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Neuromodulation in the Management of Allergic Chronic Vaginitis

Demetrios S Theodoropoulos, Alexandra P Michalopoulou, Niamh A Cullen and Colleen K Stockdale

Chronic vaginitis (CV) affects 16% of women. While a number of distinct diagnoses account for the underlying causes of CV, allergic inflammation is also present in a significant number of cases and may range from 25 to 54% of CV patients. Allergic inflammation in CV is encountered as a result of: i) direct sensitization of the vaginal mucosa to latex, local products, Candida, bacteria, etc.; ii) inhalant allergy compounding the chronic vaginitis syndrome; iii) immune cell activation secondary to neurogenic inflammation in the context of chronic neuropathic pain. Despite the varying nature of specific neuro-immune interactions, chronic pain/irritation remains a cardinal feature of CV which needs to be addressed as a priority independently of specific gynecological or allergy-modifying interventions. This is necessary not only for reasons of symptom relief but also because long-term neuronal changes due to inflammation and chronic pain have a profound effect on the course of CV by potentiating adverse pro-inflammatory and degenerating processes. The pathophysiology of these processes and their alteration by means of neuromodulators is presented with a view of long-term control of chronic pain and neurogenic inflammation. Special emphasis is placed on gamma-aminobutyric acid-served pathways, the use of tricyclic antidepressants, serotoninreuptake inhibitors and certain antihistamines with anti-serotoninergic properties.