Abstract
Vulvodynia is a chronic pain condition, without clearly identifiable and visible causes, associated with disability, sexual disfunction, and impaired quality of life. It is frequently under-reported and under-diagnosed, resulting in significant emotional burden. The pathophysiology of vulvodynia is complex and multidimensional. According to the integrated biopsychosocial model, main triggers of vulvodynia may be biological (infectious or inflammatory conditions inducing severe or prolonged nociceptive or neuropathic pain, genetic predisposition, hormonal imbalance), psychological (depression, anxiety), sexual (traumatic experiences, unhealthy intimate relationship), and social (adverse childhood experiences). The diagnostic approach is based on accurate medical history exploring the characteristics and timing of vulvar pain, as well as the presence of other chronic pain conditions that are often comorbid. Pelvic examination (vulvar and vaginal appearance, cotton swab test for vulvar sensitivity, pelvic floor evaluation) supports the diagnosis and excludes secondary vulvar pain disorders. Considering that pain is a complex human experience within a multidimensional frame, the best therapeutic strategy should be multidisciplinary encompassing different therapeutic targets. Pharmacological therapies have anti-nociceptive, neuromodulating, and anti-inflammatory purposes and include both topical and systemic treatments (antidepressants, anticonvulsants, hormonal creams). Physical therapy consists of pelvic floor physiotherapy, electrostimulation, and neuromodulation techniques, while cognitive behavioral therapy, psychosexual intervention, and neurobiological education address the psychosocial dimension of vulvodynia. If results are insufficient, a surgical approach is allowed. We present a clinical case linking amelioration of vulvodynia to a training program to increase muscle mass, especially in the lower limbs, in a girl reporting an eating disorder.