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慢性外阴疼痛,简称为外阴痛,在普通妇女人群中的发病率约为16%。本文简要概述了外阴痛的病因学以及治疗现状。到目前为止,对自发性广泛性外阴痛(unprovoked generalized vulvodynia,UGVD)的研究较少,本文重点讨论了外阴痛的一个亚类,即诱发的阴道前庭痛(provoked vestibulodynia,PVD),其症状为压迫阴道前庭周围可产生严重的烧灼样痛或剧烈疼痛。以往的研究表明外周(如阴道前庭组织异常、骨盆肌张力增高)和中枢(如神经中枢冲动增多)因素都参与了PVD的发生和维持过程。此外,由于患者对疼痛的心理性反应各异,也影响了疼痛症状的表现和时程。尽管PVD的发生包含多种因素,但到目前为止,对其治疗的研究都是单一的,回顾性和不可控的。本综述着眼于对PVD的外周(如局部用药、外阴大腺切除术等)和中枢(如应用抗抑郁药、镇痛治疗等)治疗,同时还讨论了针对于痛觉传递过程中不同水平(外周和中枢)的多向治疗方案。鉴于PVD机制的复杂性,今后对PVD的治疗推荐应用生物心理社会学疗法。
Chronic vulvar pain, referred to as vulvodynia, occurs in about 16% of the average woman population. This article briefly outlines the etiology of vulvar pain and treatment status. So far, there have been few studies on unprovoked generalized vulvodynia (UGVD). This article focuses on a subcategory of vulvar pain, provoked vestibulodynia (PVD), the symptoms of which are Compression of the vaginal vestibule can produce severe burning pain or severe pain. Previous studies have shown that the peripheral (such as abnormal vaginal vestibular tissue, pelvic muscle tone increased) and central (such as increased nerve center impulse) factors are involved in the occurrence and maintenance of PVD. In addition, due to the patient’s psychological response to pain vary, but also affect the performance and duration of pain symptoms. Although the occurrence of PVD involves many factors, so far, the study of its treatment are single, retrospective and uncontrollable. This review focuses on the treatment of peripheral PVD (topical, major gastrectomy, etc.) and central (such as the use of antidepressants, analgesic therapy, etc.) treatment, and also discusses the different levels of pain in the process of transmission And central) multi-directional treatment programs. In view of the complexity of the PVD mechanism, biopsychosocial therapies are recommended for the treatment of PVD in the future.