Characterization of Vulvodynia and Ehlers-Danlos Syndromes/Hypermobility Spectrum Disorders in Females

Current vulvodynia research emphasizes the devasting effect of vulvar pain on female’s lives compounded by lack of effective treatment methods. Treatment is largely based on findings from case and anecdotal reports with few interventional studies or fully powered randomized controlled trials. Our scoping literature review suggests that the first line of treatment should include therapies that are non-pharmacologic and least or minimally invasive, adding additional treatments as needed. Additional treatments for vulvodynia include multimodal physical therapy; acupuncture; intravaginal transcutaneous electrical nerve stimulation (TENS); overnight 5% lidocaine ointment; oral desipramine with 5% lidocaine cream; intravaginal diazepam tablets with intravaginal TENS; botulinum toxin type A 50 units; and enoxaparin sodium subcutaneous injection. Central nervous system sensitization; exaggerated immune response from recurrent yeast infections; pelvic floor dysfunction; headaches and migraines; taking combined oral contraceptives; irritable bowel syndrome; and interstitial cystitis are thought to be associated with vulvodynia, but the precise nature of their relationship is unknown is unknown. Our research suggests that 50% of females with Ehlers-Danlos syndromes (EDS) have vulvodynia. Comparing females who have EDS and vulvodynia to females who have EDS but not vulvodynia, may help identify the characteristics that put females with EDS at higher risk for vulvodynia and identify new risk factors for vulvodynia that can be applied to the general population. Central nervous system sensitization and pelvic floor dysfunction increased the risk for vulvodynia. Exaggerated immune response and gastrointestinal conditions also increased a female’s risk for vulvodynia but not to the same extent. Based on the findings of our latent class analysis we hypothesize that there is a tipping point. Once a female’s allostatic load reaches a critical threshold they are at higher risk for vulvodynia. This tipping point may only be present in females that are predisposed to vulvodynia based on genetic make-up, but this is unknown. The tipping point can be reached with different patterns of stressors or comorbid conditions, with not all individual stressors contributing equally to the risk for developing vulvodynia. In this theory, if a female’s allostatic load recedes below the threshold for vulvodynia their symptoms may resolve.