The approach to vulvar disease, which has been changed lately, has led to the introduction of the new terminologies for vulvar conditions: The IFCPC clinical and colposcopic terminology, The ISSVD terminology of Vulvar Squamous Intraepithelial Lesions (Table 1) and the consensus terminology of vulvar pain and vulvodynia (Tables 2 and 3).
Table 1: 2015 ISSVD Terminology of Vulvar Squamous Intraepithelial Lesions
Low grade squamous intraepithelial lesion of the vulva [Vulvar LSIL]
High grade squamous intraepithelial lesion of the vulva [Vulvar HSIL]
Vulvar Intraepithelial neoplasia [VIN], differentiated-type [DVIN]
Table 2: 2015 Consensus terminology and classification of persistent vulvar pain and vulvodynia
A. Vulvar pain caused by a specific disorder*
· Infectious
· Inflammatory
· Neoplastic
· Neurologic
· Trauma
· Iatrogenic
· Hormonal deficiencies
B. Vulvodynia – Vulvar pain of at least 3 months' duration, without clear identifiable cause, which may have potential associated factors
Descriptors:
· Localized (e.g. vestibulodynia, clitorodynia) or Generalized or Mixed (localized and generalized)
· Provoked (e.g. insertional, contact) or Spontaneous or Mixed (provoked and spontaneous)
· Onset (primary or secondary)
· Temporal pattern (intermittent, persistent, constant, immediate, delayed)
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*Women may have both a specific disorder (e.g. lichen sclerosus) and vulvodynia
Table 3: 2015 Consensus terminology and classification of persistent vulvar pain and vulvodynia
Appendix: Potential factors associated with Vulvodynia*
· Co-morbidities and other pain syndromes (e.g. painful bladder syndrome, fibromyalgia, irritable bowel syndrome, temporomandibular disorder) [LOE 2]
· Genetics [LOE 2]
· Hormonal factors (e.g. pharmacologically induced) [LOE 2]
· Inflammation [LOE 2]
· Musculoskeletal (e.g. pelvic muscle overactivity, myofascial, biomechanical) [LOE 2]
· Neurologic mechanisms:
Central (spine, brain) [LOE 2]
Peripheral – Neuroproliferation [LOE 2]
· Psychosocial factors (e.g. mood, interpersonal, coping, role, sexual function) [LOE 2]
· Structural defects (e.g. perineal descent) [LOE 3]
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*The factors are ranked by alphabetical order
LOE - Level of evidence