(204) Vulvar Pain Syndromes: Diagnostic Uncertainty, Therapeutic Gaps and the Urgent Need for a Multidisciplinary Approach

Abstract Introduction Vulvar pain syndromes, most notably provoked vestibulodynia (PVD) and generalized vulvodynia, represent a group of chronic pain conditions affecting up to 8–12% of women during their lifetime. These disorders significantly impair quality of life, sexual function, and psychological wellbeing, yet remain underdiagnosed, mismanaged, or misunderstood in routine clinical practice. Many patients report feeling dismissed or stigmatized, which further delays appropriate diagnosis and treatment. The etiology of vulvar pain is multifactorial, involving complex interactions between nociceptive, hormonal, inflammatory, psychosocial, and relational factors. The lack of unified diagnostic criteria and variable terminology across disciplines contribute to clinical confusion and inconsistent care delivery. Objective To review the current landscape of vulvar pain syndromes with emphasis on diagnostic challenges, therapeutic gaps, and to propose a framework for integrated, patient-centered management within a multidisciplinary model. Methods A narrative literature review was conducted using PubMed, Scopus, and Web of Science, identifying peer-reviewed articles published between 2015 and 2025. Search terms included “vulvodynia,” “vestibulodynia,” “chronic vulvar pain,” “sexual dysfunction,” and “multidisciplinary treatment.” Priority was given to systematic reviews, consensus statements, and original studies with clinically relevant endpoints. Data were synthesized on the basis of: 1. diagnostic criteria (including ISSVD and ACOG guidelines), 2. pathophysiological models, 3. therapeutic interventions (topical agents, systemic medications, pelvic floor physiotherapy, psychosexual therapy, neuromodulation), 4. patient satisfaction and outcomes, 5. healthcare barriers and stigma. Results The literature reveals persistent inconsistencies in terminology and diagnostic frameworks between specialties (gynecology, dermatology, pain medicine, psychiatry), leading to fragmented care. Average diagnostic delay exceeds 2-3 years. While multimodal treatment approaches such as pelvic floor physical therapy, low-dose tricyclic antidepressants, topical lidocaine, and CBT-based sex therapy have shown modest benefits, long-term outcomes remain suboptimal, particularly in primary care settings. Emerging evidence supports the role of central sensitization and neuroinflammation, yet few clinicians are trained in recognizing these mechanisms. The review also identifies a lack of high-quality RCTs (randomized clinical trials), limited accessibility to multidisciplinary teams, and stigmatization of both the condition and the patients reporting it. Only a minority of guidelines explicitly recommend collaborative care. Conclusions Vulvar pain syndromes illustrate a significant clinical care gap at the intersection of gynecology, pain management, and sexual medicine. To improve diagnostic accuracy and therapeutic outcomes, an integrated, biopsychosocial approach must be adopted, one that actively includes gynecologists, dermatologists, physiotherapists, psychologists, and sex therapists. Urgent efforts are needed to: • improve clinician education, • increase patient access to multidisciplinary services, • encourage research funding for vulvar pain, • establish standardized guidelines that are both evidence-based and culturally sensitive. Addressing these gaps is essential to reduce the invisible suffering of this overlooked patient population. Disclosure No