Scoping review to assess the role of the immune system in the pathophysiology of vulvodynia and post-orgasmic illness syndrome.

INTRODUCTION

Disorders that affect sexual function, including vulvodynia and post-orgasmic illness syndrome (POIS), are under-reported and under-researched, leaving many patients without optimal treatment strategies. These conditions often present with inflammatory or allergic-type symptoms, such as itching, burning, and congestion. Immune system dysregulation, including mast cell (MC) dysfunction, has been proposed as a potential mechanism underlying these disorders.

METHODS

A literature review was conducted on studies published from 2010 to 2025. Articles exploring the pathological, histopathological, pathophysiological, or etiological nature of vulvodynia and POIS were included. A total of 35 studies met the inclusion criteria and were analyzed to assess the role of immune responses in these disorders.

RESULTS

The review highlighted a compelling relationship between immune factors and vulvodynia and POIS. Vulvodynia studies increasingly support a role for immune dysregulation, including altered T- and B-cell activity, elevated cytokines, MC activation, and localized immune differences. Post-orgasmic illness syndrome cases suggest an immunoallergic mechanism, particularly IgE-mediated. Yet, in both conditions, the literature reveals complex, heterogeneous pathophysiologies that are unlikely to be explained by immune mechanisms alone.

CONCLUSION

The etiology of sexual disorders like vulvodynia and POIS remains poorly understood. However, the reviewed literature supports the hypothesis that both of these conditions may have an immunologic component to their etiology. Further research is necessary to elucidate these mechanisms fully and to develop evidence-based treatments.