Vulvodynia & genital pain syndromes: the 2015 ISSVD definition, multidimensional classification, neuropathic pain framework and multidisciplinary management

A 24-year-old woman sits in your clinic describing three years of pain at the vaginal opening every time she tries to have intercourse. She can use a tampon only with difficulty. The pain is sharp, burning and localised to the vestibule, present only with touch. Three doctors have diagnosed thrush and prescribed clotrimazole that has not worked, and one has suggested the pain is "in her head". Your job is to recognise provoked vestibulodynia, exclude the identifiable causes with a swab and a focused examination including the cotton-swab test, validate her experience, and build a multidisciplinary plan that leads with pelvic floor physiotherapy and CBT — and never with chronic opioids.^[1][4]

Overview and definition

Vulvodynia is vulvar pain of at least 3 months' duration, without a clearly identifiable cause, which may have potential associated factors — the 2015 ISSVD / ISSWSH / IPPS consensus definition.^[1]

Three ideas live inside that definition:^[1][3]

• A duration threshold (3 months) — pain shorter than this is acute vulvar pain, not vulvodynia.
• A diagnosis of exclusion — vulvodynia is reserved for pain without an identifiable cause. Infection, dermatosis, neoplasia, hormonal deficiency and neurological disease must all be excluded first.^[8]
• A multidimensional descriptor framework — the 2015 consensus replaced the old single-label terms with four axes (location, provocation, onset, temporal pattern).^[1]

The 2003 ISSVD terminology (Moyal-Barracco 2004) retired "vulvar vestibulitis" (the "-itis" implied inflammation, which is not present histologically) in favour of vestibulodynia, and the 2015 consensus took this further by introducing the full descriptor set.^[2][1]

^{[4] [5] [9]}

References12ShowHide

1. [1]Bornstein J, Goldstein AT, Stockdale CK, et al. 2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia. J Sex Med, 2016.PMID 27045260
2. [2]Moyal-Barracco M, Lynch PJ 2003 ISSVD terminology and classification of vulvodynia: a historical perspective. J Reprod Med, 2004.PMID 15568398
3. [3]Bornstein J, Preti M, Simon JA, et al. Descriptors of Vulvodynia: A Multisocietal Definition Consensus (International Society for the Study of Vulvovaginal Disease, the International Society for the Study of Women Sexual Health, and the International Pelvic Pain Society). J Low Genit Tract Dis, 2019.PMID 30768446
4. [4]Pukall CF, Goldstein AT, Bergeron S, et al. Vulvodynia: Definition, Prevalence, Impact, and Pathophysiological Factors. J Sex Med, 2016.PMID 26944461
5. [5]Bergeron S, Vaillancourt-Morel MP, Corsini-Munt S, et al. Cognitive-behavioral couple therapy versus lidocaine for provoked vestibulodynia: A randomized clinical trial. J Consult Clin Psychol, 2021.PMID 34014693
6. [6]Morin M, Carroll MS, Bergeron S Systematic Review of the Effectiveness of Physical Therapy Modalities in Women With Provoked Vestibulodynia. Sex Med Rev, 2017.PMID 28363763
7. [7]Brown CS, Wan J, Bachmann G, Rosen R Self-management, amitriptyline, and amitripyline plus triamcinolone in the management of vulvodynia. J Womens Health (Larchmt), 2009.PMID 19183087
8. [8]Vieira-Baptista P, Donders G, Margesson L, et al. Diagnosis and management of vulvodynia in postmenopausal women. Maturitas, 2018.PMID 29290220
9. [9]Reed BD, Legocki LJ, Plegue MA, et al. Factors associated with vulvodynia incidence. Obstet Gynecol, 2014.PMID 24402591
10. [10]Reed BD, Haefner HK, Harlow SD, Gorenflo DW, Sen A Reliability and validity of self-reported symptoms for predicting vulvodynia. Obstet Gynecol, 2006.PMID 17012453
11. [11]Edwards L New concepts in vulvodynia. Am J Obstet Gynecol, 2003.PMID 14532900
12. [12]Mauskar MM, Marathe K, Venkatesan A, Schlosser BJ, Edwards L Vulvar diseases: Conditions in adults and children. J Am Acad Dermatol, 2020.PMID 31712170