APPENDIX 1 International Society for the Study of Vulvovaginal Disease Classification of Vulvar Disease
Women with disorders of the vulva are cared for by clinicians trained in several different disciplines and each of these specialties has historically used its own terminology and classification for vulvar diseases. Furthermore, within each specialty, the terminology varied from country to country. This variability in nomenclature led to marked confusion and tremendous communication difficulties. Partly for this reason, the International Society for the Study of Vulvar Disease (ISSVD) was formed 35 years ago. The membership of this organization included a multinational assembly of gynecologists, dermatologists, pathologists, and others involved in the care of women with vulvar and vaginal disease. The ISSVD founding documents stated that one of the organization’s major goals was to develop and promulgate uniform terminology and classification that would be acceptable to all specialists from all countries. The initial classifications were established in the mid-1970s and revisions have subsequently been published from time to time. The history of these efforts is reviewed in three recent manuscripts that contain the current ISSVD classifications for vulvar pain, vulvar squamous cell intraepithelial neoplasia, and the vulvar dermatoses1–3. These classifications, and the terminology contained therein, are summarized in this appendix. However, we wish to emphasize that, in order to understand fully the rationale used in their formulation, it is important that the additional explanatory material contained in the original articles be reviewed.
Vulvar pain
Vulvar pain can be divided into two categories: (1) pain secondary to a specific, identifiable, underlying disorder; and (2) “idiopathic” pain associated with no recognizable underlying disease. This second category of idiopathic pain was originally termed “the burning vulva syndrome” but was subsequently renamed “vulvodynia,” a term coined by Marilynne McKay, a previous editor of this book. More recently “vulvar dysesthesia” briefly replaced it but now, once again, “vulvodynia” has become the nomenclature of choice.
In the mid-1980s, Eduard Friedrich and others identified a separate subset of patients with idiopathic vulvar pain. The pain these patients experienced was confined to the vulvar vestibule and was accompanied by entrance dyspareunia. On examination, varying degrees of vestibular redness were found. Such patients were said to have “vulvar vestibulitis.” Subsequently it has been shown that the redness was not due to inflammation and was instead just part of the normal spectrum of vulvar color. As a result, the ISSVD recommended elimination of the term “vestibulitis” and replaced it with “vestibulodynia.” The current terminology and classification of vulvar pain (Table A1.1) were formulated in 2003 and continue in use today. They remain quite well accepted, though some members of the ISSVD now believe that there are few, if any, differences between localized and generalized vulvodynia and, for that reason, classification into these two categories may be unnecessary.
Table A1.1 International Society for the Study of Vulvar Disease (ISSVD) Terminology and Classification of Vulvar Pain (2003)
| A. Vulvar Pain Related to a Specific Disorder |
|---|
Definitions and notes
“Vulvodynia” is defined as vulvar discomfort, most often described as burning pain, occurring in the absence of relevant visible findings or a specific, clinically identifiable, neurologic disorder. Specifically, a peripheral neuropathy (e.g., related to herpes zoster or herpes simplex) should be excluded based on the lack of associated symptoms such as sphincter dysfunction, weakness in the lower limbs, or sensory changes such as hypoesthesia or anesthesia involving the area of discomfort. Vulvodynia is represented under the term “vulvar pain syndrome” in the classification of the International Society for the Study of Pain.
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