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Beyond vulvodynia: from a correct diagnosis to a multidisciplinary care program. A referral center experience

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

Vulvodynia is a chronic pain condition without an identifiable cause. As such, it is a diagnosis of exclusion, and all other causes of vulvar pain should be excluded. Although a standard treatment for vulvodynia has not been established yet, multidisciplinary care programs appear to be effective.

Puropose

The aim of this retrospective monocentric study was to analyze the prevalence of vulvodynia among women referred to our institution for a suspected diagnosis and to evaluate the efficacy of a multidimensional treatment plan. The primary outcome was the prevalence of vulvodynia following differential diagnosis. Secondary outcomes included: prevalence of the differential diagnoses, symptom resolution rate following treatment, and the relation between persistence of symptoms and (a) patients’ age; (b) coexisting chronic overlapping pain conditions (COPCs).

Results

After having ruled out all other causes of vulvar pain, only 40.1% of women were considered as affected by vulvodynia. The most frequent differential diagnoses included lower genital tract infections (25.3%), vulvar lichen sclerosus (17.6%) and vulvovaginal atrophy (8.2%). Following a multidisciplinary care program, resolution of symptoms was observed in 13.6% cases, improvement in 64.3% and persistence in 21.9%. We did not find a statistically significant association between persistence of symptoms and age > 38 years (OR 2.10; p = 0.30). Women with one or more COPCs other than vulvodynia had a 75% increased risk of not obtaining a resolution of symptoms (OR 1.75; p = 0.44).

Conclusion

A thorough differential diagnosis and a multidisciplinary care program may represent a first way out of the muddle in the management of these patients.

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Acknowledgements

The authors are grateful to Mirella Di Martino for her incomparable contribution to the study by treating with physical therapy the patients included in the study.

Funding

This study was not founded.

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Author notes

  1. Veronica Boero and Giulia Emily Cetera have contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Veronica Boero, Giulia Emily Cetera, Carlotta Caia, Camilla Erminia Maria Merli, Elisa Pesce, Giussy Barbara, Monti Ermelinda & Paolo Vercellini

  2. Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy

    Giulia Emily Cetera, Giussy Barbara & Paolo Vercellini

  3. Obstetric and Gynecological Emergency Unit and SVSeD (Service for Sexual and Domestic Violence), Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Giada Gramegna

Authors
  1. Veronica Boero
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  2. Giulia Emily Cetera
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Contributions

Veronica Boero and Giulia Emily Cetera: project development, conceptualization, methodology, investigation, writing—original draft, writing—review and editing. Carlotta Caia: formal analysis, data curation, writing—review and editing. Camilla Erminia Maria Merli, Elisa Pesce and Giada Gramegna: data curation and editing. Giussy Barbara: review and editing. Ermelinda Monti: conceptualization, review. Paolo Vercellini: methodology, review and editing.

Corresponding author

Correspondence to Carlotta Caia.

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Local Institutional Review Board approval was obtained (#154_2023, Comitato etico Milano 2).

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Boero, V., Cetera, G.E., Caia, C. et al. Beyond vulvodynia: from a correct diagnosis to a multidisciplinary care program. A referral center experience. Arch Gynecol Obstet (2024). https://doi.org/10.1007/s00404-024-07496-0

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