Vulvodinia: clasificación, etiología, diagnóstico y manejo. Revisión sistemática de la literatura

  • Pio Iván Gómez-Sánchez
  • Juan Guillermo Chalela
  • Hernando Gaitán-Duarte


Objetivo: revisar la literatura del dolor vulvar en aspectos relativos a la clasificación, etiología, diagnóstico y abordaje terapéutico, como una guía que ayude al personal de salud a enfrentar este problema.

Metodología: búsqueda en las librerías electrónicas: Hinari, Pubmed/Medline, Cochrane, SciELO, Lilacs, Core Collections y E-Clinics. Además, se buscó información en textos clásicos de dermatología, ginecología y textos de patología vulvar, así como resúmenes de congresos.

Resultados: el dolor vulvar es un problema frecuente, se considera que tiene etiología multifactorial, sin embargo, la evidencia que soporta las hipótesis causales es débil. No hay un patrón de oro diagnóstico por lo que los estudios evalúan la capacidad para discriminar los criterios clínicos y su repetibilidad. En cuanto al tratamiento es inicialmente médico y como último recurso quirúrgico. La evidencia está constituida por pocos ensayos clínicos aleatorizados con tamaño muestral pequeño, series de casos y revisiones narrativas.

Conclusiones: La evidencia sobre etiología, diagnóstico y tratamiento de dolor vulvar es débil.


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Biografía del autor/a

Pio Iván Gómez-Sánchez
Ginecólogo y Epidemiólogo. Profesor Titular Departamento de Obstetricia y Ginecología. Universidad Nacional de Colombia. Miembro de International Association for Study of Pain. Bogotá, Colombia.
Juan Guillermo Chalela
Medico Internista y Dermatólogo. Profesor Emérito Universidad Militar Nueva Granada, Médico adscrito Fundación Santa Fe de Bogotá. Bogotá, Colombia.
Hernando Gaitán-Duarte
Ginecólogo y Máster en Epidemiología Clínica. Profesor Titular Departamento de Obstetricia y Ginecología, Universidad Nacional de Colombia. Bogotá, Colombia.

Referencias bibliográficas

Kaufman RH, Faro S, Brown D. Benign Diseases of the vulva and vagina. 5th Edition. Elsevier Mosby; 2005.

Goetsch MF. Vulvar vestibulitis: prevalence and historic features in a general gynecologic practice population. Am J Obstet Gynecol 1991;164:1609-14.

Harlow BL, Stewart EG. A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? J Am Med Womens Assoc 2003;58:82-8.

Resident Population Estimates of the United States by Age and Sex. April 1, 1990-July 1, 1999.Washington, DC: Population Estimates Program, Population Division, US Census Bureau; 2000.

McKay M, Farrington J. Vulvodynia: chronic vulvar pain syndromes. En: Stoudemire A, Fogel B (editors). Medical Psychiatric Practice. Washington D.C: American Psychiatric Press; 1995.

McKay M. Vulvodyinia. En: Steege J, Metzer D, Levy B (eds). Chronic Pelvic Pain: An Integrated Approach. W.B Sanders Company; 2000. p. 192-99.

Marin MG, King R, Sfameni S, Dennerstein G. Adverse behavioral and sexual factors in chronic vulvar disease. Am J Obstet Gynecol 2000;183:34-8.

Tuma R, Bornstein J. Vulvar pain syndrome (vulvodynia)-dilemmas in terminology. Harefuah 2006;145:215-8.

Goldstein AT, Marinoff S, Haefner HK. Vulvodynia: strategies for treatment. Clin Obstet Gynecol 2005;48:769-85.

Haefner HK, Collins ME, Davis GD, Edwards L, Foster DC, Hartmann ED, et al. The vulvodynia guideline. J Low Genit Tract Dis 2005;9:40-51.

Haefner HK. Report of the International Society for the Study of Vulvovaginal Disease terminology and classification of vulvodynia. J Low Genit Tract Dis 2007;11:48-9.

Moyal-Barracco M, Lynch PJ. 2003 ISSVD terminology and classification of vulvodynia: a historical perspective. J Reprod Med. 2004;49:772-7.

Orlandi A, Francesconi A, Angeloni C, Palmieri G, Fulvia G, Ciotti M, et al. Prevalence and genotyping of human papillomavirus infection in women with vulvodynia. Acta Obstet Gynecol Scand 2007;86:1003-10.

Prayson RA, Stoler MH, Hart WR. Vulvar vestibulitis. A histopathologic study of 36 cases, including human papillomavirus in situ hybridization analysis. Am J Surg Pathol 1995;19:154-60.

Morin C, Bouchard C, Brisson J, Fortier M, Blanchette C, Meisels A. Human papillomaviruses and vulvar vestibulitis. Obstet Gynecol 2000;95:683-7.

Mascherpa F, Bogliatto F, Lynch PJ, Micheletti L, Benedetto C. Vulvodynia as a possible somatization disorder. More than just an opinion. J Reprod Med 2007;52:107-10.

Jantos M, Burns NR. Vulvodynia. Development of a psychosexual profile. J Reprod Med 2007;52:63-71.

Eva LJ, MacLean AB, Reid WM, Rolfe KJ, Perrett CW. Estrogen receptor expression in vulvar vestibulitis syndrome. Am J Obstet Gynecol 2003;189:458-61.

Lotery HE, McClure N, Galask RP. Vulvodinia. Lancet 2004;363:1058-60.

Edwards L. New concepts in vulvodynia. Am J Obstet Gynecol 2003;189(3 Suppl):S24-30.

National Institutes of Child Health and Human Development (NICHD). Vulvodynia: Towards Understanding a Pain Syndrome; 2003 April 14-15.

Gordon AS, Panahian-Jand M, McComb F, Melegari C, Sharp S. Characteristics of women with vulvar pain disorders: responses to a Web-based survey. J Sex Marital Ther 2003;29(Suppl 1):45-58.

Bogart LM, Berry SH, Clemens JQ. Symptoms of interstitial cystitis, painful bladder syndrome and similar diseases in women: a systematic review. J Urol 2007;177:450-6.

Eide PK. Wind-up and the NMDA receptor complex from a clinical perspective. Eur J Pain 2000;4:5-15.

Gómez PI. Dolor Pélvico en la Mujer. En: Dolor y Cuidados Paliativos. editado por la Corporación para Investigaciones Biológicas y Organización Panamericana de la Salud, Medellín - Colombia. Primera Edición. Ed. CIB; 2005. p. 164-73.

Munday P, Buchan A, Ravenhill G, Wiggs A, Brooks F. A qualitative study of women with vulvodynia: II. Response to a multidisciplinar y approach to management. J Reprod Med 2007;52:19-22.

Giesecke J, Reed BD, Haefner HK, Giesecke T, Clauw DJ, Gracely RH. Quantitative sensor y testing in vulvodynia patients and increased peripheral pressure pain sensitivity. Obstet Gynecol 2004;104:126-33.

Reed BD, Sen A, Gracely RH. Effect of test order on sensitivity in vulvodynia. J Reprod Med 2007;52:199-206.

Masheb RM, Lozano C, Richman S, Minkin MJ, Kerns RD. On the reliability and validity of physician ratings for vulvodynia and the discriminant validity of its subtypes. Pain Med 2004;5:349-58.

Bergeron S, Binik YM, Khalife S, Pagidas K, Glazer HI. Vulvar vestibulitis syndrome: reliability of diagnosis and evaluation of current diagnostic criteria. Obstet Gynecol 2001;98:45-51.

2007 UK National Guideline on the Management of Vulval Conditions. Clinical Effectiveness Group. British Association Sexual Health and HIV. Visitado en 2007 Sept 10. Disponible en:

Pagano R. Value of colposcopy in the diagnosis of candidiasis in patients with vulvodynia. J Reprod Med 2007;52:31-4.

ACOG Committee on Gynecologic Practice. ACOG Committee Opinion: Number 345, October 2006: vulvodynia. Obstet Gynecol 2006;108:1049-52.

Reed BD, Haefner HK, Harlow SD, Gorenflo DW, Sen A. Reliability and validity of self-reported symptoms for predicting vulvodynia. Obstet Gynecol 2006;108:906-13. Conference Coverage From IPPS - Simsbury Connecticut - April/May, 1999. “Vulvodynia”. Paul Perry, MD, Chairman, Editorial Advisory Board, Chronic Pelvic Pain interviews John Gibbons, MD. Visitado en 2007 Jul 23. Disponible en:

Ridley CM. Vulvodynia: evolution of classification and management. Journal of the European Academy of Dermatology and Venereology 1996;7:129-34.

Salima A, Wojnarowskab F. Skin diseases affecting the vulva. Curr Obstet Gynaecol 2005;15:97-107.

Weijmar Schultz WC, Gianotten WL, van der Meijden WI, van de Wiel HB, Blindeman L, Chadha S, et al. Behavioral approach with or without surgical intervention to the vulvar vestibulitis syndrome: a prospective randomized and non-randomized study. J Psychosom Obstet Gynaecol 1996;17:143-8.

"Vestibulitis Educational Seminar Trial" Study. University of British Columbia. Visitado en 2007 Sept 10. Disponible en:

Solomons CC, Melmed MH, Heitler SM. Calcium citrate for vulvar vestibulitis. A case report. J Reprod Med 1991;36:879-82.

Baggish MS, Sze EH, Johnson R. Urinary oxalate excretion and its role in vulvar pain syndrome. Am J Obstet Gynecol 1997;177:507-11.

Metts JF. Vulvodynia and vulvar vestibulitis: challenges in diagnosis and management. Am Fam Physician 1999;59:1547-56.

Dede M, Yenen MC, Yilmaz A, Baser I. Successful treatment of persistent vulvodynia with submucous infiltration of betamethasone and lidocaine. Eur J Obstet Gynecol Reprod Biol 2006;124:258-9.

Zolnoun DA, Hartmann KE, Steege JF. Overnight 5% lidocaine ointment for treatment of vulvar vestibulitis. Obstet Gynecol 2003;102:84-7.

Walsh KE, Berman JR, Berman LA, Vierregger K. Safety and efficacy of topical nitroglycerin for treatment of vulvar pain in women with vulvodynia: a pilot study. J Gend Specif Med 2002;5:21-7.

Foster DC, Dworkin RH, Wood RW. Effects of intradermal foot and forearm capsaicin injections in normal and vulvodynia-afflicted women. Pain 2005;117:128-36.

Updike GM, Wiesenfeld HC. Insight into the treatment of vulvar pain: a survey of clinicians. Am J Obstet Gynecol 2005;193:1404-9.

Ljubojeviae S, Basta-Juzbasiae A, Lipozeneiae J. Steroid dermatitis resembling rosacea: aetiopathogenesis and treatment. J Eur Acad Dermatol Venereol 2002;16:121-6.

McKay M. Dysesthetic (“essential”) vulvodynia. Treatment with amitriptyline. J Reprod Med 1993;38:9-13.

Reed BD, Caron AM, Gorenflo DW, Haefner HK. Treatment of vulvodynia with tricyclic antidepressants: efficacy and associated factors. J Low Genit Tract Dis 2006;10:245-51.

Munday PE. Response to treatment in dysaesthetic vulvodynia. J Obstet Gynaecol 2001;6:610-3.

Retamal CP. Psicofarmacoterapia antidepresiva. Rev Med Chile 2001;129:813-8.

Vázquez A, Pérez JM, Casamayor T. Tratamiento del dolor. El papel de los antiepilépticos. Ámbito Farmacéutico. 2004;25: 90-94. Visitado en 2007 Jul 22. Disponible en:

Harris G, Horowitz B, Borgida A. Evaluation of gabapentin in the treatment of generalized vulvodynia, unprovoked. J Reprod Med 2007;52:103-6.

Biofeedback therapy for vulvodynia and vulvar vestibulitis. Visitado en 2007 Sept 13. Disponible en:

Hartmann EH, Nelson C. The perceived effectiveness of physical therapy treatment on women complaining of chronic vulvar pain and diagnosed with either vulvar vestibulitis syndrome or dysesthetic vulvodynia. J Sect Womens Health 2001;25:13-18.

Bergeron S, Brown C, Lord MJ, Oala M, Binik YM, Khalifé S. Physical therapy for vulvar vestibulitis syndrome: a retrospective study. J Sex Marital Ther 2002;28:183-92.

Goldstein A, Davies-Treene L, Hurtado S, et al. Interferon alpha therapy for vulvar vestibulitis syndrome: a large retrospective trial. Presented at the International Society for the Study of Women's Sexual Health Conference, Vancouver, BC, October 2002.

Haefner HK. Critique of new gynecologic surgical procedures: surgery for vulvar vestibulitis. Clin Obstet Gynecol 2000;43:689-700.

Granot M, Zimmer EZ, Friedman M, Lowenstein L, Yarnitsky D. Association between quantitative sensory testing, treatment choice, and subsequent pain reduction in vulvar vestibulitis syndrome. J Pain 2004;5:226-32.

Bornstein J, Zarfati D, Goldik Z, Abramovici H. Perineoplasty compared with vestibuloplasty for severe vulvar vestibulitis. Br J Obstet Gynaecol 1995;102:652-5.

Traas MA, Bekkers RL, Dony JM, Blom M, van Haren AW, Hendriks JC, et al. Surgical treatment for the vulvar vestibulitis syndrome. Obstet Gynecol 2006;107:256-62.

Danielsson I, Sjöberg I, Ostman C. Acupuncture for the treatment of vulvar vestibulitis: a pilot study. Acta Obstetricia et Gynecologica Scandinavica 2001;80:437-41.

Pukall C, Kandyba K, Amsel R, Khalife S, Binik Y. Effectiveness of Hypnosis for the Treatment of Vulvar Vestibulitis Syndrome: a preliminary investigation. J Sex Med 2007;4:417-25.

Cómo citar
Gómez-Sánchez PI, Chalela JG, Gaitán-Duarte H. Vulvodinia: clasificación, etiología, diagnóstico y manejo. Revisión sistemática de la literatura. Rev. Colomb. Obstet. Ginecol. [Internet]. 30 de septiembre de 2007 [citado 29 de noviembre de 2021];58(3):222-31. Disponible en:
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