Historical Perspective of Vulvodynia

History of Vulvodynia

Vulvodynia, or chronic vulvar pain, is a syndrome that appears to have been recognized for centuries, but was not fully described until recently. It is thought that early Egyptian papyri, including the Kahun Gynecological Papyrus and the Ramesseum Papyrus, were the first texts to address gynecological issues including vulvar pain [1, 2]. The condition may have been described in ancient medical literature by Soranus of Ephesus, who referred to a condition similar to what we call vulvodynia today as “satyriasis in females” [3]. However, no documented, medically accurate descriptions of the condition appear in the medical literature until modern times.

History of the Term
Provoked Vestibulodynia

Initial discussions of vulvodynia focused on the main complaint of women presenting to their physicians: dyspareunia (i.e., pain during sexual intercourse), a term coined by Barnes in 1874 [4]. In the late nineteenth century,Thomas [5] and Skene [6] described a condition of hypersensitivity in the vulvar region. Thomas [5] described this condition as an “excessive sensibility of the nerves supplying the mucous membrane of some portion of the vulva, sometimes confined to the vestibule. . . [and] other times to one labium minus.” He noted that a primary complaint of women with this condition was dyspareunia. Similarly, in 1889, Skene [6] and Kellogg [7] reported that sensitive areas around the vaginal opening could cause problems with sexual intercourse. Very little new information on dyspareunia was reported for a period of four decades, and then in 1928 the condition reemerged in the literature. Kelly [8] expanded on the damaging effects of vulvar pain on sexual intercourse, describing it “as a fruitful source of dyspareunia.”

Information regarding the specific part(s) of the vulvar area implicated in the pain appeared later in published reports. Dickinson [9] found that almost 75% of his dyspareunic patients had a physical reason for their pain, withmany suffering from problems of the hymen, urethral meatus, and fourchette. Hunt [10] stated that the minor vestibular gland structures had no link to the pain, and this claim was supported by Dickinson’s report [9]. Over time, assertions regarding the cause of this pain began to appear in the literature. O’Donnell [11] believed that the cause of the pain was chronic inflammation attributed to an incomplete rupture of the hymen. Further supporting the involvement of inflammation in dyspareunia were the reports of Pelisse and Hewitt [12], Davis et al. [13], and Woodruff and Parmley [14]. For example, Pelisse and Hewitt [12] found histopathological evidence of chronic and acute inflammation in the posterior vestibule of affected women. Names for this condition, reflecting the role of inflammation (-itis), began to emerge and included the following: focal vulvitis [15], vestibular adenitis [16], focal vestibulitis vulvae [17], and vulvar vestibulitis syndrome [18].

The term vulvar vestibulitis syndrome (VVS) is commonly used to describe a condition in which localized, provoked dyspareunia is the main presenting complaint. According to Friedrich [18], the diagnostic criteria for VVS are “severe pain on vestibular touch or attempted vaginal entry, tenderness to pressure localized within the vulvar vestibule, and physical findings confined to vestibular erythema of various degrees.” Today, the relevance of Friedrich’s criterion is questioned and most clinicians make the diagnosis by the exclusion of other etiologies of pain. Additionally, one major problem with the terminology exists: “vestibulitis” implies inflammation. However, the finding of inflammatory indices in the vestibules of women with VVS is not a consistent finding in the literature. As such, the International Society for the Study of Vulvovaginal Disease (ISSVD) renamed VVS to provoked vestibulodynia (PVD) [19].

History of the Term
Generalized Vulvodynia

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