de Belilovsky C
Consultation de dermatologie-pathologie vulvaire, institut Alfred-Fournier, 25, boulevard Saint-Jacques, 75014 Paris, France.
Gynecol Obstet Fertil. 2013 Sep;41(9):505-10. doi: 10.1016/j.gyobfe.2013.06.008. Epub 2013 Aug 22.
Provoked vestibulodynia represents the most frequent cause of dyspareunia before menopause. Vulvodynia's pain and burning sensations are related to neuropathic pain and associated to various degrees of vulvar mucosal hypersensitivity (mostly in the vestibular area), pelvic floor muscles dysfunction, a disorder of general perception of pain and/or various complex regional pain syndromes such as fibromyalgia, glossodynia, painful bladder syndrome (interstitial cystitis)… Vaginal infections such as candidiasis and vaginosis are important trigger and risk factors. Women suffering from vulvodynia are often described as vulnerable, pessimistic, developing feelings of guilt towards their partner. They tend to be hyper vigilant to their pain and develop catastrophizing reactions (rumination, magnification and helplessness) and avoidance/escape behaviors (fear-avoidance model). Diagnosis is based on medical history, clinical examination (Q-tip test) and exclusion of vaginitis. Treatment consists of a multidisciplinary approach involving topical therapies (emollients, anesthetics, hormonotherapy if necessary), pelvic floor physiotherapy with electromyographic biofeedback, drug treatment of pain with antidepressants (amitriptyline…) or anticonvulsants (pregabaline…) and a psychosexual support.
激发性前庭痛是绝经前性交困难最常见的原因。外阴痛的疼痛和烧灼感与神经性疼痛有关，并伴有不同程度的外阴黏膜超敏反应（主要在前庭区域）、盆底肌肉功能障碍、疼痛的一般感知障碍和/或各种复杂区域疼痛综合征，如纤维肌痛、舌痛、膀胱疼痛综合征（间质性膀胱炎）……念珠菌病和阴道病等阴道感染是重要的触发因素和危险因素。患有外阴痛的女性常被描述为脆弱、悲观，对伴侣产生内疚感。她们往往对自己的疼痛过度警惕，并产生灾难化反应（反复思考、放大和无助）以及回避/逃避行为（恐惧-回避模型）。诊断基于病史、临床检查（棉签试验）以及排除阴道炎。治疗采用多学科方法，包括局部治疗（润肤剂、麻醉剂、必要时的激素治疗）、采用肌电图生物反馈的盆底物理治疗、用抗抑郁药（阿米替林……）或抗惊厥药（普瑞巴林……）进行疼痛药物治疗以及性心理支持。
