New models to study vulvodynia: Hyperinnervation and nociceptor sensitization in the female genital tract

First-line treatments for management of vulvodynia, according to an expert committee of the Fourth International Consultation on Sexual Medicine, are psychological interventions, pelvic floor physiotherapy and surgical removal of painful tissue, with progression from less invasive to more invasive treatments if initial treatments fail. Hyper-innervation involved multiple types of nerve fibres, including nerve fibres that were immunoreactive for calcitonin gene related peptide (CGRP+ fibres), substance P (SP) and vasoactive intestinal peptide, in addition to nerve fibres that were identified by the pan-neuronal marker protein gene product 9.5 (PGP9.5) and not immunoreactive for CGRP (PGP9.5+CGRP- fibres). [...]studies are required to clarify if any of these mechanisms contribute to beneficial effects of treatment with botulinum toxin reported by some patients with vulvodynia, and such studies are critical to improve targeting of existing treatments and establishment of appropriate clinical trials.