What is special about the vulvar vestibule?

Farmer, Melissa A.

doi:10.1097/j.pain.0000000000000094

Cited by 4 publications

(3 citation statements)

References 11 publications

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“…Few mechanistic LPV studies have been performed, warranting the development of new models for studying disease. [30][31][32][33][34][35]39,40,113 Because of the challenges in quantifying pain and the limitations of any one model, we have pursued animal, cellular, and tissue models of vulvodynia. [30][31][32][33][34]39 We have also implemented new technologies for studying LPV, such as targeted lipidomic analysis, which provides a comprehensive assessment of key lipids involved in resolution and inflammation.…”

Section: Discussionmentioning

confidence: 99%

Inflammation, lipid dysregulation, and transient receptor potential cation channel subfamily V member 4 signaling perpetuate chronic vulvar pain

Bekauri,

Fischer,

Honn

et al. 2023

Pain

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Localized provoked vulvodynia is characterized by chronic vulvar pain that disrupts every aspect of the patient's life. Pain is localized to the vulvar vestibule, a specialized ring of tissue immediately surrounding the vaginal opening involved in immune defense. In this article, we show inflammation is the critical first step necessary for the generation of pain signals in the vulva. Inflammatory stimuli alone or combined with the transient receptor potential cation channel subfamily V member 4 (TRPV4) agonist 4α-phorbol 12,13-didecanoate stimulate calcium flux into vulvar fibroblast cells. Activity is blocked by the TRPV4 antagonist HC067047, denoting specificity to TRPV4. Using lipidomics, we found pro-resolving lipids in the vulvar vestibule were dysregulated, characterized by a reduction in pro-resolving mediators and heightened production of inflammatory mediators. We demonstrate specialized pro-resolving mediators represent a potential new therapy for vulvar pain, acting on 2 key parts of the disease mechanism by limiting inflammation and acutely inhibiting TRPV4 signaling.

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Section: Discussionmentioning

confidence: 99%

Inflammation, lipid dysregulation, and transient receptor potential cation channel subfamily V member 4 signaling perpetuate chronic vulvar pain

Bekauri,

Fischer,

Honn

et al. 2023

Pain

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“…The sensory nerve endings of the vulvar vestibule are dense and shallow, making this region more physiologically sensitive. 20 We can speculate that a thinner and delicate vestibular mucosa is more sensitive to nociception because nerve endings become more superficial, thus altering the transduction of mechanical pressure to facilitate nociception.…”

Section: Discussionmentioning

confidence: 99%

“…The sensory nerve endings of the vulvar vestibule are dense and shallow, making this region more physiologically sensitive. 20 …”

Section: Discussionmentioning

confidence: 99%

Vestibular Mucosa Thickness Measured by Ultrasound in Patients Affected by Vestibulodynia: A Case-Control Study

et al. 2021

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Introduction: A multifactorial etiology has been implicated in the development and maintenance of vestibulodynia (VBD), and atrophic changes of the vestibular mucosa have been observed in many patients. Aim: To assess the vestibular mucosa thickness in patients with VBD by comparing this sample with a control group of healthy fertile women and postmenopausal patients with symptoms of genitourinary syndrome of menopause (GSM). Methods: Vestibular mucosa thickness was measured with a 20 MHz ultrasound probe (DermaScan C, Cortex Technology, Denmark), including both the epidermis and dermis. Main outcome measures: All women were evaluated by anamnesis, physical examination, and self-report symptoms. Thickness of the vestibular mucosa (expressed in micrometers) was determined by the B-mode, excluding the hyperechogenic entrance echo and hypoechogenic subcutis. Clinical data related to VBD and GSM were recorded using a 0-to 10-point visual analog scale related to dyspareunia and vulvar pain/burning (0 ¼ no pain; 10 ¼ worst possible pain). Results: A total of 85 patients were recruited: 24 with VBD, 20 with GSM-related symptoms, and 20 matched controls. Vestibular mucosa thickness measurements were not significantly different between the VBD (mean ± DS: 1,092.5 ± 226.1 mm) and GSM groups (1,059.7 ± 221.5 mm), while the parameter was significantly lower (P < .01) than the control group (1,310.6 ± 250.0 mm). Correlation analysis in the VBD and GSM groups between low vestibular mucosa thickness and symptom intensity (burning/pain and dyspareunia) showed a significant correlation. Conclusion: Patients with VBD have a vestibular mucosa with a lower thickness than healthy women of the same age, with an almost identical value to that found in postmenopausal women. Furthermore, a low vestibular mucosa thickness in the VBD and GSM groups showed a significant correlation with burning/pain intensity and dyspareunia severity.

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Vulvodynia: Definition, Prevalence, Impact, and Pathophysiological Factors

Pukall

Goldstein

Bergeron

et al. 2016

The Journal of Sexual Medicine

235

141

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Introduction Vulvodynia constitutes a highly prevalent form of chronic genital pain in women, and current information regarding its definition, prevalence, impact, and pathophysiologic factors involved is needed. Aim To update the scientific evidence published in 2010 from the Third International Consultation of Sexual Medicine pertaining to the definition, prevalence, impact, and pathophysiologic factors of women's sexual pain. Methods An expert committee, as part of the Fourth International Consultation of Sexual Medicine, comprised of researchers and clinicians from biological and social science disciplines, reviewed the scientific evidence on the definition, prevalence, impact, and pathophysiologic factors related to chronic genital pain. Main Outcome Measures A review of the definition, prevalence, impact, and pathophysiological factors involved in vulvodynia. Results Vulvodynia is a prevalent and highly impactful genital pain condition. Numerous factors have been implicated in its development and maintenance. Conclusion What is becoming increasingly apparent is that it likely represents the end point of different factors that can differ from patient to patient. Longitudinal research is needed to shed light on risk factors involved in the expression of vulvodynia, as well as in potential subgroups of affected patients, in order to develop an empirically supported treatment algorithm.

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What is special about the vulvar vestibule?

Cited by 4 publications

References 11 publications

Inflammation, lipid dysregulation, and transient receptor potential cation channel subfamily V member 4 signaling perpetuate chronic vulvar pain

Inflammation, lipid dysregulation, and transient receptor potential cation channel subfamily V member 4 signaling perpetuate chronic vulvar pain

Vestibular Mucosa Thickness Measured by Ultrasound in Patients Affected by Vestibulodynia: A Case-Control Study

Vulvodynia: Definition, Prevalence, Impact, and Pathophysiological Factors

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