Localized Provoked Vestibulodynia: Do Multiple Etiologic Triggers Manifest as Neurogenic Vulvar Pain?

Localized Provoked Vestibulodynia: Do Multiple Etiologic Triggers Manifest as Neurogenic Vulvar Pain?

We propose that localized provoked vestibulodynia (LPV) results from diverse precipitating factors that ultimately establish and maintain neurogenic pain responses. An immune-cell–mediated inflammatory cascade may be the common mechanism through which various triggers establish neurogenic vulvar pain. Distinct etiologies of localized provoked vestibulodynia that manifest through neurogenic pain pathways may include its development subsequent to vulvovaginal infection, its comorbidity with and interstitial cystitis, and the role of sex hormones in triggering vestibulodynia. The medical history, the presence of genetic predisposing factors, the focal pattern and severity of vestibular pain, the pattern of subclinical inflammation along genital tract, and the presence of immune cell mediators and neuronal hyperplasia may provide clues as to the underlying pathophysiology of this perplexing syndrome.