Neuropathic Mechanisms in Vulvodynia

In vulvodynia: “the neurophysiopathology [functioning of the central & peripheral nervous system] is varied, & characterised by sensory abnormalities of the peripheral & central nervous system. Allodynia [pain caused by a stimulus that doesn’t normally provoke pain] & hyperalgesia [an increased sensitivity to feeling pain & an extreme reaction to pain] increased sensitivity to feeling pain & an extreme reaction to pain], are typical features of vulvodynia” [1], however, as these issues are often associated with other conditions, receiving an accurate diagnosis from a Vulva Specialist is crucial. Moreover, it is the first step towards recovery through a Holistic Personalised Treatment Plan

The Pelvis & Its Nerve Supply

When it comes to vulvodynia, it is crucial to have a basic idea of the nerve supply within the pelvis. The vulva is on the receiving end of nervous input from three key nerves:

• The ilioinguinal
• The pudendal, and
• The genitofemoral

So What Are the Neuropathic Mechanisms?

Research indicates that the cause of neuropathic issues in Vulvodynia sufferers, derives from the development of a long-term inflammatory structure of the vulvar mucosa (the vulva’s moist, inner lining). Over time, this inflammation results in an increase in the density of the nerve fibres in the vestibule (a part of the vulva between the labia minora). This increment in the density of local nerve fibre appears to be mediated by a certain cell receptor.

The neuropathy of small independent nerve fibres generate intense pain sensations which normally start in the extremities, and can also incorporate sexual organs. Of note, sufferers
are not able to perceive pain if it is condensed in very small regions of the body. Yet: “when subjected to normal stimuli, i.e., stimuli that in a healthy individual would not cause pain, the same individuals experience increased sensitivity to pain, hyperalgesia and painful sensations, a condition known as allodynia” [1]. Small-fibre neuropathy symptoms are different for each individual; however, pain remains the most reported symptom, associated with loss of sensation, sudden painful sensations, tingling and burning [1].

Booking an Appointment With a Vulva Doctor

Whether your appointment is on-line or in-person, it is very important to give your Pain Consultant as much accurate information as possible. To that end, compiling a ‘Vulva Pain Dairy,’ is strongly recommended. This dairy should have separate days, which are divided into 24 hour slots. This way, whenever you experience pain, you can note it down at the precise time of day or night. You should also note what you were doing at the time, and whether anything you did, brought it on. And if you did anything which ameliorated it.

Your Vulva Pain Specialist will provide you with a Holistic Personalised Treatment Plan, once they have reviewed your medical history, discussed various important factors, and undertaken any necessary examinations, tests, and scans.

Reference

[1]. Merlino L, Titi L, Pugliese F, D’Ovidio G, Senatori R, Rocca CD, Piccioni MG. Vulvodynia: Pain Management Strategies. Pharmaceuticals (Basel). 2022 Dec 5;15(12):1514.