Urinary excretion of oxalates, which causes burning and itching of the urethra, was proposed as a contributing factor based on a case report of symptom relief in a single patient whose symptoms were associated with hyperoxaluria and elevated urine pH (40). This etiologic theory was bolstered by the association of VVS and interstitial cystitis (41-43); both the vulvar vestibule and the urinary bladder are derived from the same embryologic cells and innervated by branches of the same nerves, suggesting the potential for a shared pathogenesis. However, a prospective study of low oxalate diets in 130 patients and 23 controls failed to confirm therapeutic efficacy (44).
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