New Insight into the Etiology and Treatment of the Vulvostomatodynia and Review of Treating Pelvic Pain with Dopaminergic Drugs

Recently a review was published concerning studies on a seemingly odd combination of burning mouth and burning vagina termed vulvostomatodynia, when burning mouth co-exists with burning penis and scrotum. It is termed dysesthesia penoscrotodynia. A general term to include burning vagina and burning penis/scrotum is termed pelvodynia. One may think this could be a rare combination of two independent conditions that coincidentally happens in the same patient, but most physicians are not aware that there is probably one common etiology which is increased cellular permeability which allows infiltration into tissues of unwanted irritants. Thus, pelvic pain of various types may be associated with several other conditions including headaches, chronic fatigue, inflammatory bowel disease, and various skin disorders. For over 40 years, there have been published case reports showing marked improvement of various manifestations of this increased cellular permeability syndrome with the drug dextroamphetamine sulfate including vulvodynia even when standard therapies were unsuccessful. However, in a recent review of vulvosomatodynia and potential etiology and treatment the concept of increased cellular permeability of these mucosal tissues related to inadequate dopaminergic effect was not considered by that author the concept pf treating vulvodynia and stomatodynia with dextroamphetamine sulfate was related to its release of dopamine from sympathetic nerve fibers. Support for the concept that relative dopamine deficiency is probably the etiologic factor that was demonstrated by showing that a pure dopaminergic drug cabergoline, could also alleviate pelvic pain including vulvodynia. Furthermore, one publication, found 100% relief of vulvodynia following levo dopa treatment for Parkinson’s disease, but more support for this theory is provided by the two new case reports described where one woman’s dysmenorrhea and stomatodynia was eradicated by dextroamphetamine and another case where the stomadynia was markedly improved by dextroamphetamine but then later with cabergoline when dexamphetamine was stopped.