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Boccella S, Perrone M, Fusco A, Bonsale R, Infantino R, Nuzzo S, Pecoraro G, Ricciardi F, Maria Morace A, Petrillo G, Leone I, Franzese M, de Novellis V, Guida F, Salvatore M, Maione S, Luongo L. Spinal neuronal activity and neuroinflammatory component in a mouse model of CFA-induced vestibulodynia. Brain Behav Immun 2024; 119:408-415. [PMID: 38636564 DOI: 10.1016/j.bbi.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/21/2024] [Accepted: 04/16/2024] [Indexed: 04/20/2024] Open
Abstract
Vestibulodynia is a complex pain disorder characterized by chronic discomfort in the vulvar region, often accompanied by tactile allodynia and spontaneous pain. In patients a depressive behaviour is also observed. In this study, we have used a model of vestibulodynia induced by complete Freund's adjuvant (CFA) focusing our investigation on the spinal cord neurons and microglia. We investigated tactile allodynia, spontaneous pain, and depressive-like behavior as key behavioral markers of vestibulodynia. In addition, we conducted in vivo electrophysiological recordings to provide, for the first time to our knowledge, the characterization of the spinal sacral neuronal activity in the L6-S1 dorsal horn of the spinal cord. Furthermore, we examined microglia activation in the L6-S1 dorsal horn using immunofluorescence, unveiling hypertrophic phenotypes indicative of neuroinflammation in the spinal cord. This represents a novel insight into the role of microglia in vestibulodynia pathology. To address the therapeutic aspect, we employed pharmacological interventions using GABApentin, amitriptyline, and PeaPol. Remarkably, all three drugs, also used in clinic, showed efficacy in alleviating tactile allodynia and depressive-like behavior. Concurrently, we also observed a normalization of the altered neuronal firing and a reduction of microglia hypertrophic phenotypes. In conclusion, our study provides a comprehensive understanding of the CFA-induced model of vestibulodynia, encompassing behavioral, neurophysiological and neuroinflammatory aspects. These data pave the way to investigate spinal cord first pain plasticity in vestibulodynia.
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Affiliation(s)
- Serena Boccella
- Department of Experimental Medicine, Division of Pharmacology, Università della Campania "L. Vanvitelli", Via Costantinopoli 16, 80138 Naples, Italy
| | - Michela Perrone
- Department of Experimental Medicine, Division of Pharmacology, Università della Campania "L. Vanvitelli", Via Costantinopoli 16, 80138 Naples, Italy
| | - Antimo Fusco
- Department of Experimental Medicine, Division of Pharmacology, Università della Campania "L. Vanvitelli", Via Costantinopoli 16, 80138 Naples, Italy
| | - Roozbe Bonsale
- Department of Experimental Medicine, Division of Pharmacology, Università della Campania "L. Vanvitelli", Via Costantinopoli 16, 80138 Naples, Italy
| | - Rosmara Infantino
- Department of Experimental Medicine, Division of Pharmacology, Università della Campania "L. Vanvitelli", Via Costantinopoli 16, 80138 Naples, Italy
| | - Silvia Nuzzo
- IRCCS Synlab SDN, Via Emanuele Gianturco 113, 80143 Naples, Italy
| | | | - Federica Ricciardi
- Department of Experimental Medicine, Division of Pharmacology, Università della Campania "L. Vanvitelli", Via Costantinopoli 16, 80138 Naples, Italy
| | - Andrea Maria Morace
- Department of Experimental Medicine, Division of Pharmacology, Università della Campania "L. Vanvitelli", Via Costantinopoli 16, 80138 Naples, Italy
| | - Gianluca Petrillo
- Department of Molecular Medicine and Medical Biotechnology, "Federico II" University of Naples, Via Tommaso de Amicis 95, 80131 Naples, Italy
| | - Ilaria Leone
- IRCCS Synlab SDN, Via Emanuele Gianturco 113, 80143 Naples, Italy
| | - Monica Franzese
- IRCCS Synlab SDN, Via Emanuele Gianturco 113, 80143 Naples, Italy
| | - Vito de Novellis
- Department of Experimental Medicine, Division of Pharmacology, Università della Campania "L. Vanvitelli", Via Costantinopoli 16, 80138 Naples, Italy
| | - Francesca Guida
- Department of Experimental Medicine, Division of Pharmacology, Università della Campania "L. Vanvitelli", Via Costantinopoli 16, 80138 Naples, Italy
| | - Marco Salvatore
- IRCCS Synlab SDN, Via Emanuele Gianturco 113, 80143 Naples, Italy
| | - Sabatino Maione
- Department of Experimental Medicine, Division of Pharmacology, Università della Campania "L. Vanvitelli", Via Costantinopoli 16, 80138 Naples, Italy.
| | - Livio Luongo
- Department of Experimental Medicine, Division of Pharmacology, Università della Campania "L. Vanvitelli", Via Costantinopoli 16, 80138 Naples, Italy.
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Examining vaginal and vulvar health and sexual dysfunction in patients with interstitial cystitis (UNICORN-1 study). Int Urogynecol J 2022; 33:2493-2499. [PMID: 35543734 DOI: 10.1007/s00192-022-05220-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The Vaginal Health Index Score (VHIS) and vulvodynia swab tests are used to assess vaginal health and vulvodynia. However, few studies have used these tests in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). IC/BPS is a chronic, debilitating disorder, characterised by urinary frequency, urinary urgency and pelvic pain. It adversely affects organs adjacent to the urinary system, leading to complications of sexual dysfunction. This study was aimed at understanding sexual dysfunction in patients with IC/BPS, as well as deterioration of vaginal health and vulvodynia. METHODS This study compared the vaginal health of IC/BPS patients with that of asymptomatic control individuals. The Pain Urgency Frequency (PUF) score, Female Sexual Function Index (FSFI), VHIS, and vulvodynia swab tests, were used as tools. The PUF and FSFI are questionnaire-based surveys of bladder symptoms and sexual function respectively. VHIS evaluation and vulvodynia swab tests are performed by physicians. The PUF was used to assess baseline IC/BPS symptoms to validate the patient population, and FSFI, vulvodynia swab tests and VHIS were used to determine between-group differences. RESULTS Thirty-seven patients were recruited in each group. The IC/BPS group had a higher PUF score (18.19±3.51 vs 3.56±2.35; p<0.05), worse total FSFI (15.72±4.46 vs 26.3±4.93; p<0.05), and worse vulvodynia swab test and total VHIS (11.59±2.87 vs 22.05±3.05; p<0.05) scores than those of the control group. CONCLUSIONS Asian women with IC/BPS experienced greater sexual dysfunction, worsened vaginal health and increased vulvodynia compared with control individuals. Information on vaginal and vulva health is very useful in evaluating IC/BPS patients.
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When Love Hurts: Evaluation and Management of Painful Intercourse in Women. CURRENT SEXUAL HEALTH REPORTS 2021. [DOI: 10.1007/s11930-020-00300-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review was to explore mechanisms, causes, and therapies of itchy conditions involving organs beyond the skin including the eyes, ears, nose, and genital region. RECENT FINDINGS Conditions which cause itch in these locations vary from skin diseases that extend to these areas (i.e., atopic dermatitis, seborrheic dermatitis, and psoriasis) to allergic conditions (i.e., allergic rhinitis and conjunctivitis) and to neuropathic conditions that relate to afferent nerve fiber damage (i.e., lumbosacral radiculopathies in genital disease) as well as some psychological components. Similar to the skin, itch in these locations involves a complex interaction between epithelial cells, unmyelinated C nerve fibers, and cytokines. There is also a significant component of neural sensitization phenomena. Mechanisms of itch beyond the skin are currently an understudied topic that affects millions of patients. Future research should be done in order to further understand the pathophysiology of itch in these body sites.
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Affiliation(s)
- Rachel Shireen Golpanian
- Department of Dermatology and Cutaneous Surgery, and Itch Center University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL, 33136, USA
| | - Peter Smith
- School of Medicine and Griffith Health Institute, Griffith Health, Griffith University, Gold Coast Campus, Southport, QLD, 4215, Australia
| | - Gil Yosipovitch
- Department of Dermatology and Cutaneous Surgery, and Itch Center University of Miami Miller School of Medicine, 1475 NW 12th Ave, Miami, FL, 33136, USA.
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Fernandes A, Skotnes LL, Major M, Falcão PF. Clinicians' Perceptions of Norwegian Women's Experiences of Infertility Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E993. [PMID: 32033324 PMCID: PMC7036994 DOI: 10.3390/ijerph17030993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/27/2020] [Accepted: 02/03/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Norway has one of the best health systems in the world. However, it has a low birth rate, which decreased by 21.2% between 2009 and 2018, and one of the highest rates of infertility prevalence. The aim of this study is to understand how Norwegian doctors perceive female infertility diseases, namely those that are more difficult to diagnose and to treat, and that are more common in their practice. METHOD Descriptive qualitative study was conducted with gynecologists and general practitioners. The sample resulted from the establishment of five criteria and on the doctors' acceptance to participate in this study. Our sample comprised thirteen highly qualified and experienced doctors. Qualitative content analysis was the method chosen to analyze the collected data. RESULTS Clinical diseases (polycystic ovary syndrome, endometriosis and vulvodynia) and consequences of these diseases were the pinpointed themes. These led to a set of sub-themes: the main symptoms and the treatment of the diseases, from the perspective of both women and doctors (stigmatization, disturbances in women's daily life, diagnostic delay, and governmental support). CONCLUSIONS The three most relevant disorders mentioned were polycystic ovary syndrome, endometriosis and vulvodynia. These diseases cause several impacts on the lives of women, because they feel stigmatized and limited in their daily life and sexuality, and the diagnosis of these diseases takes too much time. Governments should better redistribute the financing of women's health and allocate resources to specialized centers.
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Affiliation(s)
- Alexandra Fernandes
- Business Research Unit (BRU-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Avenida das Forças Armadas, 1649-026 Lisboa, Portugal; (L.-L.S.); (M.M.); (P.F.F.)
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Vulvar Vestibulectomy for Neuroproliferative-Associated Provoked Vestibulodynia: A Retrospective Analysis. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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van Beekhuizen HJ, Oost J, van der Meijden WI. Generalized unprovoked vulvodynia; A retrospective study on the efficacy of treatment with amitriptyline, gabapentin or pregabalin. Eur J Obstet Gynecol Reprod Biol 2018; 220:118-121. [DOI: 10.1016/j.ejogrb.2017.10.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/28/2017] [Accepted: 10/30/2017] [Indexed: 12/11/2022]
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Neonatal vaginal irritation results in long-term visceral and somatic hypersensitivity and increased hypothalamic-pituitary-adrenal axis output in female mice. Pain 2016; 156:2021-2031. [PMID: 26098441 PMCID: PMC4578984 DOI: 10.1097/j.pain.0000000000000264] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Neonatal irritation of the vagina permanently sensitizes the vagina and distant somatic structures in a corticotrophin-releasing factor-dependent manner. Experiencing early life stress or injury increases a woman's likelihood of developing vulvodynia and concomitant dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis. To investigate the outcome of neonatal vaginal irritation (NVI), female mouse pups were administered intravaginal zymosan on postnatal days 8 and 10 and were assessed as adults for vaginal hypersensitivity by measuring the visceromotor response to vaginal balloon distension (VBD). Western blotting and calcium imaging were performed to measure transient receptor potential ankyrin 1 (TRPA1) and vanilloid 1 (TRPV1) in the vagina and innervating primary sensory neurons. Serum corticosterone (CORT), mast cell degranulation, and corticotropin-releasing factor receptor 1 (CRF1) expression were measured as indicators of peripheral HPA axis activation. Colorectal and hind paw sensitivity were measured to determine cross-sensitization resulting from NVI. Adult NVI mice had significantly larger visceromotor response during VBD than naive mice. TRPA1 protein expression was significantly elevated in the vagina, and calcium transients evoked by mustard oil (TRPA1 ligand) or capsaicin (TRPV1 ligand) were significantly decreased in dorsal root ganglion from NVI mice, despite displaying increased depolarization-evoked calcium transients. Serum CORT, vaginal mast cell degranulation, and CRF1 protein expression were all significantly increased in NVI mice, as were colorectal and hind paw mechanical and thermal sensitivity. Neonatal treatment with a CRF1 antagonist, NBI 35965, immediately before zymosan administration largely attenuated many of the effects of NVI. These results suggest that NVI produces chronic hypersensitivity of the vagina, as well as of adjacent visceral and distant somatic structures, driven in part by increased HPA axis activation.
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Pelletier F, Girardin M, Humbert P, Puyraveau M, Aubin F, Parratte B. Long-term assessment of effectiveness and quality of life of OnabotulinumtoxinA injections in provoked vestibulodynia. J Eur Acad Dermatol Venereol 2015; 30:106-11. [PMID: 26491951 DOI: 10.1111/jdv.13437] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 07/27/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Provoked vestibulodynia is a relatively common condition that affects sexual activity. Multidisciplinary care is indicated and OnabotulinumtoxinA injections are safe and effective treatment in this indication. AIMS To assess the long-term efficacy of OnabotulinumtoxinA in provoked vestibulodynia. MATERIALS AND METHODS Twenty-one patients treated with OnabotulinumtoxinA injections (50U in each bulbospongiosus muscle) 24 months prior to the study were included. Data on pain [assessed using a visual analogue scale (VAS)], quality of life [measured by the Dermatology Life Quality Index (DLQI)] and quality of sex life [assessed using the Female Sexual Function Index (FSFI)] were collected before treatment, and 3 and 24 months after injection. RESULTS Nineteen patients participated in the study and 37% had no pain after 24 months. Significant improvements were noted in the VAS, DLQI and FSFI scores between baseline and 24 months post treatment (P < 0.0001). After 24 months, 18 patients (95%) were able to have sexual intercourse. This study was open and non-controlled. DISCUSSION AND CONCLUSION 100U OnabotulinumtoxinA injections constitute an effective treatment in provoked vestibulodynia with results maintained after 2 years. They significantly improve pain, and have a positive impact on patient quality of life and sex life. Beneficial effects continue in the long-term, allowing patients to resume sexual activity.
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Affiliation(s)
- F Pelletier
- Department of Dermatology, Besançon University Hospital, Besançon, France.,INSERM UMR1098, University of Franche-Comté, Besançon, France
| | - M Girardin
- Department of Dermatology, Besançon University Hospital, Besançon, France
| | - P Humbert
- Department of Dermatology, Besançon University Hospital, Besançon, France.,INSERM UMR1098, University of Franche-Comté, Besançon, France
| | - M Puyraveau
- Clinical Methodology Centre, Besançon University Hospital, Besançon, France
| | - F Aubin
- Department of Dermatology, Besançon University Hospital, Besançon, France.,University of Franche-Comté, Besançon, France
| | - B Parratte
- Department of Physical Medicine and Readaptation, Besançon University Hospital, Besançon, France.,Anatomy Laboratory, University of Franche-Comté, Besançon, France
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Pierce AN, Christianson JA. Stress and Chronic Pelvic Pain. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2015; 131:509-35. [DOI: 10.1016/bs.pmbts.2014.11.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Pityriasis rosea-like drug eruption due to nortriptyline in a patient with vulvodynia. J Low Genit Tract Dis 2013; 17:226-9. [PMID: 23343697 DOI: 10.1097/lgt.0b013e31825d7c5f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nortriptyline and other tricyclic antidepressants are widely used in the treatment of depression. They are also used in chronic pain syndromes such as vulvodynia. We report a case of pityriasis rosea (PR)-like eruption in a young woman who was treated with oral nortriptyline for vulvodynia. CASE REPORT The patient presented with photosensitivity and erythematous, well-defined, oval papules and patches, with fine collarettes of scale on the dorsal hands, upper arms, and trunk. She showed a complete resolution of her rash with discontinuation of nortriptyline, thereby supporting the diagnosis of a drug-induced reaction. COMMENT Pityriasis rosea-like drug eruptions have been associated with numerous medications, including angiotensin-converting enzyme inhibitors, antirheumatic drugs, lithium, and, more recently, biologics such as imatinib, adalimumab, and etanercept. A literature review did not reveal an association between PR-like drug eruptions and tricyclic antidepressants such as nortriptyline. We report a case of PR-like drug reaction to nortriptyline for clinical interest.
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Reed BD, Payne CM, Harlow SD, Legocki LJ, Haefner HK, Sen A. Urogenital symptoms and pain history as precursors of vulvodynia: a longitudinal study. J Womens Health (Larchmt) 2013; 21:1139-43. [PMID: 23134279 DOI: 10.1089/jwh.2012.3566] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We sought to assess vulvodynia incidence and risk factors among those with and without premorbid urogenital symptoms. METHODS Women's Health Registry members who completed a baseline assessment in 2004 were sent a 2-year and 4-year follow-up survey containing a validated screen for vulvodynia. Subgroup analysis of vulvodynia incidence rates was performed, and risk factors associated with incidence were assessed. RESULTS Of 1037 original enrollees, 723 (69.7%) completed consecutive surveys (initial and 2-year or initial, 2-year, and 4-year), 660 of whom did not have current or past vulvodynia at baseline. Of these 660, 71 (10.8%) first met criteria for vulvodynia within the 4-year period, for an annual incidence rate of 3.1% (95% confidence interval [CI] 2.5-4.0). Baseline strict controls were less likely to develop criteria for vulvodynia diagnosis (annual incidence rate of 1.4%) compared to those with an intermediate phenotype (presence of dyspareunia or history of short-term vulvar pain), for whom the incidence rate was 5.6% (p<0.001). Risk factors for incident vulvodynia differed between these two groups. Among the strict controls, an increased risk was noted among younger women (incidence rate ratio) [IRR] 3.6). For those with an intermediate phenotype, risk was increased among nonwhite women and those reporting pain with or after intercourse (IRR 2.2, 3.4, and 3.1, respectively). In both control groups, incident vulvodynia risk increased among those reporting urinary burning at enrollment (IRR 4.2 and 2.8 for strict and intermediate phenotype controls, respectively). CONCLUSIONS The annual incidence of vulvodynia is substantial (3.1%) and is greater among women reporting a history of dyspareunia or vulvar pain that did not meet criteria for vulvodynia compared to those without this history, suggesting that generalized urogenital sensitivity may be a common underlying mechanism predating the clinical presentation of vulvodynia.
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Affiliation(s)
- Barbara D Reed
- Department of Family Medicine, University of Michigan, Ann Arbor, MI 48104-1213, USA.
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Rimoin LP, Kwatra SG, Yosipovitch G. Female-specific pruritus from childhood to postmenopause: clinical features, hormonal factors, and treatment considerations. Dermatol Ther 2013; 26:157-67. [DOI: 10.1111/dth.12034] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Lauren P. Rimoin
- Department of Internal Medicine; Cedars-Sinai Medical Center; Los Angeles; California; USA
| | - Shawn G. Kwatra
- Departments of †Dermatology; Wake Forest University School of Medicine; Winston-Salem; North Carolina; USA
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Experience of Symptoms, Sexual Function, and Attitudes Toward Counseling of Women Newly Diagnosed With Vulvodynia. J Low Genit Tract Dis 2012; 16:447-53. [DOI: 10.1097/lgt.0b013e31825c2e24] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Role of Vulvar Care Guidelines in the Initial Management of Vulvar Complaints. J Low Genit Tract Dis 2012; 16:88-91. [DOI: 10.1097/lgt.0b013e318232fd9a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gynecologic management of neuropathic pain. Am J Obstet Gynecol 2011; 205:435-43. [PMID: 21777899 DOI: 10.1016/j.ajog.2011.05.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 04/20/2011] [Accepted: 05/05/2011] [Indexed: 11/21/2022]
Abstract
Obstetrician/gynecologists often are the initial management clinicians for pelvic neuropathic pain. Although treatment may require comprehensive team management and consultation with other specialists, there are a few critical and basic steps that can be performed during an office visit that offer the opportunity to improve quality of life significantly in this patient population. A key first step is a thorough clinical examination to map the pain site physically and to identify potentially involved nerves. Only limited evidence exists about how best to manage neuropathic pain; generally, a combination of surgical, manipulative, or pharmacologic methods should be considered. Experimental methods to characterize more precisely the nature of the nerve dysfunction exist to diagnose and treat neuropathic pain; however, additional scientific evidence is needed to recommend these options unanimously. In the meantime, an approach that was adopted from guidelines of the International Association for the Study of Pain has been tailored for gynecologic pain.
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Clare CA, Yeh J. Vulvodynia in adolescence: childhood vulvar pain syndromes. J Pediatr Adolesc Gynecol 2011; 24:110-5. [PMID: 21601807 DOI: 10.1016/j.jpag.2010.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 08/11/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Children, adolescents and young women represent a unique group of patients with vulvodynia. STUDY OBJECTIVE To define and characterize vulvodynia, diagnostic criteria, causes and pathophysiology, propose treatment modalities, emphasizing its prevalence in young children, adolescents and young women less than 25 years of age. DESIGN Medline review of the literature on vulvar pain disorders, using the key word vulvodynia, from the years 1995 to 2010, comparing characteristics in children, adolescents and young women ages 25 years and less to older adult women. SETTING MEDLINE review of current literature from 1995 to 2010. PARTICIPANTS None INTERVENTIONS There were no interventions during this literature review. MAIN OUTCOME MEASURES A synthesis of cases of vulvodynia in these populations and the specific characteristics and recommendations in these age groups. RESULTS Childhood vulvar pain is usually found to have a cause. Pain characteristics in this group are similar to adults. In adolescents and young reproductive age women, vulvar pain is associated with sexual intercourse or early tampon use. The psychological component of vulvar pain is limited due to small numbers of patients available for review. Treatment modalities and recommendations are based on limited data. CONCLUSIONS Women with vulvodynia vary in ages from 16 to 80 years with the majority between the ages of 20 to 50 years. Young women in their teens and early twenties are at the greatest risk of developing vulvodynia. Vulvar pain disorders are important in these groups because early pain syndromes may affect future development of body image, self-esteem, and attitudes toward sexual behavior and functioning.
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Affiliation(s)
- Camille A Clare
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York, USA
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Gardella B, Porru D, Nappi RE, Daccò MD, Chiesa A, Spinillo A. Interstitial Cystitis is Associated with Vulvodynia and Sexual Dysfunction—A Case-Control Study. J Sex Med 2011; 8:1726-34. [DOI: 10.1111/j.1743-6109.2011.02251.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vulvodynia. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00102-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
The diagnosis and management of chronic vulvovaginal disease requires attention to several issues. Psychological factors are usually important, because women worry about malignancy, impaired sexuality and self-image, fertility, and sexually transmitted diseases. Multifactorial processes are common due to the risk of secondary candidiasis, contact dermatitis, effects of low estrogen in postmenopausal women and women on oral contraceptives, and so forth. Undertreatment of inflammatory dermatoses is common, because clinicians use topical corticosteroids that are of inadequate potency and for insufficient duration. All of these issues must be considered for optimal benefit in the therapy of chronic vulvovaginal diseases.
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Won HR, Abbott J. Optimal management of chronic cyclical pelvic pain: an evidence-based and pragmatic approach. Int J Womens Health 2010; 2:263-77. [PMID: 21151732 PMCID: PMC2990894 DOI: 10.2147/ijwh.s7991] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
This article reviews the literature on management of chronic cyclical pelvic pain (CCPP). Electronic resources including Medline, PubMed, CINAHL, The Cochrane Library, Current Contents, and EMBASE were searched using MeSH terms including all subheadings and keywords: "cyclical pelvic pain", "chronic pain", "dysmenorrheal", "nonmenstrual pelvic pain", and "endometriosis". There is a dearth of high-quality evidence for this common problem. Chronic pelvic pain affects 4%-25% of women of reproductive age. Dysmenorrhea of varying degree affects 60% of women. Endometriosis is the commonest pathologic cause of CCPP. Other gynecological causes are adenomyosis, uterine fibroids, and pelvic floor myalgia, although other systems disease such as irritable bowel syndrome or interstitial cystitis may be responsible. Management options range from simple to invasive, where simple medical treatment such as the combined oral contraceptive pill may be used as a first-line treatment prior to invasive management. This review outlines an approach to patients with CCPP through history, physical examination, and investigation to identify the cause(s) of the pain and its optimal management.
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Affiliation(s)
- Ha Ryun Won
- Department of Endo-Gynecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Jason Abbott
- Department of Endo-Gynecology, Royal Hospital for Women, Sydney, New South Wales, Australia
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Butrick CW, Howard FM, Sand PK. Diagnosis and Treatment of Interstitial Cystitis/Painful Bladder Syndrome: A Review. J Womens Health (Larchmt) 2010; 19:1185-93. [DOI: 10.1089/jwh.2009.1702] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charles W. Butrick
- Department of Obstetrics & Gynecology, The Urogynecology Center, Overland Park, Kansas, and Kansas University Medical Center, Kansas City, Kansas
| | - Fred M. Howard
- Department of Obstetrics & Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Peter K. Sand
- Department of Obstetrics & Gynecology, Northwestern University, Feinberg School of Medicine, Evanston, Illinois
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Ventolini G, Barhan S, Duke J. Vulvodynia, a step-wise therapeutic prospective cohort study. J OBSTET GYNAECOL 2009; 29:648-50. [PMID: 19757274 DOI: 10.1080/01443610903095882] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Vulvodynia is characterised by the presence of vulval allodynia (pain evoked by non-painful stimuli) and vulval dysaesthesias (burning, soreness, rawness, stinging and irritation). We assessed a protocol for the evaluation and management of vulvodynia. The protocol was based on the most recent evidence available. We began a simple evaluation and proceeded to an aggressive one. From the cohort of 74 patients, 69 patients (93.2%) were adherent to the protocol. A total of 25 patients (36.3%) improved after antibiotic therapy: 14 patients (20.4%) had a positive fungal culture and 11 patients (15.9%) had a positive bacterial culture; none with a positive viral culture. Eight patients (11.6%) improved with dietary modification. Ten patients (14.5%) benefitted from tricyclic medications; 13 patients (18.8%) improved after gabapentin therapy; 13 patients (18.8%) did not show improvement of their condition. Some 56 patients (81.2%) manifested an improvement of their symptoms, which allowed them to achieve painless sexual intercourse.
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Affiliation(s)
- G Ventolini
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, Ohio 45409, USA.
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Forth HL, Cramp MC, Drechsler WI. Does physiotherapy treatment improve the self-reported pain levels and quality of life of women with vulvodynia? A pilot study. J OBSTET GYNAECOL 2009; 29:423-9. [PMID: 19603323 DOI: 10.1080/01443610902954345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The study investigated whether a 3-month period of physiotherapy treatment improved the pain levels and quality of life of women with vulvodynia. A quasi-experimental method was used, comprising a within-subjects, pre-test/post-test design in which subjects acted as their own controls. A convenience sample of 14 subjects was recruited from referrals to women's health physiotherapy between May and August 2004. The McGill Pain Questionnaire and Short Form 36 (version 2) were used to assess changes in self-reported pain levels and quality of life, respectively. Subjects completed questionnaires on recruitment to the study, 3 months later (immediately prior to commencing physiotherapy treatment), and after 3 months of treatment. The study investigated whether changes in pain levels and quality of life observed during the 3-month intervention phase differed from those observed during the 3-month control phase. The pain levels of study subjects reduced during the treatment period relative to the control period, and improvements were also observed in some aspects of quality of life. These results indicate that physiotherapy may offer some benefit in the treatment of vulvodynia. However, none of the findings reached statistical significance due to the small sample size. This study supports the view that physiotherapy provides pain relief for women with vulvodynia. Larger, randomised controlled trials are required to confirm the effectiveness of the treatment.
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Affiliation(s)
- H L Forth
- Department of Physiotherapy, Royal Free Hospital, London NW3 2QG, UK.
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Gynecological indications for the use of botulinum toxin in women with chronic pelvic pain. Toxicon 2009; 54:647-53. [PMID: 19264089 DOI: 10.1016/j.toxicon.2009.01.036] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 01/04/2009] [Accepted: 01/06/2009] [Indexed: 11/23/2022]
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Affiliation(s)
- Archana Rao
- Department of Endo-Gynaecology, Royal Hospital for Women, Randwick, New South Wales, Australia.
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Dell JR, Mokrzycki ML, Jayne CJ. Differentiating interstitial cystitis from similar conditions commonly seen in gynecologic practice. Eur J Obstet Gynecol Reprod Biol 2009; 144:105-9. [DOI: 10.1016/j.ejogrb.2009.02.050] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 01/09/2009] [Accepted: 02/21/2009] [Indexed: 12/01/2022]
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Abbott J. The Use of Botulinum Toxin in the Pelvic Floor for Women with Chronic Pelvic Pain–A New Answer to Old Problems? J Minim Invasive Gynecol 2009; 16:130-5. [DOI: 10.1016/j.jmig.2008.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 10/21/2008] [Accepted: 11/06/2008] [Indexed: 10/21/2022]
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Ponte M, Klemperer E, Sahay A, Chren MM. Effects of vulvodynia on quality of life. J Am Acad Dermatol 2008; 60:70-6. [PMID: 19022532 DOI: 10.1016/j.jaad.2008.06.032] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 04/28/2008] [Accepted: 06/15/2008] [Indexed: 12/18/2022]
Abstract
BACKGROUND The experiences of women with vulvodynia are poorly understood. OBJECTIVE We sought to determine the effects of vulvodynia on quality of life. METHODS We conducted a survey of 280 patients in a university-based vulvar disorders clinic. Skin-related quality of life was measured with a vulvar-specific version of Skindex-29. RESULTS The response rate was 95%; 101 patients (36%) had vulvodynia, and 179 patients (64%) had other vulvar conditions. Women with vulvodynia had significantly worse quality of life than patients with many other dermatologic conditions, and worse functioning than women with other vulvar conditions (mean functioning scores [+/-SD] of patients with psoriasis, other vulvar conditions, and vulvodynia were 23 +/- 27, 34 +/- 24, and 44 +/- 22, respectively, P = .05). A diagnosis of vulvodynia was the strongest independent correlate of poor quality of life (eg, for poor functioning, odds ratio = 1.8, 95% confidence interval 1.0-3.1). LIMITATIONS Limitations are single academic medical center and comorbid illnesses determined by self-report. CONCLUSION Vulvodynia has broad and substantial effects on quality of life.
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Affiliation(s)
- Maya Ponte
- School of Medicine, University of California-San Francisco, San Francisco, California, USA
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López-Olmos J. Dispareunia: investigación de causa física y de causa infecciosa crónica (estudio prospectivo de 4 años). CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2008. [DOI: 10.1016/s0210-573x(08)73068-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
INTRODUCTION Vulvodynia is increasingly recognized as a cause of sexual pain. Aim. The goal of this Continuing Medical Education article was to provide a comprehensive review of vulvodynia including terminology, possible etiologies, and offer treatment options. METHODS A Medline search was conducted using several terms related to and including the terms vulvodynia, vulvar vestibulitis, vestibulodynia, and pudendal neuralgia. RESULTS A thorough review of vulvodynia. CONCLUSION Vulvodynia most likely represents several disorders without an identifiable cause in many cases. The management of these patients requires a sensitive provider who can coordinate a multidisciplinary approach to their care. Despite the lack of large-scale, placebo-controlled trials, several new treatment options exist.
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Ayling K, Ussher JM. "If sex hurts, am I still a woman?" the subjective experience of vulvodynia in hetero-sexual women. ARCHIVES OF SEXUAL BEHAVIOR 2008; 37:294-304. [PMID: 17876696 DOI: 10.1007/s10508-007-9204-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Revised: 12/20/2006] [Accepted: 01/01/2007] [Indexed: 05/17/2023]
Abstract
Vulvodynia has recently been recognized as a significant health problem among women, with a considerable proportion experiencing psychological distress and sexual dysfunction for many years. This study used a material-discursive framework and a qualitative methodology to investigate women's subjective experience of vulvodynia within the context of a hetero-sexual relationship, and their negotiation of coitus, commonly associated with vulvar pain. Seven women, who had experienced vulvodynia between 2 and 10 years, took part in in-depth interviews. Thematic decomposition drawing on a Foucauldian framework for interpretation identified that six of the seven women took up subject positions of "inadequate woman" and "inadequate partner," positioning themselves as failures for experiencing pain during coitus, which they interpreted as affecting their ability to satisfy their partners sexually, resulting in feelings of shame, guilt, and a decreased desire for sexual contact. This was interpreted in relation to dominant discourses of femininity and hetero-sexuality, which conflate a woman's sexuality with her need to be romantically attached to a man, position men as having a driven need for sex, and uphold coitus as the organizing feature of hetero-sex. Only one woman positioned herself as an "adequate woman/partner," associated with having renegotiated the coital imperative and the male sex drive discourse within her relationship. These positions, along with women's agentic attempts to resist them, were discussed in relation to their impact on hetero-sexual women's negotiation of vulvodynia. Implications for future research and vulvodynia treatment regimes are also raised.
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Affiliation(s)
- Kathryn Ayling
- Gender, Culture and Health Research Unit: PsyHealth, School of Psychology, University of Western Sydney, Locked Bag 1797, Penrith South DC, NSW 1797, Australia
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Peters K, Girdler B, Carrico D, Ibrahim I, Diokno A. Painful bladder syndrome/interstitial cystitis and vulvodynia: a clinical correlation. Int Urogynecol J 2007; 19:665-9. [PMID: 18038212 DOI: 10.1007/s00192-007-0501-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Accepted: 10/24/2007] [Indexed: 12/30/2022]
Abstract
Vulvodynia affects 25% of women with painful bladder syndrome/interstitial cystitis (PBS/IC). The objective of our study was to clinically evaluate the association of PBS/IC and vulvodynia and possible contributing factors. To our knowledge, this has not been reported. Seventy women with PBS/IC were evaluated from December 2005 to December 2006 with a comprehensive history and exam. Two groups were formed--those with vulvodynia and those without vulvodynia for comparison. Of the women, 51.4% had vulvodynia and 48.6% did not have vulvodynia using our operative definition. Average levator pain levels were significantly greater in those with vulvodynia. There was no significant difference in the total number of lifetime pelvic surgeries, history of sexually transmitted infections (STIs), vaginitis, or abuse history between groups. The correlation of vulvodynia and PBS/IC may have been underestimated. Research needs to explore the link between precipitating factors, symptoms, and effective treatment options for PBS/IC and vulvodynia.
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Affiliation(s)
- Kenneth Peters
- Department of Urology, William Beaumont Hospital, Royal Oak, MI, USA
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Gumus II, Sarifakioglu E, Uslu H, Turhan NO. Vulvodynia: case report and review of literature. Gynecol Obstet Invest 2007; 65:155-61. [PMID: 17998784 DOI: 10.1159/000110896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Ilknur Inegol Gumus
- Department of Obstetrics and Gynecology, Fatih University School of Medicine, Ankara, Turkey.
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43
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Greenstein A, Ben-Aroya Z, Fass O, Militscher I, Roslik Y, Chen J, Abramov L. Vulvar Vestibulitis Syndrome and Estrogen Dose of Oral Contraceptive Pills. J Sex Med 2007; 4:1679-83. [DOI: 10.1111/j.1743-6109.2007.00621.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Collectively, new developments in the field of medical dermatology will ultimately lead to improved patient care. We review several new findings in the dermatologic literature including the following: new questions regarding the malignant potential of anti-tumor necrosis factor agents, which are widely used for the treatment of moderate to severe psoriasis as well as psoriatic arthritis; anti-interleulin-12, a promising anticytokine for the treatment of psoriasis; diagnostic advances in the detection of latent Mycobacterium tuberculosis; advances in the primary prevention of human papillomavirus and herpes zoster; and new therapeutic options with existing medications for neuropathic pain and pruritus.
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Affiliation(s)
- Lily N Clark
- Department of Dermatology, Mount Sinai School of Medicine, New York, NY 10029, USA.
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46
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Sargeant HA, O'Callaghan FV. The impact of chronic vulval pain on quality of life and psychosocial well-being. Aust N Z J Obstet Gynaecol 2007; 47:235-9. [PMID: 17550493 DOI: 10.1111/j.1479-828x.2007.00725.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic or recurrent pain associated with the female reproductive system is not well understood and has been neglected in research, despite it being a costly health problem. AIMS The present research investigated the psychosocial impact of vulval pain on health-related quality of life, sexual well-being, and relationship satisfaction among Australian women. METHODS Between June and December 2004, Australian women with and without vulval pain completed a questionnaire containing a range of well-validated self-report measures. Questionnaires were returned by 51 women aged between 19 and 68 years with vulval pain and 46 women aged between 21 and 65 years without vulval pain. RESULTS Similar to previous research, Australian women with vulval pain reported significantly worse health-related quality of life, higher levels of distress related to sexual activities, and lower levels of happiness in couple relationships than those without pain. CONCLUSIONS These results highlight serious psychosocial implications for women experiencing chronic vulval pain. Understanding the impact that vulval pain has on women may assist in developing appropriate psychosocial interventions that may improve quality of life.
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Arnold LD, Bachmann GA, Rosen R, Rhoads GG. Assessment of vulvodynia symptoms in a sample of US women: a prevalence survey with a nested case control study. Am J Obstet Gynecol 2007; 196:128.e1-6. [PMID: 17306651 PMCID: PMC2746064 DOI: 10.1016/j.ajog.2006.07.047] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Revised: 05/31/2006] [Accepted: 07/03/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Vulvodynia is a chronic pain syndrome of unknown origin with scant data on frequency. This study assessed the prevalence of vulvodynia symptoms in a sample of US women and compared health characteristics of symptomatic and asymptomatic women. STUDY DESIGN A phone survey contacted 2127 US households to identify 100 symptomatic women, who were matched on age and time zone to 325 asymptomatic controls. Odds ratios (ORs) and logistic regression were used to model associations between pain, medical conditions, and health care utilization variables. RESULTS Current vulvar pain of at least 6 months duration was reported by 3.8% of respondents, with a 9.9% lifetime prevalence. Forty-five percent of women with pain reported an adverse effect on their sexual life and 27% an adverse effect on their lifestyle. Cases more frequently reported repeated urinary tract infections (OR, 6.15; 95% CI, 3.51-10.77) and yeast infections (OR, 4.24; 95% CI, 2.47-7.28). Associations existed with chronic fatigue syndrome (OR, 2.78; 95% CI, 1.33-6.19), fibromyalgia (OR, 2.15; 95% CI, 1.06-4.36), depression (OR, 2.99; 95% CI, 1.87-4.80), and irritable bowel syndrome (OR, 1.86; 95% CI, 1.07-3.23). CONCLUSION Lifetime chronic vulvar pain was less prevalent in this national sample of women than previous data suggest and was correlated with several comorbid chronic medical conditions and substantial reduction in self-reported quality of life.
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Affiliation(s)
- Lauren D Arnold
- Department of Epidemiology, School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, NJ, USA
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48
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Vulvodynia. Pain Manag 2007. [DOI: 10.1016/b978-0-7216-0334-6.50097-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Bennani B, Raki S, Monnier G, Pelletier F, Humbert P. Vestibulite vulvaire : traitement par la toxine botulinique. Ann Dermatol Venereol 2006; 133:807-8. [PMID: 17072204 DOI: 10.1016/s0151-9638(06)77610-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Goldstein AT, Klingman D, Christopher K, Johnson C, Marinoff SC. ORIGINAL RESEARCH—SURGERY: Surgical Treatment of Vulvar Vestibulitis Syndrome: Outcome Assessment Derived from a Postoperative Questionnaire. J Sex Med 2006; 3:923-931. [PMID: 16942537 DOI: 10.1111/j.1743-6109.2006.00303.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Vulvar vestibulitis syndrome (VVS) is the most common pathology in women with sexual pain. Surgery for VVS was first described in 1981. Despite apparently high surgical success rates, most review articles suggest that surgery should be used only "as a last resort." Risks of complications such as bleeding, scarring, and recurrence of symptoms are often used to justify these cautionary statements. However, there are little data in the peer-reviewed literature to justify this cautionary statement. AIMS To determine patient satisfaction with vulvar vestibulectomy for VVS and the rate of complications with this procedure. METHODS Women who underwent a complete vulvar vestibulectomy with vaginal advancement by one of three different surgeons were contacted via telephone by an independent researcher between 12 and 72 months after surgery. MAIN OUTCOME MEASURES The primary outcome measurement of surgical success was overall patient satisfaction with surgery. Additional secondary outcome measurements included improvement in dyspareunia, changes in coital frequency, and occurrence of surgical complications. RESULTS In total, 134 women underwent surgery in a 5-year period. An independent research assistant was able to contact 106 women, and 104 agreed to participate in the study. Mean duration since surgery was 26 months. A total of 97 women (93%) were satisfied, or very satisfied, with the outcome of their surgery. Only three patients (3%) reported persistently worse symptoms after surgery and only seven (7%) reported permanent recurrence of any symptoms after surgery. Prior to surgery, 72% of the women were completely apareunic; however, after surgery, only 11% were unable to have intercourse. DISCUSSION In this cohort of patients, there was a high degree of satisfaction with surgery for VVS. In addition, the risks of complications with this procedure were low, and most complications were transient and the risk of recurrence after surgery was also found to be low.
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Affiliation(s)
- Andrew T Goldstein
- Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD; Center for Vulvovaginal Disorders, Washington, DC.
| | - Daisy Klingman
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kurt Christopher
- Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Medical Center, New York, NY
| | - Crista Johnson
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI
| | - Stanley C Marinoff
- Department of Obstetrics and Gynecology, George Washington University School of Medicine, Washington, DC, USA
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