Assessment of vulvodynia symptoms in a sample of US women: a prevalence survey with a nested case control study

Exploring clinical associations using '-omics' based enrichment analyses

Background

The vast amounts of clinical data collected in electronic health records (EHR) is analogous to the data explosion from the “-omics” revolution. In the EHR clinicians often maintain patient-specific problem summary lists which are used to provide a concise overview of significant medical diagnoses. We hypothesized that by tapping into the collective wisdom generated by hundreds of physicians entering problems into the EHR we could detect significant associations among diagnoses that are not described in the literature.

Methodology/Principal Findings

We employed an analytic approach original developed for detecting associations between sets of gene expression data, called Molecular Concept Map (MCM), to find significant associations among the 1.5 million clinical problem summary list entries in 327,000 patients from our institution's EHR. An odds ratio (OR) and p-value was calculated for each association. A subset of the 750,000 associations found were explored using the MCM tool. Expected associations were confirmed and recently reported but poorly known associations were uncovered. Novel associations which may warrant further exploration were also found. Examples of expected associations included non-insulin dependent diabetes mellitus and various diagnoses such as retinopathy, hypertension, and coronary artery disease. A recently reported association included irritable bowel and vulvodynia (OR 2.9, p = 5.6×10⁻⁴). Associations that are currently unknown or very poorly known included those between granuloma annulare and osteoarthritis (OR 4.3, p = 1.1×10⁻⁴) and pyloric stenosis and ventricular septal defect (OR 12.1, p = 2.0×10⁻³).

Conclusions/Significance

Computer programs developed for analyses of “-omic” data can be successfully applied to the area of clinical medicine. The results of the analysis may be useful for hypothesis generation as well as supporting clinical care by reminding clinicians of likely problems associated with a patient's existing problems.

Assessment of vulvodynia symptoms in a sample of U.S. women: a follow-up national incidence survey

OBJECTIVE

To estimate the annual incidence of vulvodynia-like symptoms and evaluate triggers of vulvar pain in a sample of U.S. women.

METHODS

After a 1-year interval, women who previously participated in a national vulvodynia prevalence study were recontacted and administered a telephone questionnaire that assessed self-reported vulvodynia-like symptoms and triggers of symptoms.

RESULTS

From the original cohort of 425 women, 285 (67%) participated in this follow-up study. Symptoms consistent with vulvodynia occurring within 1 year of initial contact were reported by 4.7% of previously asymptomatic women. Nearly 50% of the original patients again reported a history of vulvodynia-like symptoms, with 68.6% of these as persistent over the past year. Of significance, pain or discomfort with first-time tampon use was 2.15 times more likely (95% CI 1.0-4.62) in symptomatic women. These women were also 2.4 times more likely (95% CI 1.29-4.53) to use a combination of tampons and pads for sanitary protection rather than one method alone.

CONCLUSIONS

Over the course of 1 year, as many as 1 in 20 women may experience new-onset chronic genital pain. Despite a higher likelihood of having discomfort or pain with first tampon use, symptomatic women did not exhibit a preference for sanitary napkins. This indicates that lack of tampon use because of pain may not be an effective screening criterion for vulvodynia. We recommend additional studies with symptomatic and diagnosed women to explore in more detail the issues surrounding tampon use history and chronic genital pain.

A randomized clinical trial for women with vulvodynia: Cognitive-behavioral therapy vs. supportive psychotherapy

Many treatments used for women with vulvodynia are based solely upon expert opinion. This randomized trial aimed to test the relative efficacy of cognitive-behavioral therapy (CBT) and supportive psychotherapy (SPT) in women with vulvodynia. Of the 50 participants, 42 (84%) completed 10-week treatments and 47 (94%) completed one-year follow-up assessments. Mixed effects modeling was used to make use of all available data. Participants had statistically significant decreases in pain severity (p's<0.001) with 42% of the overall sample achieving clinical improvement. CBT, relative to SPT, resulted in significantly greater improvement in pain severity during physician examination (p=0.014), and greater improvement in sexual function (p=0.034), from pre- to post-treatment. Treatment effects were well maintained at one-year follow-up in both groups. Participants in the CBT condition reported significantly greater treatment improvement, satisfaction and credibility than participants in the SPT condition (p's<0.05). Findings from the present study suggest that psychosocial treatments for vulvodynia are effective. CBT, a directed treatment approach that involves learning and practice of specific pain-relevant coping and self-management skills, yielded better outcomes and greater patient satisfaction than a less directive approach.

[Review of the literature on the psychoemotional reality of women with vulvodynia: difficulties met and strategies developed]

BACKGROUND

Within the past three decades, increased attention has been placed on the study of vulvodynia -- an unexplained chronic vulvular discomfort felt without any related pathology. In addition to its physical implications, vulvodynia has a psychosocial dimension.

OBJECTIVE

The purpose of the current article is to present a review of the literature on the psychoemotional reality of women with vulvodynia.

METHOD

A systematic literature review was conducted in the main social sciences databases, such as Dissertation Abstracts, Current Contents and PsycINFO.

RESULTS

Although some discrepancies were found in study results, the review of the literature revealed that women with vulvodynia are often confronted with identity and psychological difficulties, which are, in turn, influenced by social standards regarding sexuality and femininity. To cope with these difficulties, women develop different strategies to decrease the stress related to pain and enhance their psychological well-being.

CONCLUSION

The psychological and relational difficulties experienced by women with vulvodynia are not only due to the physical pain but also to the meaning they attribute to it, often influenced by social expectations related to heterosexuality and femininity. Hence, it is important to assist these women by increasing their knowledge on the psychosocial aspects of their experience while taking into account influences from the social context.

Vulvodynia: case report and review of literature

Vulvodynia is defined as chronic vulvar burning, stinging, rawness, soreness or pain in the absence of objective clinical or laboratory findings to explain these symptoms. Vulvodynia is a chronic pain syndrome affecting up to 18% of the female population and is generally regarded as an underdiagnosed difficult to treat gynecological disorder. An increasing number of patients present with symptoms of vulvar pain, soreness, burning or irritation, which becomes chronic. Vulvodynia is a term used to describe chronic burning and/or pain in the vulva without objective clinical or laboratory findings to explain these symptoms. We present a case of vulvodynia accompanying somatoform disorder and depression.