Hospital of the Poznań University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznan, Poland https://orcid.org/0009-0006-8144-6339
Martyna Sternik 4th Military Clinical Hospital with Polyclinic in Wroclaw, Rudolfa Weigla 5, 50-981 Wroclaw, Poland https://orcid.org/0009-0003-2235-7932
Kamil Wendrychowicz Central Teaching Hospital of The Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland https://orcid.org/0009-0005-5452-5384
Filip Wróbel Norbert Barlicki Memorial Teaching Hospital No. 1 of the Medical University of Lodz, Kopcinskiego 22, 90-153 Lodz, Poland https://orcid.org/0009-0000-7572-9451

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5312

Keywords:

Vulvodynia, Vestibulodynia, Dyspareunia, Chronic Pelvic Pain, Central Sensitization, Pelvic Floor Dysfunction

Abstract

Background: Vulvodynia is a chronic vulvar pain condition frequently associated with dyspareunia and significant impairment of quality of life in women of all ages. Despite increasing clinical awareness, diagnosis and management remain challenging due to its heterogeneous presentation and multifactorial etiology.

Aim: This review aims to evaluate the current understanding of the pathogenesis, clinical presentation, diagnostic approaches, and management strategies of vulvodynia, and to synthesize available evidence to support clinical practice and guide future research.

Methods: A narrative review of the literature was conducted using PubMed, Scopus, Web of Science, and Embase, focusing on publications from 2005–2025. Additional sources included reference screening and international society guidelines. Narrative and systematic reviews, meta-analyses, consensus statements, clinical guidelines, and relevant observational or experimental studies were included. Due to methodological heterogeneity, findings were synthesized narratively.

Results: According to the International Society for the Study of Vulvovaginal Disease, vulvodynia is defined as vulvar pain lasting at least three months without an identifiable cause. Current evidence suggests a multifactorial pathophysiology involving neurogenic, inflammatory, myofascial, hormonal, and psychosocial mechanisms, including central sensitization. Diagnosis relies on detailed history-taking, comprehensive physical examination, targeted pain assessment, and exclusion of other gynecologic, dermatologic, or neurologic conditions. Management increasingly emphasizes a multimodal, interdisciplinary approach combining patient education, pelvic floor physical therapy, psychological interventions, and pharmacological treatment.

Conclusions: Vulvodynia is a complex chronic pain disorder requiring individualized, patient-centered care. Interdisciplinary management tailored to underlying pain mechanisms and coexisting factors is essential to improve clinical outcomes and quality of life.

References

Bergeron, S., Reed, B. D., Wesselmann, U., Bohm-Starke, N., & Vulvodynia Nature Reviews Disease Primers Authors. (2020). Vulvodynia. Nature Reviews Disease Primers, 6. https://doi.org/10.1038/s41572-020-0164-2

Bornstein, J., Goldstein, A. T., Stockdale, C. K., Bergeron, S., Pukall, C., Zolnoun, D., & Coady, D. (2016). 2015 ISSVD, ISSWSH, and IPPS consensus terminology and classification of persistent vulvar pain and vulvodynia. Journal of Lower Genital Tract Disease, 20(2), 126–130.

Torres-Cueco, R., & Nohales-Alfonso, F. (2021). Vulvodynia—It is time to accept a new understanding from a neurobiological perspective. International Journal of Environmental Research and Public Health, 18(12), 6639. https://doi.org/10.3390/ijerph18126639

Bornstein, J., Goldstein, A., Coady, D., Bergeron, S., Pukall, C., & Zolnoun, D. (2015). Consensus terminology and classification of persistent vulvar pain.

Trutnovsky, G., Plieseis, C., Bjelic-Radisic, V., Bertholiny Galvez, M. C., Tamussino, K., & Ulrich, D. (2019). Vulvodynia and chronic pelvic pain in a gynecologic outpatient clinic. Journal of Psychosomatic Obstetrics & Gynecology, 40(3), 243–247.

Patla, G., Mazur-Bialy, A. I., Humaj-Grysztar, M., & Gajewska, E. (2023). Chronic vulvar pain and health-related quality of life in women with vulvodynia. Life, 13(2), 328. https://doi.org/10.3390/life13020328

Thomas, T. G. (1880). Practical treatise on the diseases of women. Henry C. Lea’s Son & Co.

Tiranini, L., Cantamessi, M., Serra, E., & others. (2023). Vulvodynia: When a training program to increase muscle mass in the lower limbs does some good! AboutOpen, 10, 119–123.

Schrepf, A., Maixner, W., Fillingim, R., & others. (2024). The chronic overlapping pain condition screener. The Journal of Pain, 25, 265–272.

National Research Council. (2011). Relieving pain in America: A blueprint for transforming prevention, care, education, and research. National Academies Press.

Neblett, R., Hartzell, M. M., Mayer, T. G., Cohen, H., & Gatchel, R. J. (2017). Establishing clinically relevant severity levels for the Central Sensitization Inventory. Pain Practice, 17(2), 166–175.

Bartley, E. J., Alappattu, M. J., Manko, K., & others. (2024). Presence of endometriosis and chronic overlapping pain conditions negatively impacts the pain experience in women with chronic pelvic–abdominal pain: A cross-sectional survey. Women’s Health, 20. https://doi.org/10.1177/17455057241248017

Nimbi, F. M., Renzi, A., Mesce, M., & others. (2024). Central sensitization symptoms in vulvodynia: Exploring the role of temperament, personality traits, childhood adverse events, defense mechanisms, and mental pain on quality of life. The Journal of Sexual Medicine, 21, 912–921.

International Association for the Study of Pain. (2017). Terminology. Retrieved March 13, 2024, from https://www.iasp-pain.org/resources/terminology/

Liao, Z., Chakrabarty, A., Mu, Y., & others. (2017). A local inflammatory renin-angiotensin system drives sensory axon sprouting in provoked vestibulodynia. The Journal of Pain, 18, 511–525.

Tommola, P., Unkila-Kallio, L., Paetau, A., Meri, S., & Kalso, E. (2016). Immune activation enhances epithelial nerve growth in provoked vestibulodynia. American Journal of Obstetrics and Gynecology, 215, 768.e1–768.e8.

Hormonal contraception and vulvodynia: An update. (n.d.).

Simon, J. A., Davis, S. R., Althof, S. E., Chedraui, P., Clayton, A. H., Kingsberg, S. A., Nappi, R. E., Parish, S. J., Wolfman, W., & Bitzer, J. (2018). Sexual well-being after menopause: An International Menopause Society White Paper. Climacteric, 21(5), 415–427.

Champaneria, R., D’Andrea, R. M., & Latthe, P. M. (2016). Hormonal contraception and pelvic floor function: A systematic review. International Urogynecology Journal, 27, 709–722.

Baszak-Radomańska, E. (n.d.). Warsztaty mentoringowe. https://www.ewabaszakradomanska.pl

Baszak-Radomańska, E., Wańczyk-Baszak, J., & Paszkowski, T. (2025). Pelvic floor examination in vulvodynia: VAMP protocol validation in correlation with central sensitization. Women’s Health, 21. https://doi.org/10.1177/17455057251338410

Khandker, M., Brady, S. S., Vitonis, A. F., MacLehose, R. F., Stewart, E. G., & Harlow, B. L. (2011). The influence of depression and anxiety on risk of adult onset vulvodynia. Journal of Women’s Health, 20(10), 1445–1451.

Tribó, M. J., Canal, C., Baños, J. E., Robleda, G., & others. (2020). Pain, anxiety, depression, and quality of life in patients with vulvodynia. Dermatology, 236, 255–261.

Harlow, B. L., & Stewart, E. G. (2005). Adult-onset vulvodynia in relation to childhood violence victimization. American Journal of Epidemiology, 161(9), 871–880.

Dagostin Ferraz, S., Rodrigues Candido, A. C., Rodrigues Uggioni, M. L., & others. (2024). Assessment of anxiety, depression and somatization in women with vulvodynia: A systematic review and meta-analysis. Journal of Affective Disorders, 344, 122–131.

Persistent vulvar pain. (n.d.).

Pukall, C. F., Goldstein, A. T., Bergeron, S., Foster, D., Stein, A., Kellogg-Spadt, S., & Bachmann, G. (2016). Vulvodynia: Definition, prevalence, impact, and pathophysiological factors. The Journal of Sexual Medicine, 13(3), 291–304.

American College of Obstetricians and Gynecologists. (2008). Diagnosis and management of vulvar skin disorders: Clinical management guidelines for obstetrician-gynecologists.

Sadownik, L. A. (2014). Etiology, diagnosis, and clinical management of vulvodynia. International Journal of Women’s Health, 6, 437–449.

Baszak-Radomanska, E., Wanczyk-Baszak, J., & Paszkowski, T. (2021). Pilot study of testing a clinical tool for pelvic physical examination in patients with vulvodynia. Ginekologia Polska, 92, 410–416.

Schlaeger, J. M., Glayzer, J. E., Villegas-Downs, M., & others. (2023). Evaluation and treatment of vulvodynia: State of the science. Journal of Midwifery & Women’s Health, 68, 9–34.

International Society for the Study of Vulvovaginal Disease. (2023). Recommendations for the diagnosis and treatment of vaginitis. Ad Médic, Lda. https://doi.org/10.59153/adm.rdtv.001

Prendergast, S. A. (2017). Pelvic floor physical therapy for vulvodynia: A clinician’s guide. Obstetrics and Gynecology Clinics of North America, 44, 509–522.

Lountzi, A. Z., Abhyankar, P., & Durand, H. (2025). A scoping review of vulvodynia research: Diagnosis, treatment, and care experiences. Women’s Health, 21. https://doi.org/10.1177/17455057251345946

Vasileva, P., Strashilov, S. A., & Yordanov, A. D. (2020). Aetiology, diagnosis, and clinical management of vulvodynia. Przeglad Menopauzalny, 19, 44–48.

Falsetta, M. L., Foster, D. C., Bonham, A. D., & Phipps, R. P. (2017). A review of the available clinical therapies for vulvodynia management and new data implicating proinflammatory mediators in pain elicitation. BJOG: An International Journal of Obstetrics & Gynaecology, 124, 210–218.

Maksimova, M. Y., Sharov, M. N., Zaitsev, A. V., & others. (2021). Vulvodynia: A modern perspective on the problem. Neurology, Neuropsychiatry, Psychosomatics, 13, 4–9.