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Provoked vulvodynia: A peripheral neurological pain syndrome
JACOB BORNSTEIN1, EILAM PALZUR21Department of Obstetrics and Gynaecology, Galilee Medical Center and Azrieli Faculty of Medicine, Bar-Ilan University, Nahariya, Israel, 2The Research Institute of Galilee Medical Center and Azrieli Faculty of Medicine, Bar-Ilan University, Nahariya, Israel
The main cause of vulvar pain and dyspareunia is provoked vulvodynia (PV), also known as vestibulodynia, and formerly termed “vulvar vestibulitis”. It affects 8-10% of women of all ages. Although the etiology remains an enigma, peripheral neurologic mechanism has recently been identified as a factor associated with vulvodynia. The aim of the present review is to present and discuss neuroproliferation as a main cause of PV.
Studies comparing Immunohistochemical staining of specimens from women with PV to controls, and animal models of PV, have been analysed for evidence of inflammation and neuroproliferation.
The density of nerve fibres in the vestibular stroma of women with PV was 10 times greater than that in the vestibular stroma of non-affected women controls. Moreover, the fibres penetrated the basal membrane and continued vertically, reaching close to the surface of the epithelial surface. An increase in the number of stromal mast cells has also been demonstrated in women with PV. Heparanase, discharged from mast cells, degrades the connective tissue and epithelial basement membrane, allowing the proliferating nerve fibres to penetrate the degraded epithelial basement membrane into the epithelium. This intraepithelial hyperinnervation results in local hyperesthesia characteristic of PV. In a mouse model a significant increase has been depicted in the density of nerve fibres in 40% of the mice repeatedly infected with fungal antigen. An increase in mast cells number has been depicted in a mouse model as well.
A peripheral neurologic mechanism leading to neuroproliferation has been recognised in women with PV and animal models. Future research should consider this pathogenesis.
Cite This Article
BORNSTEIN J, PALZUR E. Provoked vulvodynia: A peripheral neurological pain syndrome. 2020; 39(3): 68-76
Corresponding Author: BORNSTEIN J.