The latest definition by the International Society for the Study of Vulvovaginal Disease (ISSVD) and the International Society for the Study of Women’s Sexual Health (ISSWSH) describes vulvodynia as intermittent, immediate, or delayed vulvar pain lasting at least three months, without an identifiable cause, but potentially associated with contributing factors. This invisible condition affects one in seven women, making early diagnosis critical to interrupt the self-perpetuating pathological mechanism that can lead to unpleasant sensations from mere touch (allodynia) or even neuropathic pain.

Does This Condition Only Affect Young Women, or All Women? How Important Is Timely Diagnosis?

We delve deeper into the topic with Dr. Raffaella Delfini, gynecologist at Ars Medica.

Vulvodynia’s symptoms, combined with the absence of visible lesions, can be misleading. This often results in misdiagnosis as an infectious or inflammatory condition, unnecessarily delaying treatment. Patients commonly report irritation, pain upon touch, tenderness, dryness, a raw or abraded feeling, swelling, and even electric shock sensations.

Who Is Most Affected by Vulvodynia?

While vulvodynia is often associated with younger women, it also affects women over 40 due to factors such as reduced vaginal trophism (atrophy).

Where Does the Diagnostic Process Begin?

Diagnosis begins with a thorough patient consultation and medical history review, which is critical to identifying risk factors such as recurrent cervico-vaginal and urinary infections, obstetric history, allergies, hormonal treatments, irritable bowel syndrome, and psychosocial factors.

The diagnostic process focuses initially on excluding other potential causes of vulvar pain, including:

• Neoplastic conditions
• Inflammatory diseases
• Neurological disorders
• Active infections

Vulvodynia often presents as vestibulodynia, the most common localized form, which may be spontaneous or provoked. The provoked form, more prevalent, can be triggered by sexual intercourse, prolonged sitting, physical activity, or even a gynecological examination—especially if not conducted by a skilled professional.

The diagnostic process includes:

• Vestibular Sensitivity Assessment: Inspection of the vulva using appropriate tests, such as the swab test.
• Pelvic Floor Muscle Evaluation: Identifying any hypertonic conditions of the pelvic floor musculature.

Is There an Ideal Cure?

Treatment for vulvodynia requires a personalized and multidisciplinary approach. Due to the multifactorial nature of the condition, no single treatment works for all patients, as each case reflects its own complexity.

Today, various treatment options are available, offering women the chance to regain a normal life and a fulfilling relationship with their partner. These treatments may include:

• Local or Systemic Therapies: Tailored to the patient’s specific needs.
• Integrated Approaches: Incorporating rehabilitative and desensitization therapies.

What Are the Goals of Treatment?

• Reducing triggers and irritative stimuli
• Alleviating vestibular hypersensitivity
• Addressing pelvic floor dysfunction
• Managing the psychological and sexual implications of chronic pain

At Ars Medica, the patient is always at the center of care. Open communication and trust between doctor and patient form the foundation for effective therapeutic collaboration. Backed by ongoing scientific research, we are committed to advancing new possibilities for managing a condition that still holds many mysteries.