外阴痛:病理生理因素和临床治疗新观点方面的综述(英文)

Vulvodynia:A review of pathophysiological factors and treatment options

慢性外阴疼痛,简称为外阴痛,在普通妇女人群中的发病率约为16%。本文简要概述了外阴痛的病因学以及治疗现状。到目前为止,对自发性广泛性外阴痛(unprovoked generalized vulvodynia,UGVD)的研究较少,本文重点讨论了外阴痛的一个亚类,即诱发的阴道前庭痛(provoked vestibulodynia,PVD),其症状为压迫阴道前庭周围可产生严重的烧灼样痛或剧烈疼痛。以往的研究表明外周(如阴道前庭组织异常、骨盆肌张力增高)和中枢(如神经中枢冲动增多)因素都参与了PVD的发生和维持过程。此外,由于患者对疼痛的心理性反应各异,也影响了疼痛症状的表现和时程。尽管PVD的发生包含多种因素,但到目前为止,对其治疗的研究都是单一的,回顾性和不可控的。本综述着眼于对PVD的外周(如局部用药、外阴大腺切除术等)和中枢(如应用抗抑郁药、镇痛治疗等)治疗,同时还讨论了针对于痛觉传递过程中不同水平(外周和中枢)的多向治疗方案。鉴于PVD机制的复杂性,今后对PVD的治疗推荐应用生物心理社会学疗法。

Vulvodynia, or chronic vulvar pain, affects 16% of women in the general population and has negative effects on numerous aspects of a woman＇ s life. The purpose of this paper is to review the literature on the etiology and treatment of vulvodynia. Since relatively little research has been carried out on unprovoked generalized vulvodynia （UGVD）, this review focuses on provoked vestibulodynia （PVD）, a subtype of vulvodynia characterized by a severe, burning/sharp pain that occurs in response to pressure localized to the vestibule. Research examining the pathophysiology of PVD provides evidence that both peripheral （ e. g., vestibular tissue abnormalities, pelvic floor hypertonicity） and central （e. g. , increased neural activation） factors are involved in the development and maintenance of PVD. Additionally, psychological reactions to the pain may vary and influence the expression and course of the pain. Despite the multitude of factors involved in PVD, most treatment studies to date are unimodal in nature, retrospective, and uncontrolled. A review of treatment studies targeting peripheral （ e. g. , topical applications, vestibulectomy） and central （ e. g. , antidepressants, pain management therapy） components of PVD is provided, and the need for multimodal treatment plans which target both levels of pain processing is discussed. Given the complexity of PVD, a biopsychosocial approach is recommended for future research endeavors and treatment plans.