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Vulvar Pain and Vulvodynia

  • Chapter
Vulvar Disease

Abstract

Vulvar pain is an enigma. Its etiology, pathophysiology, and treatment have not yet been elucidated. The most perplexing presentation is pain during intercourse, sometimes prevents the possibility to have intercourse. Around the enigma of vulvar pain, myths about its causes and treatments emerged. This chapter breaks these myths. The 2015 consensus terminology has changed the management paradigm of vulvar pain: now evaluation should be made according to the associated factor.

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References

  1. Bornstein J, Goldstein AT, Stockdale CK, Bergeron S, Pukall C, Zolnoun D, Coady D. 2015 ISSVD, ISSWSH, and IPPS consensus terminology and classification of persistent vulvar pain and vulvodynia. J Low Genit Tract Dis. 2016;20:126–30.

    PubMed  Google Scholar 

  2. Bogliatto F, Miletta M. Vulvodynia: when a paradigm challenges the management. J Low Genit Tract Dis. 2017;21:85–6.

    PubMed  Google Scholar 

  3. McKay M. Dysesthetic (“essential”) vulvodynia: treatment with amitriptyline. J Reprod Med. 1993;38:9–13.

    CAS  PubMed  Google Scholar 

  4. Bornstein J, Maman M, Abramovici H. Primary versus secondary vestibulitis - one disease, two variants. Am J Obstet Gynecol. 2001;184:28–31.

    CAS  PubMed  Google Scholar 

  5. Sutton K, Pukall C, Chamberlain S. Pain, psychosocial, sexual, and psychophysical characteristics of women with primary vs. secondary provoked vestibulodynia. J Sex Med. 2009;6:205.

    PubMed  Google Scholar 

  6. van Lankveld JJDM, Granot M, Weijmar Schultz WCM, et al. Women’s sexual pain disorders. J Sex Med. 2010;7:615.

    PubMed  Google Scholar 

  7. Reed BD, Harlow SD, Sen A, et al. Prevalence and demographic characteristics of vulvodynia in a population-based sample. Am J Obstet Gynecol. 2012;206:170.e1.

    Google Scholar 

  8. Reed BD, Haefner HK, Sen A, et al. Vulvodynia incidence and remission rates among adult women: a 2-year follow-up study. Obstet Gynecol. 2008;112:231.

    PubMed  Google Scholar 

  9. Reed BD, Crawford S, Couper M, et al. Pain at the vulvar vestibule: a web-based survey. J Low Genit Tract Dis. 2004;8:48.

    PubMed  Google Scholar 

  10. Harlow BL, Stewart EG. A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? J Am Med Womens Assoc. 2003;58:82.

    Google Scholar 

  11. Arnold LD, Bachmann GA, Rosen R, et al. Assessment of vulvodynia symptoms in a sample of US women: a prevalence survey with a nested case control study. Am J Obstet Gynecol. 2007;196:128.e1.

    Google Scholar 

  12. Harlow B, Kunitz C, Nguyen R, et al. Prevalence of symptoms consistent with a diagnosis of vulvodynia: population-based estimates from 2 geographic regions. Am J Obstet Gynecol. 2014;210:40.e1.

    Google Scholar 

  13. Turk DC, Galer BS, Hewitt DJ, et al. Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain. 2003;106:337–45.

    PubMed  Google Scholar 

  14. Friedrich EG. Vulvar vestibulitis syndrome. J Reprod Med. 1987;32:110.

    PubMed  Google Scholar 

  15. Goldfinger C, Pukall CF, Gentilcore-Saulnier E, et al. A prospective study of the effectiveness of pelvic floor physical therapy: pain and psychosexual outcomes in provoked vestibulodynia. J Sex Med. 2009;6:1955–68.

    PubMed  Google Scholar 

  16. King M, Rubin R, Goldstein AT. Current uses of surgery in the treatment of genital pain. Curr Sex Health Rep. 2014;6:252.

    Google Scholar 

  17. Pukall CF, Binik YM, Khalifé S. A new instrument for pain assessment in vulvar vestibulitis syndrome. J Sex Marital Ther. 2004;30:69.

    PubMed  Google Scholar 

  18. Pukall CF, Binik YM, Khalifé S, et al. Vestibular tactile and pain thresholds in women with vulvar vestibulitis syndrome. Pain. 2002;96:163.

    PubMed  Google Scholar 

  19. Marinoff SC, Turner ML. Vulvar vestibulitis syndrome. Dermatol Clin. 1992;10:435–44.

    CAS  PubMed  Google Scholar 

  20. Foster D, Kotok M, Huang L, et al. The tampon test for vulvodynia treatment outcomes research reliability, construct validity, and responsiveness. Obstet Gynecol. 2009;113:825–32.

    PubMed  PubMed Central  Google Scholar 

  21. Reed BD, Harlow SD, Plegue MA, Sen A. Remission, relapse, and persistence of vulvodynia: a longitudinal population-based study. J Womens Health (Larchmt). 2016;25:276–83.

    Google Scholar 

  22. Reed BD, Plegue MA, Harlow SD, Haefner HK, Sen A. Does degree of vulvar sensitivity predict vulvodynia characteristics and prognosis? J Pain. 2017;18:113–23.

    PubMed  Google Scholar 

  23. Smith EM, Ritchie JM, Galask R, Pugh EE, Jia J, Ricks-McGillan J. Case-control study of vulvar vestibulitis risk associated with genital infections. Infect Dis Obstet Gynecol. 2002;10(4):193–202.

    PubMed  PubMed Central  Google Scholar 

  24. Farmer MA, Taylor AM, Bailey AL, et al. Repeated vulvovaginal fungal infections cause persistent pain in a mouse model of vulvodynia. Sci Transl Med. 2011;3:101–91.

    Google Scholar 

  25. Foster DC, Falsetta ML, Woeller CF, et al. Site-specific mesenchymal control of inflammatory pain to yeast challenge in vulvodynia-afflicted and pain-free women. Pain. 2015;156:386–96.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Bornstein J, Livnat G, Stolar Z, Abramovici H. Pure versus complicated vulvar vestibulitis: a randomized trial of fluconazole treatment. Gynecol Obstet Invest. 2000;50(3):194–7.

    CAS  PubMed  Google Scholar 

  27. Arnold LD, Bachmann GA, Rosen R, et al. Vulvodynia: characteristics and associations with comorbidities and quality of life. Obstet Gynecol. 2006;107:617.

    PubMed  PubMed Central  Google Scholar 

  28. Marinoff SC, Turner ML. Hypersensitivity to vaginal candidiasis or treatment vehicles in the pathogenesis of minor vestibular gland syndrome. J Reprod Med. 1986;31(9):796–9.

    CAS  PubMed  Google Scholar 

  29. Burrows LJ, Basha M, Goldstein AT. The effects of hormonal contraceptives on female sexuality: a review. J Sex Med. 2012;9:2213.

    CAS  PubMed  Google Scholar 

  30. Bornstein J, Goldshmid N, Sabo E. Hyperinnervation and mast cell activation may be used as histopathologic diagnostic criteria for vulvar vestibulitis. Gynecol Obstet Invest. 2004;58:171–8.

    PubMed  Google Scholar 

  31. Bornstein J, Zarfati D, Sela S, Cohen Y, Ophir E. Involvement of heparanase in the pathogenesis of localized vulvodynia. Int J Gynecol Pathol. 2008;27(1):136–41.

    PubMed  Google Scholar 

  32. Morin M, Bergeron S, Khalifé S, et al. Morphometry of the pelvic floor muscles in women with and without provoked vestibulodynia using 4D ultrasound. J Sex Med. 2014;11:776–85.

    PubMed  Google Scholar 

  33. Westrom LV, Willen R. Vestibular nerve fiber proliferation in vulvar vestibulitis syndrome. Obstet Gynecol. 1998;91:572–6.

    CAS  PubMed  Google Scholar 

  34. Bohm-Starke N, Hilliges M, Falconer C, Rylander E. Neurochemical characterization of the vestibular nerves in women with vulvar vestibulitis syndrome. Gynecol Obstet Invest. 1999;48:270–5.

    CAS  PubMed  Google Scholar 

  35. Bohm-Starke N, Hilliges M, Brodda-Jansen G, Rylander E, Torebjörk E. Psychophysical evidence of nociceptor sensitization in vulvar vestibulitis syndrome. Pain. 2001;94:177–83.

    CAS  PubMed  Google Scholar 

  36. Leclair CM, Goetsch MF, Korcheva VB, et al. Differences in primary compared with secondary vestibulodynia in immunohistochemistry. Obstet Gynecol. 2011;117:1307.

    PubMed  PubMed Central  Google Scholar 

  37. Goetsch MF, Morgan TK, Korcheva VB, et al. Histologic and receptor analysis of primary and secondary Vestibulodynia and controls: a prospective study. Am J Obstet Gynecol. 2010;202:614.e1.

    Google Scholar 

  38. Tympanidis P, Casula MA, Yiangou Y, Terenghi G, Dowd P, Anand P. Increased vanilloid receptor VR1 innervation in vulvodynia. Eur J Pain. 2004;8(2):129–33.

    CAS  PubMed  Google Scholar 

  39. Gerber S, Bongiovanni AM, Ledger WJ, et al. Defective regulation of the proinflammatory immune response in women with vulvar vestibulitis syndrome. Am J Obstet Gynecol. 2002;186:696.

    PubMed  Google Scholar 

  40. Pukall CF, Cahill CM. New developments in the pathophysiology of genital pain: the role of central sensitization. Curr Sex Health Rep. 2014;6:11.

    Google Scholar 

  41. Willis WD. Role of neurotransmitters in sensitization of pain responses. Ann N Y Acad Sci. 2001;933:142–56.

    CAS  PubMed  Google Scholar 

  42. Pierce AN, Zhang Z, Fuentes IM, Wang R, Ryals JM, Christianson JA. Neonatal vaginal irritation results in long-term visceral and somatic hypersensitivity and increased hypothalamic-pituitary-adrenal axis output in female mice. Pain. 2015;156(10):2021–31.

    CAS  PubMed  PubMed Central  Google Scholar 

  43. Gerber S, Bongiovanni AM, Ledger WJ, et al. Interleukin-1b gene polymorphism in women with vulvar vestibulitis syndrome. Eur J Obstet Gynecol Reprod Biol. 2003;107:74.

    CAS  PubMed  Google Scholar 

  44. Goldstein AT, Belkin ZR, Krapf JM, et al. Polymorphisms of the androgen receptor gene and hormonal contraceptive induced provoked vestibulodynia. J Sex Med. 2014;11:2764.

    CAS  PubMed  Google Scholar 

  45. Babula O, Linhares IM, Bongiovanni AM, Ledger WJ, Witkin SS. Association between primary vulvar vestibulitis syndrome, defective induction of tumor necrosis factor-alpha, and carriage of the mannose-binding lectin codon 54 gene polymorphism. Am J Obstet Gynecol. 2008;198(1):101.e1–4.

    Google Scholar 

  46. Foster DC, Sazenski TM, Stodgell CJ. Impact of genetic variation in interleukin-1 receptor antagonist and melanocortin-1 receptor genes on vulvar vestibulitis syndrome. J Reprod Med. 2004;49:503.

    CAS  PubMed  Google Scholar 

  47. FitzGerald MP, Kotarinos R. Rehabilitation of the short pelvic floor. I: background and patient evaluation. Int Urogynecol J. 2003;14:261–8.

    CAS  Google Scholar 

  48. Reed B, Harlow S, Legocki L, et al. Oral contraceptive use and risk of vulvodynia: a population-based longitudinal study. BJOG. 2013;120:1678.

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Foster DC, Woodruff JD. Case-control study of vulvar vestibulitis syndrome. J Womens Health. 1995;4:677.

    Google Scholar 

  50. Bazin S, Bouchard C, Brisson J, et al. Vulvar vestibulitis syndrome: an exploratory case-control study. Obstet Gynecol. 1994;83:47.

    CAS  PubMed  Google Scholar 

  51. Bouchard C, Brisson J, Fortier M, et al. Use of oral contraceptive pills and vulvar vestibulitis: a case-control study. Am J Epidemiol. 2002;156:254.

    PubMed  Google Scholar 

  52. Harlow BL, Vitonis AF, Stewart EG. Influence of oral contraceptive use on the risk of adult-onset vulvodynia. J Reprod Med. 2008;53:102.

    PubMed  Google Scholar 

  53. Greenstein A, Ben-Aroya Z, Fass O, et al. Vulvar vestibulitis syndrome and estrogen dose of oral contraceptive pills. J Sex Med. 2007;4:1679.

    PubMed  Google Scholar 

  54. Burrows LJ, Goldstein AT. The treatment of Vestibulodynia with topical estradiol and testosterone. Sex Med. 2013;1:30.

    CAS  PubMed  PubMed Central  Google Scholar 

  55. Kingsberg S, Kellogg S, Krychman M. Treating dyspareunia caused by vaginal atrophy: a review of treatment options using vaginal estrogen therapy. Int J Womens Health. 2010;1:105–11.

    PubMed  PubMed Central  Google Scholar 

  56. Harlow BL, He W, Nguyen RHN. Allergic reactions and risk of vulvodynia. Ann Epidemiol. 2009;19:771.

    PubMed  PubMed Central  Google Scholar 

  57. Chaim W, Meriwether C, Gonik B, et al. Vulvar vestibulitis subjects undergoing surgical intervention: a descriptive analysis and histopathological correlates. Eur J Obstet Gynecol. 1996;68:165.

    CAS  Google Scholar 

  58. Farajun Y, Zarfati D, Abramov L, Livoff A, Bornstein J. Enoxaparin treatment for vulvodynia: a randomized controlled trial. Obstet Gynecol. 2012;120(3):565–72.

    CAS  PubMed  Google Scholar 

  59. Kakurai M, Monteforte R, Suto H, Tsai M, Nakae S, Galli SJ. Mast cell-derived tumor necrosis factor can promote nerve fiber elongation in the skin during contact hypersensitivity in mice. Am J Pathol. 2006;169(5):1713–21.

    CAS  PubMed  PubMed Central  Google Scholar 

  60. Harlow B, Stewart E. Adult-onset vulvodynia in relation to childhood violence victimization. Am J Epidemiol. 2005;161:871.

    PubMed  Google Scholar 

  61. Khandker M, Brady SS, Stewart EG, et al. Is chronic stress during childhood associated with adult-onset vulvodynia? J Womens Health. 2014;23:649.

    Google Scholar 

  62. Leclerc B, Bergeron S, Binik YM, et al. History of sexual and physical abuse in women with dyspareunia: association with pain, psychosocial adjustment, and sexual functioning. J Sex Med. 2010;7:971.

    PubMed  Google Scholar 

  63. Ayling K, Ussher JM. “If sex hurts, am I still a woman?” The subjective experience of vulvodynia in hetero-sexual women. Arch Sex Behav. 2008;37:294.

    PubMed  Google Scholar 

  64. Desrochers G, Bergeron S, Khalifé S, et al. Fear avoidance and self-efficacy in relation to pain and sexual impairment in women with provoked vestibulodynia. Clin J Pain. 2009;25:520–7.

    PubMed  Google Scholar 

  65. Nguyen RHN, Turner RM, Rydell SA, et al. Perceived stereotyping and seeking care for chronic vulvar pain. Pain Med. 2013;14:1461.

    PubMed  PubMed Central  Google Scholar 

  66. Landry T, Bergeron S, Dupuis M, et al. The treatment of provoked vestibulodynia: a critical review. Clin J Pain. 2008;24:155–71.

    PubMed  Google Scholar 

  67. Bornstein J, Abramovici H. Combination of sub-total perineoplasty and interferon for vulvar vestibulitis - a comparative study. Gynecol Obstet Invest. 1997;44:53–4.

    CAS  PubMed  Google Scholar 

  68. Bornstein J, Goldik Z, Stolar Z, et al. Predicting the outcome of surgical treatment of vulvar vestibulitis. Obstet Gynecol. 1997;89:695–8.

    CAS  PubMed  Google Scholar 

  69. Heddini U, Bohm-Starke N, Nilsson KW, et al. Provoked vestibulodynia—medical factors and comorbidity associated with treatment outcome. J Sex Med. 2012;9:1400–6.

    PubMed  Google Scholar 

  70. Snyder DS, Unanue ER. Corticosteroids inhibit murine macrophage 1a expression and interleukin 1 production. J Immunol. 1982;129:1803–5.

    CAS  PubMed  Google Scholar 

  71. Horowitz BJ. Interferon therapy for condylomatous vulvitis. Obstet Gynecol. 1989;73(3 Pt 1):446–8.

    CAS  PubMed  Google Scholar 

  72. Kieseier BC. The mechanism of action of interferon-β in relapsing multiple sclerosis. CNS Drugs. 2011;25(6):491–502.

    CAS  PubMed  Google Scholar 

  73. Foster DC, Hasday JD. Elevated tissue levels of interleukin-1b and tumor necrosis factor-a in vulvar vestibulitis. Obstet Gynecol. 1997;89:291–6.

    CAS  PubMed  Google Scholar 

  74. Bornstein J, Pascal B, Abramovici H. Intramuscular beta interferon treatment for severe vulvar vestibulitis. J Reprod Med. 1993;38:117–20.

    CAS  PubMed  Google Scholar 

  75. Bornstein J, Pascal B, Abramovici H. Long term follow up of patients treated for severe vulvar vestibulitis by intramuscular interferon beta administration. Isr J Obstet Gynecol. 1994;5:146–8.

    Google Scholar 

  76. Marinoff S, Turner M, Hirsch R, Richard G. Intralesional alpha interferon. Cost-effective therapy for vulvar vestibulitis syndrome. J Reprod Med. 1993;38:19–24.

    CAS  PubMed  Google Scholar 

  77. Kent HL, Wisniewski PM. Interferon for vulvar vestibulitis. J Reprod Med. 1990;35:1138–40.

    CAS  PubMed  Google Scholar 

  78. Nyirjesy P, Sobel JD, Weitz MV, et al. Cromolyn cream for recalcitrant idiopathic vulvar vestibulitis: results of a placebo controlled study. Sex Transm Infect. 2001;77:53–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  79. Crisp CC, Vaccaro CM, Estanol MV, Oakley SH, Kleeman SD, Fellner AN, Pauls RN. Intra-vaginal diazepam for high-tone pelvic floor dysfunction: a randomized placebo-controlled trial. Int Urogynecol J. 2013;24:1915–23.

    PubMed  Google Scholar 

  80. Cui M, Khanijou S, Rubino J, Aoki KR. Subcutaneous administration of botulinum toxin A reduces formalin-induced pain. Pain. 2004;107:125–33.

    CAS  PubMed  Google Scholar 

  81. Petersen CD, Giraldi A, Lundvall L, Kristensen E. Botulinum toxin type A e a novel treatment for provoked vestibulodynia? Results from a randomized, placebo controlled, double blinded study. J Sex Med. 2009;6:2523–37.

    CAS  PubMed  Google Scholar 

  82. Pelletier F, Parratte B, Penz S, et al. Efficacy of high doses of botulinum toxin A for treating provoked vestibulodynia. Br J Dermatol. 2011;164:617–22.

    CAS  PubMed  Google Scholar 

  83. Dystra DD, Presthus J. Botulinum toxin type A for the treatment of provoked vestibulodynia: an open-label pilot study. J Reprod Med. 2006;51:467–70.

    Google Scholar 

  84. Romito S, Bottanelli M, Pellegrini M, et al. Botulinum toxin for the treatment of genital pain syndromes. Gynecol Obstet Invest. 2004;58:164–7.

    CAS  PubMed  Google Scholar 

  85. Brown CS, Glazer HI, Vog V, Menkes D, Bachmann G. Subjective and objective outcomes of botulinum toxin type A treatment in vestibulodynia: pilot data. J Reprod Med. 2006;51:635–41.

    CAS  PubMed  Google Scholar 

  86. Hartmann D, Strauhal MJ, Nelson CA. Treatment of women in the United States with localized, provoked vulvodynia: practice survey of women’s health physical therapists. J Reprod Med. 2007;52:48.

    PubMed  Google Scholar 

  87. Vallinga MS, Spoelstra SK, Hemel IL, van de Wiel HB, Weijmar Schultz WC. Transcutaneous electrical nerve stimulation as an additional treatment for women suffering from therapy-resistant provoked vestibulodynia: a feasibility study. J Sex Med. 2015;12(1):228–37.

    PubMed  Google Scholar 

  88. Murina F, Graziottin A, Felice R, Radici G, Tognocchi C. Vestibulodynia: synergy between palmitoylethanolamide + transpolydatin and transcutaneous electrical nerve stimulation. J Low Genit Tract Dis. 2013;17(2):111–6.

    PubMed  Google Scholar 

  89. Cecilio SB, Zaghi S, Cecilio LB, Correa CF, Fregni F. Exploring a novel therapeutic approach with noninvasive cortical stimulation for vulvodynia. Am J Obstet Gynecol. 2008;199(6):e6–7.

    PubMed  Google Scholar 

  90. Morin A, Léonard G, Gougeon V, Cyr MP, Waddell G, Bureau YA, Girard I, Morin M. Efficacy of transcranial direct-current stimulation in women with provoked vestibulodynia. Am J Obstet Gynecol. 2017;216(6):584.e1–584.e11.

    Google Scholar 

  91. Haefner HK, Collins ME, Davis GD, Edwards L, Foster DC, Hartmann ED, Kaufman RH, Lynch PJ, Margesson LJ, Moyal-Barracco M, Piper CK, Reed BD, Stewart EG, Wilkinson EJ. The vulvodynia guideline. J Low Genit Tract Dis. 2005;9(1):40–51.

    PubMed  Google Scholar 

  92. Zolnoun DA, Hartmann KE, Steege JF. Overnight 5% lidocaine ointment for treatment of vulvar vestibulitis. Obstet Gynecol. 2003;102:84–7.

    CAS  PubMed  Google Scholar 

  93. Goetsch MF, Lim JY, Caughey AB. Locating pain in breast cancer survivors experiencing dyspareunia: a randomized controlled trial. Obstet Gynecol. 2014;123(6):1231–6.

    PubMed  Google Scholar 

  94. Rapkin AJ, McDonald JS, Morgan M. Multilevel local anesthetic nerve blockade for the treatment of vulvar vestibulitis syndrome. Am J Obstet Gynecol. 2008;198(41):e1–5.

    Google Scholar 

  95. Foster DC, Kotok MB, Huang L, et al. Oral desipramine and topical lidocaine for vulvodynia: a randomized controlled trial. Obstet Gynecol. 2010;116:583–93.

    CAS  PubMed  PubMed Central  Google Scholar 

  96. Bornstein J, Tuma R, Farajun Y, Azran A, Zarfati D. Topical nifedipine for the treatment of localized provoked vulvodynia: a placebo-controlled study. J Pain. 2010;11(12):1403–9.

    CAS  PubMed  Google Scholar 

  97. Goldstein AT, Pukall CF, Brown C, Bergeron S, Stein A, Kellogg-Spadt S. Vulvodynia: assessment and treatment. J Sex Med. 2016;13(4):572–90.

    PubMed  Google Scholar 

  98. Stockdale CK, Lawson HW. 2013 vulvodynia guideline update. J Low Genit Tract Dis. 2014;18(2):93–100.

    PubMed  Google Scholar 

  99. Danielsson I, Torstensson T, Brodda-Jansen G, et al. EMG biofeedback versus topical lidocaine gel: a randomized study for the treatment of women with vulvar vestibulitis. Acta Obstet Gynecol Scand. 2006;85:1360–7.

    PubMed  Google Scholar 

  100. Baron R. Capsaicin and nociception: from basic mechanism to novel drug. Lancet. 2000;356:785–6.

    CAS  PubMed  Google Scholar 

  101. Andrews JC. Vulvodynia interventions--systematic review and evidence grading. Obstet Gynecol Surv. 2011;66(5):299–315.

    PubMed  Google Scholar 

  102. Bornstein J, Zarfati D, Goldik Z, Abramovici H. Vulvar vestibulitis: physical or psychosexual problem. Obstet Gynecol. 1999;93:876–80.

    CAS  PubMed  Google Scholar 

  103. Har-Toov J, Militscher I, Lessing JB, Abramov L, Chen J. Combined vulvar vestibulitis syndrome with vaginismus: which to treat first? J Sex Marital Ther. 2001;27:521–3.

    CAS  PubMed  Google Scholar 

  104. Bornstein J, Zarfati D, Goldik Z, Abramovici H. Perineoplasty versus vestibuloplasty for severe vulvar vestibulitis: a randomized comparison. Br J Obstet Gynecol. 1995;102:652–5.

    CAS  Google Scholar 

  105. Bornstein J, Goldik Z, Stolar Z, Zarfati D, Abramovici H. Predicting the outcome of surgical treatment for vulvar vestibulitis. Obstet Gynecol. 1997;89:695–8.

    CAS  PubMed  Google Scholar 

  106. Tommola P, Unkila-Kallio L, Paavonen J. Surgical treatment of vulvar vestibulitis: a review. Acta Obstet Gynecol Scand. 2010;89:1385–95.

    PubMed  Google Scholar 

  107. Bergeron S, Khalifé S, Glazer HI, et al. Surgical and behavioral treatments for vestibulodynia: two-and-one-half year follow-up and predictors of outcome. Obstet Gynecol. 2008;111:159–66.

    PubMed  Google Scholar 

  108. Woodruff JD, Parmley TH. Infection of the minor vestibular gland. Obstet Gynecol. 1983;62(5):609–12.

    CAS  PubMed  Google Scholar 

  109. Burrows LJ, Sloane M, Davis G, Heller DS, Brooks J, Goldstein AT. Parturition after vestibulectomy. J Sex Med. 2011;8:303–5.

    PubMed  Google Scholar 

  110. Corsini-Munt S, Bergeron S, Rosen NO, et al. Feasibility and preliminary effectiveness of a novel cognitive behavioral couple therapy for provoked vestibulodynia: a pilot study. J Sex Med. 2014;11:2515–27.

    PubMed  Google Scholar 

  111. Wan EL, Goldstein AT, Tolson H, Dellon AL. Injury to perineal branch of pudendal nerve in women: outcome from resection of the perineal branches. J Reconstr Microsurg. 2017;33:395–401.

    PubMed  Google Scholar 

  112. Bornstein J, Goldik Z, Alter Z, Zarfati D, Abramovici H. Persistent vulvar vestibulitis- the continuing challenge. Obstet Gynecol Surv. 1997;53:39–44.

    Google Scholar 

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  1. Department of Obstetrics and Gynecology Galilee Medical Center, Bar-Ilan University Faculty of Medicine, Nahariya, Israel

    Jacob Bornstein

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  1. Department of Obstetrics and Gynecology Galilee Medical Center, Bar-Ilan University Faculty of Medicine, Nahariya, Israel

    Jacob Bornstein

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Bornstein, J. (2019). Vulvar Pain and Vulvodynia. In: Bornstein, J. (eds) Vulvar Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-61621-6_54

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