Velikonja Leah, Giovannetti Olivia, Adams Michael A, Tomalty Diane
Department of Biomedical and Molecular Science, Queen's University, Kingston, Canada.
Clin Anat. 2023 Jan;36(1):18-27. doi: 10.1002/ca.23966. Epub 2022 Oct 19.
Pain of the vulvar vestibule, including provoked vestibulodynia, is prevalent among women, yet challenging to treat due to its multifactorial etiology. Recent evidence indicates a neuroproliferative subtype in which hypersensitivity of the vulvar vestibule is due, in part, to hyperinnervation. Detailed knowledge regarding the innervation of the vulvar vestibule is crucial to understanding and treating pain conditions impacting this region. The purpose of this review is to consolidate the current evidence regarding the innervation of the human vulvar vestibule and discuss the implications of this innervation for pathological conditions affecting this tissue. A comprehensive review of the literature was conducted using keywords including vulvar vestibule, innervation, and vestibulodynia to identify articles concerning the innervation of the vulvar vestibule. Fifteen studies published between 1998 and 2017 were reviewed. Evidence from immunohistochemical investigations support that the vulvar vestibule has nociceptive, mechanosensory, sympathetic, and parasympathetic innervation. In pathological samples, hyperinnervation supports the neuroproliferative etiology of provoked vestibulodynia. Additionally, there is some evidence supporting the role of the pudendal nerve in vulvar vestibule innervation, although no cadaveric studies have been reported to date. Progress has been made in our understanding of the innervation of the vulvar vestibule, though further research into the origin of sensory and autonomic innervation of this region is needed. Advancing the knowledge of vulvar vestibule innervation is crucial towards improving our understanding of the function of this tissue, in addition to informing the etiology and management of pain syndromes impacting this region.
外阴前庭疼痛，包括激发性前庭痛，在女性中很常见，但由于其多因素病因，治疗具有挑战性。最近的证据表明存在一种神经增生亚型，其中外阴前庭的超敏反应部分归因于神经支配过度。关于外阴前庭神经支配的详细知识对于理解和治疗影响该区域的疼痛状况至关重要。本综述的目的是整合关于人类外阴前庭神经支配的现有证据，并讨论这种神经支配对影响该组织的病理状况的影响。使用包括外阴前庭、神经支配和前庭痛在内的关键词对文献进行了全面综述，以识别有关外阴前庭神经支配的文章。对1998年至2017年间发表的15项研究进行了综述。免疫组织化学研究的证据支持外阴前庭具有伤害性、机械性感觉、交感和副交感神经支配。在病理样本中，神经支配过度支持激发性前庭痛的神经增生病因。此外，有一些证据支持阴部神经在外阴前庭神经支配中的作用，尽管迄今为止尚未有尸体研究报告。我们对外阴前庭神经支配的理解取得了进展，不过仍需要进一步研究该区域感觉和自主神经支配的起源。除了为影响该区域的疼痛综合征的病因和管理提供信息外，增进对外阴前庭神经支配的了解对于提高我们对该组织功能的认识至关重要。
