Vulvodynia: still a dramatically neglected condition. A position statement on pathogenetic mechanisms from the Italian Society of Andrology and Sexual Medicine (SIAMS)

Purpose: 8–10% of women experience vulvar pain. We aim to summarize the current literature on pathogenetic mechanisms of vulvodynia, and highlight its invisible nature, that often results in misdiagnosis, prolonged diagnostic process and/or inappropriate care. Methods: A comprehensive search was conducted on the main medical databases, including studies up to April 30, 2025. The statements were internally discussed, and levels of evidence were provided according to the Oxford 2011 LoE criteria. Results: The panel highlights the multifactorial and complex systems underlying vulvodynia, advocating for a more comprehensive and genuinely holistic evaluation of this condition. We discuss the role of vulvovaginal dysbiosis and vestibular inflammation, increased neuronal density, central sensitization, pelvic floor muscle dysfunction/hypertonicity, reduced plasma sex steroids levels, reduced expression/altered function of estrogen and androgen receptors, prolonged and early use of Combined Hormonal Contraceptives, and psychological distress, including symptoms of anxiety and depression. Conclusion: Vulvodynia is an often-unrecognized condition that significantly impacts a woman’s quality of life. Our understanding of its underlying mechanisms is still limited, and more research is urgently needed. These gaps in knowledge pose major challenges for the diagnosis and effective treatment of the condition.