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Local and Systemic Inflammation in Localized, Provoked Vestibulodynia: A Systematic Review

Chalmers, K. Jane B Phty (Hons); Madden, Victoria J. PhD; Hutchinson, Mark R. PhD; Moseley, G. Lorimer PhD

doi: 10.1097/AOG.0000000000001510
Contents: Review

OBJECTIVE: To synthesize and critically evaluate all available evidence investigating whether localized, provoked vestibulodynia is associated with a specific inflammatory profile at both a local and a systemic level.

DATA SOURCES: Comprehensive electronic searches were performed in MEDLINE, EMBASE, Scopus, PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Collaboration databases, and ClinicalTrials.gov. The search strategy was developed using MeSH terms related to localized, provoked vestibulodynia, and inflammatory markers.

METHODS OF STUDY SELECTION: Two independent investigators screened titles and abstracts and performed data extraction and risk of bias assessments. Studies were included if they reported at least one baseline inflammatory marker in women with localized, provoked vestibulodynia and compared them with healthy women. Reference lists from published reviews on localized, provoked vestibulodynia were screened for additional studies.

TABULATION, INTEGRATION, AND RESULTS: There were 1,619 studies identified. Eighteen studies met the inclusion criteria, including 400 women with localized, provoked vestibulodynia and 212 healthy women in a control group. Risk of bias assessment revealed that the methodologic quality was generally low. Fifteen studies investigated local inflammation and three studies investigated systemic inflammation. On a local level, the number of mast cells expressed in vestibular tissues was greater in women with localized, provoked vestibulodynia expressed than in women in the control group. Several studies reported undefined inflammatory infiltrate in vestibular tissues to a greater level in women with localized, provoked vestibulodynia than in women in the control group. Systemically, levels of natural killer cells were lower in women with localized, provoked vestibulodynia than in women in the control group. There were no systemic differences in systemic interferon-α and interferon-υ levels between groups.

CONCLUSION: There is limited and contradictory evidence regarding the characteristics of local and systemic inflammation in women with localized, provoked vestibulodynia.

Supplemental Digital Content is Available in the Text.There is no clear pattern of inflammation in women with localized, provoked vestibulodynia; what evidence exists for inflammation is inconsistent and, at times, contradictory.

Sansom Institute for Health Research, University of South Australia, and the Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, University of Adelaide, Adelaide, South Australia, Australia.

Corresponding author: G. Lorimer Moseley, PhD, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001; e-mail: lorimer.moseley@gmail.com.

K. Jane Chalmers is supported by a Research Grant from Pelvic Pain Foundation and the Gould Experimental Science Grant from the University of South Australia. Victoria J. Madden is supported by the Oppenheimer Memorial Trust (South Africa): and an Innovation Postdoctoral Fellowship from the National Research Foundation of South Africa. Mark R. Hutchinson is supported by an Australian Research Council Research Fellowship ID DP110100297. G. Lorimer Moseley is supported by a Principal Research Fellowship from the National Health & Medical Research Council of Australia ID 1061279.

Financial Disclosure Dr. Moseley has received royalties from NOI Group Publishing for Explain Pain; Explain Pain Handbook: Protectometer; Painful Yarns: Metaphors and Stories to Help Understand the Biology of Pain; and The Graded Motor Imagery Handbook. He receives speaker fees for lectures on pain and its treatment. He has been a consultant for Pfizer, Kaiser Permanente, and Providence Health Care. The other authors did not report any potential conflicts of interest.

Presented as a poster at the International Association for the Study of Pain 15th World Congress on Pain, October 6–11, 2014, Buenos Aires, Argentina, and at PainAdelaide, March 30, 2015, Adelaide, Australia.

© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.