(029) INVESTIGATING THE OVERLAPPING PRESENTATION OF IRRITABLE BOWEL SYNDROME AND VULVODYNIA: A SYSTEMATIC REVIEW OF THE EVIDENCE AND MECHANISMS
Authors: Perelmuter S , Maliszewski K , Soogoor A 
Published: June 2024

Abstract

Introduction
Vulvodynia is a complex and multifactorial medical condition characterized by pain and discomfort in the vulvar and vaginal area without any identifiable cause. Despite its prevalence, vulvodynia remains underdiagnosed, especially in the United States, leading to delayed diagnosis, increased risk of sexual dysfunction, and reduced quality of life. Concurrently, irritable bowel syndrome (IBS) is a gastrointestinal disorder with a global prevalence predominantly affecting women. Vulvodynia and IBS frequently co-occur in women, with a 2 to 4-fold increased likelihood of IBS diagnosis in those with vulvodynia (1). These comorbid conditions may share common underlying causes, highlighting the need for comprehensive research to better understand the underlying molecule mechanisms and develop effective management strategies. Recognizing the interplay between vulvodynia and IBS is crucial for improving women's health and well-being.

Objective
The aim of this review was to assess the evidence and mechanism of simultaneous presentation of IBS and vulvodynia, and whether the incidence of one condition predicts the incidence or increases susceptibility of the other condition. Additionally, this review aims to assess whether treating one condition impacts the presentation, prognosis, or outcome of the other.

Methods
A systematic search was conducted in 6 electronic databases: PubMed, Web of Science, Scopus, Science Direct, Google Scholar, and Cochrane Library (publication dates between January 1950 and August 2023). Primary research about the overlap of presentation, diagnosis, or treatment of IBS and vulvodynia was included. Data were extracted from eligible studies, summarized, and collated.

Results
Of the 306 unique articles identified, 38 were included in the final analysis: 33 were cross-sectional studies, along with 2 case reports, 1 open-label non-comparative study, 1 cohort study, and 1 nested case-control study. The data represents patients from 21 countries. Common themes amongst the studies included a hypothesis of central hypersensitization which can manifest as either and/or both vulvodynia and IBS, the incidence of vulvodynia being higher in younger and older women (women in their mid-40s had the lowest odds), the significant diagnostic delay in vulvodynia, and the need for a multimodal treatment strategy.

Conclusions
Our review adds to the evidence that there is a pervasive association with vulvodynia and IBS. Despite this, research on the underlying molecular mechanisms of the association is scarce, and diagnostic delays persist for vulvodynia. Increasing awareness of the overlap of these conditions will improve screening for vulvodynia in the IBS patient population, therefore improving the diagnostic delay. Further studies over longer time periods, and utilizing randomized study designs are needed to elucidate the mechanism of simultaneous presentation of IBS and vulvodynia, and how we can leverage their pathophysiology clinically to optimize diagnosis and treatment.

Disclosure
No.