Evaluation of vestibular biopsy features in patients affected by fibromyalgia, by vulvodynia or by their association

Objective: To evaluate the histologic features of vestibular biopsies from patients affected by fibro myalgia (FM), or vulvodynia (VD), or the their association (FM-VD) in order to facilitate differential diagnosis among conditions that present sexual pain with similar clinical characteristics.

Study design: Fourty-four women already diagnosed with FM were recruited to evaluate the presence of sexual pain not owing to FM. Fourteen women affected by sexual pain of unknown origin who came to our department requesting treatment were also recruited. All subjects were interviewed regarding their history of pain and examined in order to exclude vaginal conditions. Sexual pain did not show the characteristics of VD in 18 FM women; in the remaining 22 women VD resulted as associated with FM. All fourteen self-referred women were diagnosed with VD. All subjects underwent a posterior vestibular biopsy at the fourchette under local anesthesia. Tissue specimens were processed for histologic examination and immunostained for S-100protein and CD34. Statistical analysis was performed with the Pearson's Chisquare test.

Results: Data analysis showed a statistically significant prevalence of inflammation in the VD group. Analysis of the histologic features showed that the concomitant presence of inflammation, nerve bundles, and fibrosis (often mild) is prevalent in VD. Fibrosis is highly frequent and often moderate/severe in FM and it is rarely associated to inflammation and nerve bundles. FM-VD women show intermediate grading.

Conclusions: Our findings show different histologic characteristics in vestibular biopsy in patients affected by Fibro Myalgia, by Vulvodynia or by their association that could be useful to facilitate the differential diagnosis between conditions of sexual pain with similar clinical characteristics.