Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain.
Gynecology Section, Clinical Area of Women's Diseases, La Fe University Hospital, 46010 Valencia, Spain.
Int J Environ Res Public Health. 2021 Jun 21;18(12):6639. doi: 10.3390/ijerph18126639.
Vulvodynia is one the most common causes of pain during sexual intercourse in premenopausal women. The burden of vulvodynia in a woman's life can be devastating due to its consequences in the couple's sexuality and intimacy, in activities of daily living, and psychological well-being. In recent decades, there has been considerable progress in the understanding of vulvar pain. The most significant change has been the differentiation of vulvar pain secondary to pathology or disease from vulvodynia. However, although it is currently proposed that vulvodynia should be considered as a primary chronic pain condition and, therefore, without an obvious identifiable cause, it is still believed that different inflammatory, genetic, hormonal, muscular factors, etc. may be involved in its development. Advances in pain neuroscience and the central sensitization paradigm have led to a new approach to vulvodynia from a neurobiological perspective. It is proposed that vulvodynia should be understood as complex pain without relevant nociception. Different clinical identifiers of vulvodynia are presented from a neurobiological and psychosocial perspective. In this case, strategies to modulate altered central pain processing is necessary, changing the patient's erroneous cognitions about their pain, and also reducing fear avoidance-behaviors and the disability of the patient.
外阴痛是绝经前妇女性交过程中疼痛的最常见原因之一。由于外阴痛对夫妻性生活和亲密关系、日常生活活动以及心理健康的影响，其对女性生活的影响可能是毁灭性的。近几十年来，人们对外阴疼痛的认识有了相当大的进展。最重要的变化是将继发于病理或疾病的外阴疼痛与外阴痛区分开来。然而，尽管目前提出外阴痛应被视为一种原发性慢性疼痛疾病，因此没有明显可识别的病因，但仍认为不同的炎症、遗传、激素、肌肉等因素可能参与其发展。疼痛神经科学和中枢敏化范式的进步使人们从神经生物学的角度对外阴痛有了新的认识。有人提出，外阴痛应被理解为无相关伤害感受的复杂疼痛。从神经生物学和心理社会的角度提出了不同的外阴痛临床标识。在这种情况下，有必要调节中枢疼痛处理的改变，改变患者对疼痛的错误认知，减少恐惧回避行为和患者的残疾。
