References:
1) Presse Med 2000 Jun 17;29(21):1191-6
[Vulvodynia]. [Article in French]
de Belilovsky C.
Institut Alfred Fournier, Paris.
DEFINITION: Vulvodynia includes a group of vulva disorders in patients with a normal clinical presentation. Chronic and spontaneous complaints are observed, sometimes aggravated by sexual intercourse. Most patients complain of a burning vulva. MANAGEMENT: The diagnostic and therapeutic approach to vulvodynia is long and difficult. Complementary explorations may be useful initially but should not be repeated too often. They are helpful in ruling out vulvovaginal infections (candidiasis, sexually transmitted diseases) and vulva dermatosis. Vulvodynia can then be classed as cyclic vulvo-dynia, vestibulitis or essential (dysesthesic vulvodynia). MULTIDISCIPLINARY CARE: Each different type of vulvodynia requires specific care. In all cases, the psychosomatic aspect must be considered. Multidisciplinary care may involve the primary care physician, the gynecologist, the dermatologist, the pain specialist, the psychologist, the psychiatrist, and the physical therapy specialist.

2) World J Urol 2001 Jun;19(3):180-5
Neurogenic inflammation and chronic pelvic pain.
Wesselmann U.
Department of Neurology, The Johns Hopkins University School of Medicine, Blaustein Pain Treatment Center, Baltimore, MD 21287, USA. pain@jhmi.edu
Chronic pelvic pain is a puzzling disease entity. The pathophysiological mechanisms of chronic pelvic pain are not clear and current treatment strategies are often not successful, leaving patients as well as health care providers frustrated. In a subgroup of patients with chronic pelvic pain (e.g., interstitial cystitis, irritable bowel syndrome, vulvar vestibulitis, prostatodynia/prostatitis, and loin pain/hematuria syndrome) inflammatory changes are observed, for which no etiology has been identified. These inflammatory changes might be due to neurogenic inflammation. Applying the concept of neurogenic inflammation to chronic pelvic pain provides new insights into the pathophysiological mechanisms of these pain syndromes, makes it possible to account for the heterogeneity and variability observed in the clinical presentation, and might lead to the development of novel therapies.

3) Pain 1997 Dec;73(3):269-94
The urogenital and rectal pain syndromes.
Wesselmann U, Burnett AL, Heinberg LJ.
Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Pain syndromes of the urogenital and rectal area are well described but poorly understood and underrecognized focal pain syndromes. They include vulvodynia, orchialgia, urethral syndrome, penile pain, prostatodynia, coccygodynia, perineal pain, proctodynia and proctalgia fugax. The etiology of these focal pain syndromes is not known. A specific secondary cause can be identified in a minority of patients, but most often the examination and work-up remain unrevealing. Although these patients are often depressed, rarely are these pain syndromes the only manifestation of a psychiatric disease. This review article presents an overview of the neuroanatomy of the pelvis, which is a prerequisite to trying to understand the chronic pain syndromes in this region. We then discuss the clinical presentation, etiology and differential diagnosis of chronic pain syndromes of the urogenital and rectal area and review treatment options. The current knowledge of the psychological aspects of these pain syndromes is reviewed. Patients presenting with these pain syndromes are best assessed and treated using a multidisciplinary approach. Currently available treatment options are empirical only. Although cures are uncommon, some pain relief can be provided to almost all patients using a multidisciplinary approach including pain medications, local treatment regimens, physical therapy and psychological support, while exercising caution toward invasive and irreversible therapeutic procedures. Better knowledge of the underlying pathophysioloigical mechanisms of the urogenital and rectal pain syndromes is needed to allow investigators to develop treatment strategies, specifically targeted against the pathophysiological mechanism.

Book Review from Sunday, October 14, 2001 New York Times
'The Camera My Mother Gave Me': A Medical Detective Story
Susanna Kaysen

It's unusual, to say the least, to encounter an entire book
(a memoir, no less) about a vagina. After all, it's hardly
a common topic of conversation+outside gynecologists'
offices and theaters where ''The Vagina Monologues'' is
enjoying yet another successful run. Unfortunately for
what prompted her bracing meditation, ''The
Camera My Mother Gave Me,'' was chronic, excruciating and
unexplained pain in said organ.

The narrative begins when Kaysen, author of the
best-selling memoir ''Girl, Interrupted,'' suddenly starts
experiencing searing discomfort in an inchlong section of
her vagina, exactly where a cyst was removed 20 years
earlier. It is a sensation that's impossible to ignore:
''Some days it felt as if someone had poured ammonia
inside. . . . Some days it felt as if a little dentist was
drilling a little hole.'' After various visits to various
doctors, she is told that she is suffering from
vestibulitis (the vestibule being the entrance to the
vagina), and while the cyst removal is a suspected factor,
the precise cause -- and, worse, an effective treatment --
remains elusive. In desperation, Kaysen visits a
vulvologist, a surgeon at a prestigious hospital who, after
inflicting further pain with his insensitive examination,
simply declares, ''You have a sore spot,'' then offhandedly
adds, ''I could cut it out.'' Kaysen recoils from the idea,
and good thing: she later discovers that the operation has
only a 45 percent success rate.

Much of this account of Kaysen's months, then years, of
intense, frequently debilitating pain reads like a medical
detective story: why would such a malady strike to begin
with and what is the cure? But it is also -- necessarily --
an intimate+story that is well served by Kaysen's wry
writing and thorough candor. Kaysen moves from doctor to
doctor, conducts her own research, endures biofeedback
sessions and various other treatments. At the same time,
the toll the vestibulitis takes on her two-year romance
with a carpenter makes the investigation more urgent. It's
too bad this affair is so obviously disastrous, since the
effect of involuntary abstinence on a solid relationship
might have yielded many issues for discussion. As it is,
the reader quickly concludes that Kaysen just needs to dump
the jerk -- which she finally does after he tries to force
Novocain on her so he may relieve his own urges.

Still, the questions this book raises are provocative and
complex. After booting her beau and sidelining herself from
the sexual arena, Kaysen concludes that ''sex really is the
basis of everything. . . . It's not that you have to act on
it, but when Eros goes away, life gets dull. It's as if I'm
colorblind. The world is gray.''

Few would argue this point, and it's fascinating to
think+about the ways in which our sexual viability informs
our character. But is there no symbolic value worth
exploring here? What metaphors would a psychoanalyst find
in this ailment? Or, for that matter, a novelist? In fact,
Kaysen is a novelist, but apparently she isn't yet able to
look very far beyond the limitations of her physical
predicament.

There is a reason she hasn't gained that perspective, and
it accounts for the great disappointment of this book
(greater for Kaysen, to be sure): the illness is never
fully understood or cured. Eventually, the pain subsides,
but Kaysen continues to suffer. Given her well-known
history with the psychiatric profession, documented in her
earlier memoir, it's odd that she does so little here to
explore the link between her emotional life and her body's
complaints. Of course, there are many who would view this
kind of connection with suspicion, but Kaysen isn't one of
them; she merely comes to this part of her investigation
very late.

The narrative ends with a thud, a kind of epilogue in which
she admonishes: ''Don't separate the mind from the body.
Don't separate even character -- you can't. . . . My vagina
. . . has something important to say to me. I'm listening.
I'm still listening.''

Review written by Laura Jamison, a writer living in New York.