Vulvodynia, a common cause of dyspareunia, inflicts physical pain and emotional distress in 16% of women during their lifetime. Symptoms include burning, knife-like pain or pain on contact in the vulvar area for at least 3 months. The etiology of this condition is unclear, and acceptable diagnostic criteria are subjective. Treatment is empirical. A recent review reported success rates for medical treatments ranging from 13% to 67%. Few randomized treatment trials have been conducted. Two previous studies reported that vestibular tissues from women with localized provoked vulvodynia (LPV) when compared with healthy women showed a significant increase in vestibular mast cells, heparanase activity, and intraepithelial neuroproliferation. Data suggest that mast cell heparanase degrades and weakens the structural integrity of the vestibular stroma, resulting in penetration of nerve fibers through the epithelial basement membrane and vestibular hyperinnervation. Enoxaparin, a low-molecular-weight heparin (LMWH), is a strong inhibitor of heparanase activity. Some investigators have suggested that enoxaparin treatment may strengthen the vestibular stroma and prevent neuroproliferation in women with vulvodynia.
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