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.
The NIH Research Plan on Vulvodynia (PDF - 747 KB), developed by 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 Gynecologic Health and Disease Branch (GHDB) leads the Institute's research initiatives relative to vulvodynia. Research supported by these Branches includes the following initiatives:
- Researchers are testing whether localized provoked vulvodynia (LPV) arises from activation of pro-inflammatory fibroblasts by yeast and other irritants and whether specific genetic changes predispose women for LPV. The study will look for the presence of fibroblasts at painful sites in women with LPV and will determine the specific species of yeast these women have. The study will also investigate the relationship between functioning of the melancortin-1 receptor and localized fibroblast activation.
- By combining advanced brain imaging with clinical assessments, researchers aim to identify unique "brain signatures" in how vulvodynia patients process pain. The researchers hypothesize that such brain signatures could predict treatment outcomes and be helpful in finding effective treatments for vulvodynia.
- Scientists are studying the underlying mechanisms that may lead to vulvodynia. Using comprehensive clinical exams of the vulvar mucosa and muscle, they will explore the role of altered pain regulation, such as abnormal central pain processing at the spine, and psychological distress in vulvodynia pain.
- Researchers conducted 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.
- A long-term, population-based study of genetic and hormonal influences on the occurrence and remission of vulvodynia, involving 2,500 women, examined 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. The researchers found that women with vulvodynia were more likely than other women to also have another chronic pain condition, such as fibromyalgia, interstitial cystitis, or irritable bowel syndrome. Recently, researchers reported that there was no association between oral contraceptive use and vulvodynia.
- A study of immune system factors and vulvodynia risk suggests that vulvodynia may result from an altered immune-inflammatory response mechanism that is a consequence of reproductive, gynecologic, environmental, or psychological exposures. Researchers tested whether the first three of these exposures or psychological trauma and morbidity influence the odds of having vulvodynia. They also examined markers of immuno-inflammation and the proliferation of nerve fibers.
- Researchers are using a mouse model of vestibulodynia, the most common form of vulvodynia, to examine neural consequences of vestibular inflammation as well as the effect of estrogen on neuronal activity. The study will also assess the role of the angiotensin II receptor type 2, a potential therapeutic target for vulvodynia.
- Investigators leading a study of methods of evaluating and classifying pelvic pain 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.
- Currently, the diagnosis of PVD, 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. NICHD-supported research aims to refine the diagnosis of chronic vulvar pain by establishing the reliability and reproducibility of quantitative assessment tools to evaluate vulvodynia. The researchers recently found that many women with vulvodynia also have anxiety and musculoskeletal dysfunction. They suggested that women be screened for these conditions at the same time as the evaluation for vulvodynia.
NICHD's Division of Intramural Research also contributes to vulvodynia research through research conducted through several labs in the Program in Reproductive and Adult Endocrinology. These include studies on the underlying physiology, diagnosis, and treatment of reproductive disorders.
- In 2016, NICHD reissued funding opportunity announcements that are designed to stimulate new research applications in the exploration of etiology, prevention, diagnosis, and therapeutics in the field of vulvodynia:
- In 2011, 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 (PDF - 747 KB).
NICHD participates in the NIH Pain Consortium, a multidisciplinary, trans-NIH effort to advance the agenda of pain research.