外阴痛诊疗策略及研究进展

Vulvodynia:Strategies for Diagnosis and Treatment and Research Progress

国际外阴阴道疾病研究协会(ISSVD)最新有关外阴疼痛的术语将外阴痛定义为"外阴不适,最常被描述为烧灼痛,不伴随相关的可见表现或特殊的临床可识别的神经功能紊乱。"可分为广泛性和局限性外阴痛,根据诱发性,非诱发性或混合性区分亚型。对其病因,发病机制尚无定论,流行病学待深入。外阴痛诊断是排除性的,需排除病因明确的其他疾病,如感染,炎症,肿瘤或神经功能障碍。外阴痛治疗方法包括:外阴护理,外用和口服药物,局部注射,生物反馈和物理治疗,心理及性咨询,外科手术等。但有关联合治疗,辅助治疗的疗效还需临床随机对照研究证实。

The most recent terminology of vulvar pain by the International Society for the Study of Vulvovaginal Disease （ISSVD） defines vulvodynia as ＂vulvar discomfort,most often described as burning pain,occurring in the absence of relevant visible findings or a specific,clinically identifiable,neurologic disorder.＂ The classification of vulvodynia is based on the site of the pain,whether it is generalized or localized,and whether it is provoked,unprovoked,or mixed.The etiology and pathogenesis of this condition is complex and epidemiology remains elusive.An accurate diagnosis is exclusive and requires a comprehensive history,physical examination and targeted diagnostic tests.excluding diseases with definite causes,such as infections,inflammations,tumor and neurological dysfunction.Treatments described include general vulvar care,topical medications,oral medications,injectables,biofeedback and physical therapy,psychological and sexual counseling and surgery.Although many treatment options have been utilized,a rational therapeutic strategy is still under research.