Zolnoun Denniz, Hartmann Katherine, Lamvu Georgine, As-Sanie Suzie, Maixner William, Steege John
Division of Advanced Laparoscopy and Pelvic Pain, Department of Obstetrics and Gynecology, and Center for Women's Health Research, University of North Carolina, Chapel Hill, North Carolina 27599-7570, USA.
Obstet Gynecol Surv. 2006 Jun;61(6):395-401; quiz 423. doi: 10.1097/01.ogx.0000219814.40759.38.
Vulvar vestibulitis syndrome (vestibulitis), the most common type of chronic vulvovaginal pain, impairs the psychologic, physical, and reproductive health of approximately 10% of women at some point in their lives. Research on the pathophysiology of vestibulitis suggests abnormalities in 3 interdependent systems: vestibular mucosa, pelvic floor muscles, and central nervous system pain regulatory pathways. To date, causes and relative contributions of these abnormalities to the development and maintenance of vestibulitis remain poorly understood. Research consistently supports the conceptualization of vestibulitis as a chronic pain disorder-akin to fibromyalgia, irritable bowel disorder, and temporomandibular disorder (TMD)-that is far more complex than vestibular hypersensitivity alone. Nevertheless, the clinical diagnosis of vestibulitis continues to rely on subjective report of pain during intercourse and vestibular sensitivity on clinical examination after exclusion of other gynecologic disorders. We propose that current diagnostic criteria, which are based on highly subjective patient and clinician measures, are not sufficient to describe and properly classify the heterogeneous clinical presentations of this disorder. To inform clinical care or research, we must be able to objectively characterize women with vestibulitis. This narrative review critically appraises current conceptualization of vestibulitis and presents a context for studying vestibulitis as a chronic pain disorder, emphasizing the need for objective assessment of clinical features.
Obstetricians & Gynecologists, Family Physicians.
After completion of this article, the reader should be able to state that vulvar vestibulitis is common; recall that the disorder has three major pathophysiological pathways and that understanding of these pathways is important in selecting treatment options, and explain that the clinician must attempt to properly classify the clinical presentations of the disorder.
外阴前庭炎综合征（前庭炎）是慢性外阴阴道疼痛最常见的类型，在大约10%的女性一生中的某个阶段会损害其心理、身体和生殖健康。对前庭炎病理生理学的研究表明，在3个相互依存的系统中存在异常：前庭黏膜、盆底肌肉和中枢神经系统疼痛调节通路。迄今为止，这些异常对前庭炎发生和持续存在的原因及相对作用仍知之甚少。研究一致支持将前庭炎概念化为一种慢性疼痛疾病，类似于纤维肌痛、肠易激综合征和颞下颌关节紊乱症（TMD），其远比单纯的前庭超敏反应复杂。然而，前庭炎的临床诊断仍依赖于性交时疼痛的主观报告以及排除其他妇科疾病后临床检查时的前庭敏感性。我们认为，基于高度主观的患者和临床医生测量的现行诊断标准，不足以描述和正确分类该疾病的异质性临床表现。为了指导临床护理或研究，我们必须能够客观地表征患有前庭炎的女性。这篇叙述性综述批判性地评估了当前前庭炎的概念，并为将前庭炎作为一种慢性疼痛疾病进行研究提供了背景，强调了对临床特征进行客观评估的必要性。
妇产科医生、家庭医生。
阅读本文后，读者应能够指出外阴前庭炎很常见；回忆起该疾病有三条主要病理生理途径，并且了解这些途径对选择治疗方案很重要；并解释临床医生必须尝试正确分类该疾病的临床表现。
