Vulvodynia and persistent vulvar pain – diagnosis, treatment, and the role of laser vaporization

Abstract

This article reviews the issue of persistent vulvar pain and vulvodynia, which are common conditions in women of reproductive age. Vulvodynia is defined as chronic vulvar pain lasting at least 3 months with no identified cause. It is characterized by increased sensitivity of the vulvar and vestibular tissues, neuroproliferation, increased vascularization, and structural changes of the mucosa. In contrast, persistent vulvar pain is usually associated with a specific, identifiable underlying condition. Both types of pain may coexist and overlap. This article comments on the current classification of vulvar pain according to the consensus of international societies dealing with this condition. It also summarizes the principles of differential diagnosis and therapeutic options for the management of vulvar pain. Treatment should be based on a comprehensive multidisciplinary approach including local and systemic pharmacotherapy, physiotherapy, psychotherapy, and in selected cases, surgical interventions. This article focuses on novel and promising therapeutic modalities in the treatment of vulvodynia, particularly various types of laser therapy. The review is supplemented by a case report of a patient with chronic provoked vestibulodynia treated by laser vaporization.