What are the causes of vulvodynia?

Myofascial or Other Biomechanical Disorders are a Primary Cause of Vulvodynia

Myofascial or other biomechanical disorders (option D) are the correct answer as a cause of vulvodynia. The evidence strongly supports that pelvic floor muscle dysfunction and myofascial factors play a significant role in the development and maintenance of vulvodynia.

Understanding Vulvodynia and Its Causes

Vulvodynia is defined as vulvar pain or burning sensation lasting more than 3 months without an identifiable cause 1. It affects approximately 8-10% of women of all ages and can significantly impair quality of life 1, 2.

Primary Causes of Vulvodynia:

1. Myofascial and Biomechanical Disorders:

   • Pelvic floor muscle dysfunction is a well-established contributor to vulvodynia 3, 1
   • Physical therapy targeting these myofascial issues shows strong evidence of effectiveness 3, 4
   • Biomechanical factors create a complex interplay with peripheral and central pain mechanisms 1

2. Other Potential Contributing Factors:

   • Neuroproliferative changes and central sensitization
   • Psychological factors (anxiety, depression)
   • Genetic predisposition
   • History of trauma or abuse

Why Other Options Are Not Primary Causes

A. Recurrent Candidiasis

While vulvovaginal candidiasis (VVC) can cause vulvar symptoms including pruritus, vaginal discharge, soreness, burning, and dyspareunia 5, 6, it is not considered a primary cause of vulvodynia. Candidiasis has identifiable causes and responds to antifungal treatment 5, whereas vulvodynia is defined as pain without identifiable cause 1.

B. Decreasing Hormones of Menopause

Hormonal changes during menopause can cause vulvovaginal atrophy leading to pain, but this is distinct from vulvodynia 7. As noted in the evidence: "While correction of vulvovaginal atrophy is an important part of the management of these patients, it will usually be insufficient to manage vulvodynia" 7. This indicates that hormonal factors alone do not explain vulvodynia.

C. Obstetric Trauma

While trauma may potentially contribute to vulvar pain, there is insufficient evidence in the provided literature to establish obstetric trauma as a primary cause of vulvodynia. The evidence does not specifically link obstetric trauma to vulvodynia development.

Treatment Approaches Supporting Myofascial Etiology

The effectiveness of treatments targeting myofascial dysfunction provides further evidence for its role as a primary cause:

• Pelvic floor physical therapy shows strong evidence of effectiveness 3, 4
• Multimodal physical therapy demonstrates pre-to-post test reduction in vulvar pain 4
• Muscle relaxants like botulinum toxin have shown benefit in randomized controlled trials 4

Clinical Implications

Understanding that myofascial and biomechanical disorders are a primary cause of vulvodynia guides treatment:

1. Pelvic floor physical therapy should be considered a first-line treatment
2. Assessment of pelvic floor muscle function is essential in evaluation
3. Treatments targeting muscle dysfunction (relaxation techniques, biofeedback) are appropriate

In conclusion, while vulvodynia likely has multiple contributing factors, the evidence most strongly supports myofascial or other biomechanical disorders as a primary cause, making option D the correct answer.