{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T03:03:36Z","timestamp":1783739016234,"version":"3.55.0"},"reference-count":29,"publisher":"Elsevier BV","issue":"4","license":[{"start":{"date-parts":[[2015,4,1]],"date-time":"2015-04-01T00:00:00Z","timestamp":1427846400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2015,4,1]],"date-time":"2015-04-01T00:00:00Z","timestamp":1427846400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["ajog.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["American Journal of Obstetrics and Gynecology"],"published-print":{"date-parts":[[2015,4]]},"DOI":"10.1016\/j.ajog.2014.10.1098","type":"journal-article","created":{"date-parts":[[2014,10,30]],"date-time":"2014-10-30T05:42:30Z","timestamp":1414647750000},"page":"476.e1-476.e8","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":50,"title":["Activation of vestibule-associated lymphoid tissue in localized provoked vulvodynia"],"prefix":"10.1016","volume":"212","author":[{"given":"P\u00e4ivi","family":"Tommola","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"B\u00fctzow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leila","family":"Unkila-Kallio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorma","family":"Paavonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seppo","family":"Meri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.ajog.2014.10.1098_bib1","first-page":"772","article-title":"2003 ISSVD terminology and classification of vulvodynia: a historical perspective","volume":"49","author":"Moyal-Barracco","year":"2004","journal-title":"J\u00a0Reprod Med"},{"key":"10.1016\/j.ajog.2014.10.1098_bib2","doi-asserted-by":"crossref","first-page":"40.e1","DOI":"10.1016\/j.ajog.2013.09.033","article-title":"Prevalence of symptoms consistent with a diagnosis of vulvodynia: population-based estimates from 2 geographic regions","volume":"210","author":"Harlow","year":"2014","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2014.10.1098_bib3","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1016\/0002-9378(91)91444-2","article-title":"Vulvar vestibulitis: prevalence and historic features in a general gynecologic practice population","volume":"164","author":"Goetsch","year":"1991","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2014.10.1098_bib4","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1067\/mob.2001.116748","article-title":"Prevalence and predictors of chronic lower genital tract discomfort","volume":"185","author":"Harlow","year":"2001","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2014.10.1098_bib5","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1155\/S1064744902000224","article-title":"Case-control study of vulvar vestibulitis risk associated with genital infections","volume":"10","author":"Smith","year":"2002","journal-title":"Infect Dis Obstet Gynecol"},{"key":"10.1016\/j.ajog.2014.10.1098_bib6","doi-asserted-by":"crossref","first-page":"101ra91","DOI":"10.1126\/scitranslmed.3002613","article-title":"Repeated vulvovaginal fungal infections cause persistent pain in a mouse model of vulvodynia","volume":"3","author":"Farmer","year":"2011","journal-title":"Sci Transl Med"},{"key":"10.1016\/j.ajog.2014.10.1098_bib7","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1097\/00004347-198809000-00005","article-title":"The histopathology of vulvar vestibulitis syndrome","volume":"7","author":"Pyka","year":"1988","journal-title":"Int J Gynecol Pathol"},{"key":"10.1016\/j.ajog.2014.10.1098_bib8","doi-asserted-by":"crossref","first-page":"614.e1","DOI":"10.1016\/j.ajog.2010.01.028","article-title":"Histologic and receptor analysis of primary and secondary vestibulodynia and controls: a prospective study","volume":"202","author":"Goetsch","year":"2010","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2014.10.1098_bib9","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1034\/j.1600-0412.2001.800709.x","article-title":"The expression of cyclooxygenase 2 and inducible nitric oxide synthase indicates no active inflammation in vulvar vestibulitis","volume":"80","author":"Bohm-Starke","year":"2001","journal-title":"Acta Obstet Gynecol Scand"},{"key":"10.1016\/j.ajog.2014.10.1098_bib10","first-page":"379","article-title":"Is localized, provoked vulvodynia an inflammatory condition?","volume":"52","author":"Eva","year":"2007","journal-title":"J\u00a0Reprod Med"},{"key":"10.1016\/j.ajog.2014.10.1098_bib11","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/S0029-7844(96)00447-4","article-title":"Elevated tissue levels of interleukin-1 beta and tumor necrosis factor-alpha in vulvar vestibulitis","volume":"89","author":"Foster","year":"1997","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2014.10.1098_bib12","doi-asserted-by":"crossref","first-page":"346.e1","DOI":"10.1016\/j.ajog.2006.12.038","article-title":"Enhanced synthesis of proinflammatory cytokines by vulvar vestibular fibroblasts: implications for vulvar vestibulitis","volume":"196","author":"Foster","year":"2007","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2014.10.1098_bib13","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1067\/mob.2002.121869","article-title":"Defective regulation of the proinflammatory immune response in women with vulvar vestibulitis syndrome","volume":"186","author":"Gerber","year":"2002","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2014.10.1098_bib14","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1067\/mob.2002.121091","article-title":"A\u00a0deficiency in interferon-alpha production in women with vulvar vestibulitis","volume":"186","author":"Gerber","year":"2002","journal-title":"Am J Obstet Gynecol"},{"key":"10.1016\/j.ajog.2014.10.1098_bib15","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1046\/j.1365-2133.2003.05308.x","article-title":"Increased innervation of the vulval vestibule in patients with vulvodynia","volume":"148","author":"Tympanidis","year":"2003","journal-title":"Br J Dermatol"},{"key":"10.1016\/j.ajog.2014.10.1098_bib16","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1159\/000079663","article-title":"Hyperinnervation and mast cell activation may be used as histopathologic diagnostic criteria for\u00a0vulvar vestibulitis","volume":"58","author":"Bornstein","year":"2004","journal-title":"Gynecol Obstet Invest"},{"key":"10.1016\/j.ajog.2014.10.1098_bib17","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1159\/000082112","article-title":"The major histopathologic characteristics in the vulvar vestibulitis syndrome","volume":"59","author":"Halperin","year":"2005","journal-title":"Gynecol Obstet Invest"},{"key":"10.1016\/j.ajog.2014.10.1098_bib18","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1111\/j.1600-0412.2011.01248.x","article-title":"Long-term follow up of posterior vestibulectomy for treating vulvar vestibulitis","volume":"90","author":"Tommola","year":"2011","journal-title":"Acta Obstet Gynecol Scand"},{"key":"10.1016\/j.ajog.2014.10.1098_bib19","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1111\/j.1600-0412.2012.01466.x","article-title":"Long-term well-being after surgical or conservative treatment of severe vulvar vestibulitis","volume":"91","author":"Tommola","year":"2012","journal-title":"Acta Obstet Gynecol Scand"},{"key":"10.1016\/j.ajog.2014.10.1098_bib20","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1038\/mi.2007.9","article-title":"Terminology: nomenclature of mucosa-associated lymphoid tissue","volume":"1","author":"Brandtzaeg","year":"2008","journal-title":"Mucosal Immunol"},{"key":"10.1016\/j.ajog.2014.10.1098_bib21","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1097\/AOG.0b013e31821c33dc","article-title":"Differences in primary compared with secondary vestibulodynia by immunohistochemistry","volume":"117","author":"Leclair","year":"2011","journal-title":"Obstet Gynecol"},{"key":"10.1016\/j.ajog.2014.10.1098_bib22","first-page":"910","article-title":"Reliability and reproducibility of novel methodology for assessment of\u00a0pressure pain sensitivity in pelvis","volume":"13","author":"Zolnoun","year":"2012","journal-title":"J\u00a0Pain"},{"key":"10.1016\/j.ajog.2014.10.1098_bib23","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.ejogrb.2004.04.039","article-title":"Modified vulvar vestibulectomy: simple and effective surgery for the treatment of vulvar vestibulitis","volume":"120","author":"Lavy","year":"2005","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"10.1016\/j.ajog.2014.10.1098_bib24","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1095\/biolreprod.105.043133","article-title":"Immunological microenvironments in the human vagina and cervix: mediators of cellular immunity are concentrated in the cervical transformation zone","volume":"73","author":"Pudney","year":"2005","journal-title":"Biol Reprod"},{"key":"10.1016\/j.ajog.2014.10.1098_bib25","doi-asserted-by":"crossref","DOI":"10.1097\/LGT.0b013e31829fae32","article-title":"The value of histology in predicting the effectiveness of vulvar vestibulectomy in provoked vestibulodynia","volume":"18","author":"Brokenshire","year":"2014","journal-title":"J\u00a0Low Genit Tract Dis"},{"key":"10.1016\/j.ajog.2014.10.1098_bib26","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/0301-2115(96)02502-X","article-title":"Vulvar vestibulitis subjects undergoing surgical intervention: a descriptive analysis and histopathological correlates","volume":"68","author":"Chaim","year":"1996","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"10.1016\/j.ajog.2014.10.1098_bib27","first-page":"196","article-title":"The mast cell\u2013nerve functional unit: a key component of physiologic and pathophysiologic responses","author":"Forsythe","year":"2012"},{"key":"10.1016\/j.ajog.2014.10.1098_bib28","doi-asserted-by":"crossref","first-page":"1880","DOI":"10.1161\/01.ATV.0000140820.51174.8d","article-title":"Mast cells in neovascularized human coronary plaques store and secrete basic fibroblast growth factor, a potent angiogenic mediator","volume":"24","author":"Lappalainen","year":"2004","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"10.1016\/j.ajog.2014.10.1098_bib29","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1136\/sti.75.5.320","article-title":"Epidemiology of vulvar vestibulitis syndrome: an exploratory case-control study","volume":"75","author":"Sarma","year":"1999","journal-title":"Sex Transm Infect"}],"container-title":["American Journal of Obstetrics and Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S000293781402153X?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S000293781402153X?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T10:33:20Z","timestamp":1762079600000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S000293781402153X"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,4]]},"references-count":29,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2015,4]]}},"alternative-id":["S000293781402153X"],"URL":"https:\/\/doi.org\/10.1016\/j.ajog.2014.10.1098","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.725422537.793506787","asserted-by":"object"}]},"ISSN":["0002-9378"],"issn-type":[{"value":"0002-9378","type":"print"}],"subject":[],"published":{"date-parts":[[2015,4]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Activation of vestibule-associated lymphoid tissue in localized provoked vulvodynia","name":"articletitle","label":"Article Title"},{"value":"American Journal of Obstetrics and Gynecology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ajog.2014.10.1098","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"Copyright \u00a9 2015 Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}