(026) KEY OUTCOMES OF THE VULVODYNIA SUMMIT: IDENTIFYING THERAPEUTIC OPTIONS FOR FURTHER RESEARCH STUDY IN THE TREATMENT OF PROVOKED VESTIBULODYNIA

Abstract Introduction Provoked vestibulodynia is the most common subtype of vulvodynia, chronic vulvar pain which impacts up to 8% of women by the age of 40. As there are no visible signs, it is a diagnosis of exclusion. Neuroproliferation and activated mast cells are nonspecific findings in the setting of provoked vestibulodynia, supporting the theory that inflammation is the critical first step necessary for the generation of pain signals in the vulvar vestibule. The current treatment of provoked vestibulodynia involving neuroproliferation is often complete vestibulectomy; however, less invasive treatments are scientifically plausible yet lack study. Objective Identify therapeutic options for further research study in the treatment of provoked vestibulodynia through expert consensus. Methods The International Society for the Study of Women’s Sexual Health (ISSWSH), the National Vulvodynia Association (NVA), the Gynecologic Cancers Research Foundation and TightLipped, a grassroots non-profit organization to support people with chronic vulvovaginal and pelvic pain, collectively sponsored a consensus conference, which was held April 19-21, 2024 in Washington, D.C. Format consisted of 14 one-hour sessions involving 20 minute presentation and 40 minute discussion by experts and stakeholders in genitopelvic pain. Following the conference, attendees ranked the identified therapeutics in order from 1 to 15 using SurveyMonkey. Results Expert consensus was achieved that vestibulodynia is fundamentally a neuroinflammatory condition. Fifteen therapeutic options were identified and ranked in order of most to least promising for further study to treat the neuroinflammation of vestibulodynia: ketotifen fumarate, Resiniferatoxin, Maresin-1, Luteolin, Alpha-Lipoic Acid, trifluoromethoxyphenyl-3-(1-propionylpiperidin-4-yl) urea (TPPU), NGFR121W-SNAP IR700 trimer exposed to NIR (photoablation), Ketamine, TrkA inhibitors, Palmitoylethanolamide (PEA), Mepyramine, 5% Dextrose injection (neural prolotherapy), Cryoneurolysis, Loperamide, and Salsalate. Ketotifen fumarate, Resiniferatoxin, and Maresin 1 had scores between 10-12 and Luteolin, Alpha-Lipoic Acid and TPPU had a score between 8-10. TPPU was combined with Maresin-1 due to their similar mechanism of action in increasing levels of specialized pro-resolving mediators. Conclusions The top five identified therapeutics for further research in the treatment of provoked vestibulodynia with a neuroinflammatory basis were: Ketotifen fumarate, Resiniferatoxin, specialized pro-resolving mediators and agents that increase their levels (Maresin-1 and TPPU), Luteolin, and Alpha-Lipoic Acid. Although surgery has the most robust clinical data, less invasive therapeutic options that target neuroproliferative and inflammatory causes exist. As evidenced by the findings of the Vulvodynia Summit, there are many therapeutic targets that hold promise in the treatment of provoked vestibulodynia. These treatments have been utilized in adjacent conditions with similar pathophysiology as provoked vestibulodynia. Research funding is necessary to promote study and implementation of these promising therapeutics to provide safe and effective non-surgical treatment options for neuroinflammatory vestibulodynia targeting neuroinflammatory processes. Disclosure Yes, this is sponsored by industry/sponsor: ISSWSH, NVA, TightLipped, Gynecologic Cancers Research Foundation. Clarification: Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: Evvy, Pelva Health, UpToDate (author).