In the world of medicine, where every condition vies for attention, there exists a silent struggle faced by countless individuals grappling with vulvodynia. The debilitating pain associated with this condition permeates patients’ lives, overshadowing daily activities and intimate moments. Yet, the path to diagnosis and relief remains fraught with challenges, largely due to a dearth of understanding among health care providers and the absence of unified guidelines for the diagnosis and treatment of vulvar pain.

Vulvodynia is a debilitating, painful vulvar condition that can make it difficult to sit, stand, work, engage in sexual intimacy, or otherwise enjoy life. Patients often go untreated for years due to inadequate training of health care providers and conflicting professional guidelines. New diagnosis and treatment protocols, developed by an interdisciplinary council, are necessary to address this important but overlooked health issue. An estimated 1 in 4 women and individuals with vulvas experience vulvodynia.¹ Shockingly, nearly 40% of those afflicted choose to endure the pain in silence.² Of those who do seek help, 60% leave physicians’ offices without a diagnosis or relief.² On average, it takes 7 years for these patients to get the correct diagnosis with a significant cost burden averaging $6000 out-of-pocket costs.³ Using conservative prevalence estimates of 3% to 7% (with some reports up to 16%), Xie et al³ estimated the economic impact of vulvodynia to be between $31 billion and $72 billion, with 70% of these costs being direct health care expenses. Patients with vestibulodynia suffer significant detriment to their quality of life and are often led to fend for themselves and become their advocates as they navigate a health care system that has largely erased their stories.

The underdiagnosis and inadequate treatment of vulvar pain stem from systemic issues within medical education. The dearth of knowledge on vulvar anatomy, combined with the persistent stigma surrounding female reproductive organs and genitalia, contributes to the widespread ignorance among health care professionals. The blinkered approach in academic training, where pelvic examinations focus disproportionately on reproductive organs, only further sidelines crucial components of sexual health. A survey revealed that a mere 40% of obstetrician/gynecologist clerkship directors deemed their pelvic examination training “excellent,” highlighting a significant gap in education.^4,5

Even within the realm of women’s health, sexual health is often overshadowed. This ignorance extends to the professional guidelines for female genital examinations, with neither the American College of Obstetricians and Gynecologists nor the US Preventive Services Task Force offering recommendations beyond Pap smears.⁶ Compounding this problem is the historical compartmentalization of female pelvic pain as an exclusively gynecological issue. Emerging evidence underscores the interconnectedness of vulvar and urinary disorders: individuals suffering from vulvodynia at an elevated risk of interstitial cystitis and urinary tract infections.^7,8 As we know the increasing preponderance of urinary tract infections in menopausal people is associated with hormonal changes of the vulva called genitourinary syndrome of menopause. Of note, genitourinary syndrome of menopause has components of vulvodynia (pain, itching, vaginal dryness, etc). Thus, it is imperative that the urologist starts understanding vulvar anatomy and intervene early on this completely preventable condition. While the AUA has increased its inclusion of female sexual dysfunction in its training/educational content through the core curriculum, we as an organization still lack formal guidelines on vulvar sexual pain disorders, perpetuating a critical gap in care.

To bridge this divide, we propose the establishment of an interdisciplinary council comprised of experts from various fields, including obstetricians/gynecologists, urologists, psychologists, dermatologists, and physical therapists. This council will collaboratively develop a joint guideline for pelvic examinations, diagnosis, and treatment of vulvar pain. By harnessing the collective expertise of diverse disciplines, we can create comprehensive guidelines that revolutionize the care paradigm for a condition affecting up to one quarter of the population.

The time has come for a transformative approach, one that ensures safe, timely, and effective treatment for those affected by vulvodynia. It is within our collective power as a medical community to pave the way for a future where vulvar pain is understood, diagnosed, and treated with the compassion and expertise it deserves. Together, let’s usher in a new era of care for the countless individuals who silently endure the burden of vulvar pain.