Congenital or acquired neuroproliferative vulvodynia

Lit up like the night sky, a neuron has little fairy lights on each of the strands. Very nice, like a christmas tree but a nerve ending!

Neuroproliferative vulvodynia is a condition whereby the vestibule, around the entrance to the vagina, has a lot (a proliferation) of pain-sensing nerves in it. ‘Neuroproliferative’ means, essentially, nerves that have overgrown, or proliferated.

There are several forms of vulvodynia, with neuroproliferative vulvodynia, either congenital or acquired, a possible diagnosis.

The vulva and clitoris are famous for having a considerable number of nerve-endings compared with the rest of the body​1,2​, but these nerves are able to multiply. The more nerves, the greater the sensitivity, which might sound nice when it’s pleasurable, but when it’s pain, it can become severe.

Neuroproliferative vulvodynia is either congenital (you’re born with it) or acquired (it develops over time). Any type of vulvodynia causes severe pain, preventing anything from touching or entering the vagina.

Early trauma and vaginal sensitivity

Hypersensitivity of the vaginal mucosa may develop early in life, only seeming to appear in teenage years as girls try to use tampons and experiment with their vaginas sexually.

Adverse events early in life is linked with adults with vulvodynia, which has been attributed to a dysfunctional feedback loop in the hypothalamic-pituitary-adrenal (HPA) axis. Animal models have found that early stress in mice​3​, namely irritating chemicals applied to the vagina of mice, resulted in a lifetime of vaginal sensitivity.

How the nerve fibres in your vestibule work

There are a few types of nerve fibre in our bodies, and in neuroproliferative vulvodynia, there tends to be more of one type, the C-afferent nociceptors. C-afferent nociceptors send pain signals, so more of these C nerve fibres can mean more pain, but this pain is quite specific: slow, long-lasting, burning pain.

This is a controversial discussion in vulvar circles. Some vulvar specialist researchers think neuroproliferation to be a response to trauma or inflammation of the mucosa, meaning that the perception of pain is due to inflammation of nerves.

To counter this, it is known that a reduction – not an increase – in nerve fibre density is associated with pain. Our understanding of vulvodynia is limited.

How do I know if my vulvodynia is neuroproliferative, congenital or acquired?

You need to be examined by a pelvic pain specialist or knowledgeable, experienced gynaecologist for a correct diagnosis of vulvodynia of any kind.

It’s important for a practitioner to establish whether you have congenital or acquired neuroproliferative vulvodynia, as this may impact your treatment options.

How vulvodynia is diagnosed:

  • If the pain or sensitivity is around the vestibule, this could mean the vulvodynia is neuroproliferative, since this is the area those nerves tend to grow.
  • If there is hypersensitivity in the umbilical area (around your belly button) it could indicate that your type of vulvodynia may be congenital, since the umbilicus and the vestibule are made from the same tissue when we are developing in the womb​4​.
  • In congenital neuroproliferative vulvodynia, you may have experienced pain when you first tried to use a tampon or have anything put into your vagina (penis, sex toy, fingers).
  • If you have acquired neuroproliferative vulvodynia, you may have a history of vulvovaginal infections (yeast, bacteria, etc.) or had an allergic reaction to something.
  • Those who acquire proliferative vulvodynia can have higher levels of immune-related mediators in blood tests, such as elevated mast cells and pro-inflammatory cytokines.​5,6​

Treatments for acquired or congenital neuroproliferative vulvodynia

Each person will be treated as an individual, with your unique set of signs and symptoms taken into account when treatment is discussed.

Medical treatments range from medication (capsaicin, anti-depressants topically or orally or both, gabapentin), botulinum toxin (Botox) injections to block nerve signals. Where appropriate, vestibulectomy to remove the tissue with excessive nerves and replace it with other, less sensitive tissue.

While surgery is a last resort, a vestibulectomy can be extremely successful when performed by a highly experienced surgeon.

Non-drug non-surgery options for neuroproliferative vulvodynia, whether acquired or congenital, would be considered on a case-by-case basis, but may include herbal medicines to augment nerve pain, and pain management strategies.

Due to the increase in pro-inflammatory cytokines, mast cells and histamine​5,6​, treatments that address inflammation and histamine production may be prescribed as supportive pain-management strategies.

Speak to your local pelvic pain specialist for more information, medical treatment and a diagnosis, and also book an holistic vulvovaginal specialist practitioner for supportive treatments. Tackling vulvodynia through multiple avenues using an integrative approach works best for most people.

References​3–10​

  1. 1.
    Uloko M, Isabey EP, Peters BR. How many nerve fibers innervate the human glans clitoris: a histomorphometric evaluation of the dorsal nerve of the clitoris. The Journal of Sexual Medicine. Published online January 30, 2023:247-252. doi:10.1093/jsxmed/qdac027
  2. 2.
    Malinovský L, Sommerová J, Martincík J. Quantitative evaluation of sensory nerve endings in hypertrophy of labia minora pudendi in women. Acta Anat (Basel). 1975;92(1):129-144. https://www.ncbi.nlm.nih.gov/pubmed/1163192
  3. 3.
    Bohm-Starke N, Hilliges M, Falconer C, Rylander E. Neurochemical Characterization of the Vestibular Nerves in Women with Vulvar Vestibulitis Syndrome. Gynecol Obstet Invest. Published online 1999:270-275. doi:10.1159/000010198
  4. 4.
    Burrows L, Klingman D, Pukall C, Goldstein A. Umbilical hypersensitivity in women with primary vestibulodynia. J Reprod Med. 2008;53(6):413-416. https://www.ncbi.nlm.nih.gov/pubmed/18664058
  5. 5.
    Foster DC, Piekarz KH, Murant TI, LaPoint R, Haidaris CG, Phipps RP. Enhanced synthesis of proinflammatory cytokines by vulvar vestibular fibroblasts: implications for vulvar vestibulitis. American Journal of Obstetrics and Gynecology. Published online April 2007:346.e1-346.e8. doi:10.1016/j.ajog.2006.12.038
  6. 6.
    Harlow BL, He W, Nguyen RHN. Allergic Reactions and Risk of Vulvodynia. Annals of Epidemiology. Published online November 2009:771-777. doi:10.1016/j.annepidem.2009.06.006
  7. 7.
    Bornstein J, Goldstein AT, Stockdale CK, et al. 2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia. The Journal of Sexual Medicine. Published online April 2016:607-612. doi:10.1016/j.jsxm.2016.02.167
  8. 8.
    Bornstein J, Cohen Y, Zarfati D, Sela S, Ophir E. Involvement of Heparanase in the Pathogenesis of Localized Vulvodynia. International Journal of Gynecological Pathology. Published online January 2008:136-141. doi:10.1097/pgp.0b013e318140021b
  9. 9.
    Morin M, Carroll MS, Bergeron S. Systematic Review of the Effectiveness of Physical Therapy Modalities in Women With Provoked Vestibulodynia. Sexual Medicine Reviews. Published online July 2017:295-322. doi:10.1016/j.sxmr.2017.02.003
  10. 10.
    Burrows LJ, Goldstein AT. The Treatment of Vestibulodynia with Topical Estradiol and Testosterone. Sexual Medicine. Published online August 1, 2013:30-33. doi:10.1002/sm2.4


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Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)
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