title: Vulvodynia--An Evidence-Based Literature Review and Proposed Treatment Algorithm.
abstract: OBJECTIVE
  We searched the medical literature from the last 15 years (1998 to 2013) relating to the etiology, diagnosis, and treatment of vulvodynia. The evidence was reviewed supporting the therapeutic proposals currently in use and propose the incorporation of novel, minimally invasive, interventional therapies, within the context of a multidisciplinary approach.
  
  
  METHODS
  This was a systematic review of all relevant studies with no language restrictions. Studies were identified through Medline/PubMed (1998 to March 2013), the Cochrane Library (2001 to 2013), and conference records and book chapters. The keywords used included "chronic pelvic pain," "vulvodynia," "vestibulodynia," and search terms "etiology," "diagnosis," and "treatment" were added. The levels of evidence were assessed using grading system for "Therapy/Prevention/Etiology/Harm" developed by the Centre for Evidence-Based Medicine (CEBM). The grading system assists in clinical decision-making, and we decided to use "The Grading of Recommendations Assessment, Development, and Evaluation (GRADE)."
  
  
  RESULTS
  A total of 391 papers were assessed. Of these, 215 were analyzed and 175 were excluded, as they pertained to areas not directly related to the disease under review.
  
  
  CONCLUSIONS
  The optimal therapy for vulvar pain syndrome remains elusive, with low percentages of therapeutic success, using either local or systemic pharmacological approaches. Surgery involving invasive and often irreversible therapeutic procedures has resulted in success for certain subtypes of vulvodynia. We present a multidisciplinary approach whereby pain treatment units may provide an intermediate level of care between standard medical and surgical treatments.
authors.affiliation: Valencia University Medical School, Valencia, Spain.|Department of Anesthesiology Critical Care and Pain Management, General University Hospital, Valencia, Spain.|Multidisciplinary Pain Management Department, General University Hospital, Valencia, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: De Andres
authors.affiliation: Department of Anesthesiology Critical Care and Pain Management, General University Hospital, Valencia, Spain.|Multidisciplinary Pain Management Department, General University Hospital, Valencia, Spain.
authors.forename: Nerea
authors.initials: N
authors.lastname: Sanchis-Lopez
authors.affiliation: Department of Anesthesiology Critical Care and Pain Management, General University Hospital, Valencia, Spain.|Multidisciplinary Pain Management Department, General University Hospital, Valencia, Spain.
authors.forename: Juan Marcos
authors.initials: JM
authors.lastname: Asensio-Samper
authors.affiliation: Department of Anesthesiology Critical Care and Pain Management, General University Hospital, Valencia, Spain.|Multidisciplinary Pain Management Department, General University Hospital, Valencia, Spain.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Fabregat-Cid
authors.affiliation: Department of Anesthesiology Critical Care and Pain Management, General University Hospital, Valencia, Spain.|Multidisciplinary Pain Management Department, General University Hospital, Valencia, Spain.
authors.forename: Vicente L
authors.initials: VL
authors.lastname: Villanueva-Perez
authors.affiliation: Department of Anesthesiology Critical Care and Pain Management, General University Hospital, Valencia, Spain.|Multidisciplinary Pain Management Department, General University Hospital, Valencia, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Monsalve Dolz
authors.affiliation: Department of Anesthesiology Critical Care and Pain Management, General University Hospital, Valencia, Spain.|Multidisciplinary Pain Management Department, General University Hospital, Valencia, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Minguez
mesh_terms: D000465:Algorithms; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D056650:Vulvodynia / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy*
keywords: chronic pelvic pain; physical therapy; pulsed radiofrequency; radiofrequency ablation; review; spinal cord stimulation; therapeutics; transcutaneous electric nerve stimulation; vestibulodynia; vulvodynia