Vulvodynia is a common problem among women, and the pain associated with this disorder can cause not only great physical anguish but also emotional distress. In the absence of effective treatments that can be applied widely, it is important that researchers gain a greater understanding of the disease's causes, develop better treatments, and, if possible, learn how to prevent vulvodynia altogether. The NICHD conducts and supports research in a variety of areas related to vulvodynia, from basic science to clinical research.
Institute Activities and Advances
The Research Plan on Vulvodynia (PDF - 681 KB), developed by the NICHD in collaboration with other federal, private, and nonprofit agencies and researchers in the field, lays out an agenda for the rigorous scientific research needed to answer questions and fill in knowledge gaps about vulvodynia. The agenda builds on ongoing vulvodynia research and seeks to advance the field by enhancing capacity for conducting research related to vulvodynia. In addition, the plan aims to apprise the research community of scientific goals for vulvodynia research and to foster collaborations among agencies and organizations interested in the topic.
The Institute's current research in the area of vulvodynia includes the study of an epilepsy drug to reduce women's pain levels, investigation into genetic and hormonal influences on vulvodynia, and an examination of the role of immune factors. The Institute's portfolio also includes an investigation of the relationship of hormones to pelvic pain, including pain from vulvodynia; an inquiry into methods for evaluating and classifying pelvic pain; and studies of ways to refine and thus improve the diagnosis of chronic vulvar pain.
The Gynecologic Health and Disease Branch (GHDB)
and the Fertility and Infertility (FI) Branch
lead the Institute's research initiatives relative to vulvodynia. Research currently supported by these Branches includes the following initiatives:
- In the clinical trial of an anti-seizure drug to reduce the pain of vulvodynia, researchers are conducting a randomized, controlled trial of the drug gabapentin, which is currently used to control epileptic seizures, to treat pain among women with provoked vestibulodynia (PVD), a type of localized vulvar pain. Researchers selected this medication to study because of its efficacy in treating other neuropathic pain conditions and the promising data on its use in PVD.
- The long-term study of genetic and hormonal influences on the occurrence and remission of vulvodynia, a population-based study involves 2,500 women, is examining whether women with vulvodynia have an increased prevalence of one or more genetic polymorphisms that are associated with pain, and whether the risk of vulvodynia is influenced by the use of exogenous hormones, such as oral contraceptives and hormone therapy.
- Immune system factors and risk for vulvodynia32,33 suggests that vulvodynia may result from an altered immune-inflammatory response mechanism that is a consequence of reproductive, gynecologic, environmental, or psychological exposures. Researchers are testing whether the first three of these exposures or psychological trauma and morbidity influence the odds of having vulvodynia. They are also examining markers of immuno-inflammation and the proliferation of nerve fibers.
- To examine the Relationship of hormones to pelvic pain, including pain from vulvodynia, researchers are employing a variety of methods to learn more about the mechanisms that underlie hormone-dependent remodeling of the nerve supply (innervation) of the vagina and whether altered innervation may contribute to vaginal dysfunction. These studies may lead to new therapeutics aimed at reversing hyperinnervation of the vagina
- Investigators leading the Methods of evaluating and classifying pelvic pain study are assessing the physiology of pain in disease states and characterizing the psychological determinants of the pain experience. Having valid measures of pain in the pelvic floor will allow the rational application of a variety of treatments, such as physical therapy, medications, cognitive-behavioral therapy, and injections of botulinum toxins.
- Refining the diagnosis of chronic vulvar pain. Currently, the diagnosis of vulvar vestibulitis syndrome, the most common form of vulvodynia, relies on rather crude measures, such as using a cotton swab to apply gentle pressure to various vulvar sites and relying on the patient's own reports of pain. Research is now under way to establish the reliability and reproducibility of quantitative assessment tools to evaluate vulvodynia.
The NICHD's Division of Intramural Research also contributes to vulvodynia research through research conducted through several units in the Program in Reproductive and Adult Endocrinology . These include studies on the underlying physiology, diagnosis, and treatment of reproductive disorders.
Other Activities and Advances
- On July 11 and 12, 2011, the NICHD and the NIH Office of Research on Women’s Health (ORWH) sponsored a meeting, Vulvodynia: A Chronic Pain Condition-Setting a Research Agenda, to continue focused efforts to understand vulvodynia. More than 75 researchers and members of organizations and agencies interested in the condition took part. This meeting was a key part of the process for developing the NIH Research Plan on Vulvodynia.
- In 2007, the NICHD joined the NIH ORWH, the National Institute of Neurological Disorders and Stroke, the NIH Pain Consortium, and other partners to establish the Vulvodynia Awareness Campaign. The campaign aimed to raise awareness among women and health care providers about the condition to help improve care for women with vulvodynia.
- The NICHD participates in the NIH Pain Consortium, a multidisciplinary, trans-NIH effort to advance the agenda of pain research.