Vulvodynia is a distressing chronic pain syndrome that affects up to 15% of women. The symptoms include stinging, burning pain and hypersensitivity of the external genital area and vagina that can be provoked by genital contact or occur spontaneously. The etiology of vulvodynia remains unclear and there is a lack of scientific evidence assessing the causes, prevention and management of this disorder. No one therapy has been proven successful and up to 50% of women even after treatment Vulvodynia, continue to experience pain that interferes with general functioning and can prevent sexual intercourse. Vulvodynia also commonly co-occurs with other problematic chronic pain conditions such as irritable bowel syndrome, painful bladder syndrome/interstitial cystitis, and fibromyalgia. To better understand this syndrome with the goal of developing targeted therapies, we are currently engaged in research to identify “biomarkers“ which will allow us to more accurately characterize the symptoms. Currently, the diagnosis of vulvodynia is based on symptoms and physical findings on the genital examination, however if we can more accurately identify subgroups of women, based on more accurate or relevant markers we will be able to identify targeted treatments for these specific subgroups of women, who all present as vulvodynia , but may have quite different causes for their pain.
UCLA researchers from CNS and the Division of Obstetrics and Gynecology are investigating structural and functional changes in the brain associated with Vulvodynia using state-of-the-art neuroimaging Magnetic Resonance Imaging (MRI) techniques. In addition, we perform a detailed neurologic assessment of the vulva, vagina, and muscular exam of the pelvic floor muscles. We are also assessing pain responses in other body regions and evaluating a number of genetic and other psychological and behavioral assessments. The aim of this innovative and far reaching project is to identify specific patterns of response in the vulva area, pelvic floor and in activity of the brain to see to discover mechanisms underlying brain body interactions leading to Vulvodynia symptoms.
We are hopeful that the differences we find between individuals on these parameters will predict who will respond to which of the various treatments currently available. If so, in the future it may be possible that combining images from a brief session in any high resolution MRI scanner with findings from a specialized physical exam will allow physicians to choose at the first visit an effective treatment or treatments specifically tailored for an individual patient. This will change the long and difficult trial and error process most patients go through to find a treatment that works.
In addition, we believe that identifying the relationship between changes in brain networks and connections and patterns of physical findings in the pelvic region can lead directly to discover and development of novel treatments for Vulvodynia based on new mechanisms. The importance of the Vulvodynia research program has been recognized by the National Institutes of Health which awarded a substantial research grant to CNS investigators, Andrea Rapkin, MD and Jennifer Labus, PhD to move this research forward. Further funding is currently being sought to expand the program and its impact.