Editing Vulvodynia (section)

==Causes==
Vulvodynia has many different sub-types and causes. The disease is highly idiopathic. Identifying the cause is important to determine the appropriate treatment.<ref name="Female" />

Pain confined to the [[vulval vestibule]], known as [[vestibulodynia]], has at least three known sub-types:<ref name="Female">{{cite book |last1=Goldstein |first1=Andrew |editor-first1=Andrew T. |editor-first2=Caroline F. |editor-first3=Irwin |editor-first4=Jill M. |editor-first5=Sue W. |editor-first6=Gail |editor-last1=Goldstein |editor-last2=Pukall |editor-last3=Goldstein |editor-last4=Krapf |editor-last5=Goldstein |editor-last6=Goldstein |title=Female Sexual Pain Disorders: Evaluation and Management |date=2020 |pages=157–162 |edition=2 |doi=10.1002/9781119482598 |isbn=978-1-119-48266-6 |url=https://onlinelibrary.wiley.com/doi/book/10.1002/9781119482598}}</ref> neuroproliferation, hormonally-mediation, and inflammation. Neuroproliferation can be present from birth or acquired later in life. This type of vestibulodynia is known as [[neuroproliferative vestibulodynia]]. [[Hormonally-mediated vestibulodynia]] can be caused by hormonal medications like oral birth control. [[Inflammatory vestibulodynia]] can develop as part of an immune response.

Other possible causes include [[Sjögren syndrome]], the symptoms of which include [[Chronic condition|chronic]] [[vaginal dryness]]. Others include genetic predisposition to inflammation,<ref name="pmid12593899">{{cite journal |doi=10.1016/S0301-2115(02)00276-2 |pmid=12593899 |title=Interleukin-1β gene polymorphism in women with vulvar vestibulitis syndrome |journal=European Journal of Obstetrics & Gynecology and Reproductive Biology |volume=107 |issue=1 |pages=74–77 |year=2003 |last1=Gerber |first1=Stefan |last2=Bongiovanni |first2=Ann Marie |last3=Ledger |first3=William J. |last4=Witkin |first4=Steven S. }}</ref> allergy or other sensitivity (for example: oxalates in the urine), an [[autoimmune disorder]] similar to [[lupus erythematosus]] or to [[eczema]] or to [[lichen sclerosus]], infection (e.g., [[yeast infection]]s, [[bacterial vaginosis]], [[Human papillomavirus|HPV]], [[Herpes simplex virus|HSV]]), injury, and [[neuropathy]]—including an increased number of nerve endings in the vaginal area. Some cases seem to be negative outcomes of genital [[surgery]], such as a [[labioplasty]].  Initiation of hormonal contraceptives that contain low- dose estrogen before the age of 16 could predispose women to vulvar vestibulitis syndrome. A significantly lower pain threshold, especially in the posterior vestibulum, has also been associated with the use of hormonal contraceptives in women without vulvar vestibulitis syndrome.<ref>{{cite journal |doi=10.1016/S0140-6736(07)60197-4 |pmid=17276781 |title=Sexual sequelae of general medical disorders |journal=The Lancet |volume=369 |issue=9559 |pages=409–424 |year=2007 |last1=Basson |first1=Rosemary |last2=Weijmar Schultz |first2=Willibrord |s2cid=44628975 }}</ref> [[Pelvic floor dysfunction]] may be the underlying cause of some women's pain.<ref>{{cite news | title = Differential Diagnosis of Pelvic Floor Dysfunction and Vulvar Pain | url = http://www.medscape.org/viewarticle/465853| access-date = 2012-09-11 | date= October 2003 | author=Kellogg-Spadt, S}}</ref>

Many co-morbidities are commonly associated with vulvodynia, including [[fibromyalgia]], [[irritable bowel syndrome]], [[interstitial cystitis]], [[pelvic floor dysfunction]], [[endometriosis]], [[major depressive disorder|depression]] and [[anxiety|anxiety disorders]].<ref name="Hill 2021">{{cite journal |last1=Hill |first1=DA |last2=Taylor |first2=CA |title=Dyspareunia in Women. |journal=American Family Physician |date=15 May 2021 |volume=103 |issue=10 |pages=597–604 |pmid=33983001}}</ref>