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Blaustein RB, Parker CA, Haefner HK, Reed BD, Haefner JK, Welch KC. Relationship Between Childhood Sexual Abuse, Obesity, and Vulvodynia in Adulthood. J Low Genit Tract Dis 2024; 28:160-163. [PMID: 38346428 DOI: 10.1097/lgt.0000000000000799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVE The aim of the study is to assess the relationship between childhood sexual abuse, obesity, and vulvodynia among adult women participating in a population-based longitudinal vulvodynia study. MATERIALS AND METHODS Surveys assessed health status, diagnoses, risk factors, and screening test outcomes for women with vulvodynia. Associations between childhood sexual abuse (CSA) and obesity, CSA and vulvodynia, and obesity and vulvodynia were investigated. A multivariate model was used to determine if obesity mediates and/or modifies the relationship between CSA and vulvodynia. RESULTS Of 2,277 women participating in the study, 1,647 completed survey data on CSA at 18 months, body mass index at 24 months, and vulvodynia over the first 54 months of the survey. Mean age was 50.9 ± 15.8 years. Overall, race and ethnicity were 77.4% White, 15.7% Black, 2.4% Hispanic, and 4.5% other. Five hundred thirty-nine participants (32.7%) were obese (body mass index >30) and 468 (28.4%) were overweight. Physical CSA before age of 18 years was reported by 20.0% ( n = 329). During the study, 22.0% ( n = 362) screened positive for vulvodynia on one or more surveys. After controlling for demographic variables, both obesity and screening positive for vulvodynia were associated with a history of CSA before age of 18 years ( p = .013 and p < .001, respectively), but obesity was not associated with screening positive for vulvodynia ( p = .865). In addition, multivariate analysis indicated no mediation of the CSA/vulvodynia relationship by obesity. CONCLUSIONS Although obesity and vulvodynia were independently associated with a history of CSA, obesity did not mediate or modify the relationship between CSA and vulvodynia in adulthood.
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Affiliation(s)
| | | | - Hope K Haefner
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI
| | - Barbara D Reed
- University of Michigan, Department of Family Medicine, Ann Arbor, MI
| | - Jessica K Haefner
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI
| | - Kathryn C Welch
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI
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Falsetta ML. Editorial: Vulvodynia and beyond: innate immune sensing, microbes, inflammation, and chronic pain. Front Cell Infect Microbiol 2023; 13:1338659. [PMID: 38145051 PMCID: PMC10739423 DOI: 10.3389/fcimb.2023.1338659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- Megan L. Falsetta
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY, United States
- Department of Pharmacology and Physiology, University of Rochester, Rochester, NY, United States
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Padoa A, Tomashev R, Brenner I, Golan A, Igawa MS, Lurie I, Reicher Y, Talmon A, Ginzburg K. Obstetric outcome and emotional reactions to childbirth in women with dyspareunia: A cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2023; 288:7-11. [PMID: 37413830 DOI: 10.1016/j.ejogrb.2023.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/04/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To assess obstetrical outcomes, perceptions of childbirth experience and emotional adjustment, in women with dyspareunia. STUDY DESIGN In this cross-sectional study, 440 women were recruited within 48 h postpartum in the maternity ward of a large medical center, during the period of April 2018- August 2020. Self-report questionnaires were administered which addressed demographic and reproductive background, dyspareunia, perceptions of control during labor (Labor Agentry Scale), perceived professional support (Intrapartum Care Scale), and maternal adjustment, implicated in perinatal dissociation (Peritraumatic Dissociative Experiences Questionnaire), acute stress disorder (ASD) symptoms (Stanford Acute Stress Reaction Questionnaire), bonding (Mother-to-Infant Bonding Scale), anticipated maternal self-efficacy (Maternal Self-Efficacy Scale) and well-being (Positive and Negative Affect Schedule, Edinburgh Postnatal Depression Scale). Obstetrical information was retrieved from clinical files and included pregnancy complications, week and mode of delivery, nature of labor onset, analgesia during delivery, birthweight, perineal tears. RESULTS The dyspareunia group included 71 women (18.3%) and the comparison group 317 (81.7%). Demographic data were similar among groups. No difference was observed in nature of labor onset, type of analgesia, route of delivery, perineal tears. More participants with dyspareunia had premature delivery versus comparisons (14.1% vs 5.6%, p = 0.02). Women with dyspareunia reported lower levels of control (p = 0.01) and perceived support during childbirth (p < 0.001), higher levels of perinatal dissociation (p < 0.001) ASD symptoms (p < 0.001), depression (p = 0.02), negative affect (p < 0.001), and reported lower levels of maternal bonding (p < 0.001) and anticipated maternal self-efficacy (p = 0.01). CONCLUSION Dyspareunia was associated with more premature deliveries, parameters of emotional distress during childbirth and poorer maternal adjustment following childbirth. Perinatal caregivers should be cognizant of such cognitive and emotional reactions in women with dyspareunia, so as to assess for a history of dyspareunia in pregnant women and provide adequate support during pregnancy and delivery.
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Affiliation(s)
- Anna Padoa
- Department of Obstetrics and Gynecology, Shamir-Assaf Harofeh Medical Center, Tsrifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Roni Tomashev
- Department of Obstetrics and Gynecology, Shamir-Assaf Harofeh Medical Center, Tsrifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Brenner
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Lev-Hasharon Medical Center, Pardesiya, Israel
| | - Ayelet Golan
- Department of Obstetrics and Gynecology, Shamir-Assaf Harofeh Medical Center, Tsrifin, Israel
| | - May Shir Igawa
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Lurie
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Yael Reicher
- Department of Obstetrics and Gynecology, Soroka Medical Center, Beersheba, Israel; Ben Gurion University of the Negev, Beersheba, Israel
| | - Anat Talmon
- Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel; Department of Psychology, Stanford University, Stanford, CA, USA
| | - Karni Ginzburg
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
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Tonc E, Omwanda GK, Tovar KA, Golden XME, Chatterjea D. Immune mechanisms in vulvodynia: key roles for mast cells and fibroblasts. Front Cell Infect Microbiol 2023; 13:1215380. [PMID: 37360527 PMCID: PMC10285386 DOI: 10.3389/fcimb.2023.1215380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
Vulvodynia is a debilitating condition characterized by painful sensitivity to touch and pressure in the vestibular tissue surrounding the vaginal opening. It is often a "diagnosis of exclusion" of idiopathic pain made in the absence of visible inflammation or injury. However, the association between increased vulvodynia risk and a history of yeast infections and skin allergies has led researchers to explore whether immune mechanisms of dysregulated inflammation might underlie the pathophysiology of this chronic pain condition. Here we synthesize epidemiological investigations, clinical biopsies and primary cell culture studies, and mechanistic insights from several pre-clinical models of vulvar pain. Taken together, these findings suggest that altered inflammatory responses of tissue fibroblasts, and other immune changes in the genital tissues, potentially driven by the accumulation of mast cells may be key to the development of chronic vulvar pain. The association of increased numbers and function of mast cells with a wide variety of chronic pain conditions lends credence to their involvement in vulvodynia pathology and underscores their potential as an immune biomarker for chronic pain. Alongside mast cells, neutrophils, macrophages, and numerous inflammatory cytokines and mediators are associated with chronic pain suggesting immune-targeted approaches including the therapeutic administration of endogenous anti-inflammatory compounds could provide much needed new ways to treat, manage, and control the growing global pandemic of chronic pain.
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Chisari C, Begleris I, Monajemi MB, Lewis F, Moss-Morris R, Scott W, McCracken LM. A Network Analysis of Selected Psychosocial Factors in Vulvodynia and Its Subtypes. PAIN MEDICINE 2021; 22:2863-2875. [PMID: 34453826 DOI: 10.1093/pm/pnab265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Psychosocial factors are related to pain and sex-related outcomes in provoked vulvodynia and possibly in mixed and spontaneous vulvodynia. However, a broader behavioral framework, such as the psychological flexibility model, has received limited attention in this context. Recently, additional psychosocial variables have also emerged that appear relevant to vulvodynia, including perceived injustice, body-exposure anxiety during intercourse, and unmitigated sexual communion. The present study applied network analysis to explore relations between psychological flexibility, newly emerging psychosocial variables relevant to vulvodynia, and their associations with vulvodynia outcomes. The study also explored potential differences across vulvodynia subtypes. DESIGN An online cross-sectional study of 349 participants with vulvodynia (112 provoked, 237 spontaneous/mixed) was carried out. METHODS Participants completed self-report questionnaires, including questions on pain and sexual outcomes, depression, facets of psychological flexibility, body-exposure anxiety during intercourse, unmitigated sexual communion, and perceived injustice. Networks were computed for the total sample and for provoked and mixed/spontaneous vulvodynia subsamples. RESULTS Perceived injustice, pain acceptance, and depression were "central" factors among the included variables, in all models. Psychological flexibility processes were relevant for all networks. Depression was more central in the network for mixed/spontaneous vulvodynia; body-exposure anxiety during intercourse was most central for the provoked subtype. CONCLUSIONS Among the included variables, perceived injustice, pain acceptance, depression, and psychological flexibility appear to be important in vulvodynia. As different factors are significant across subtypes, tailored treatment approaches are suggested.
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Affiliation(s)
- Claudia Chisari
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | | | - Mani B Monajemi
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - Fiona Lewis
- St. John's Institute of Dermatology, Guy's & St. Thomas's NHS Foundation Trust, Guy's Hospital, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK.,INPUT Pain Management Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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Willis SK, Aiello AE, Chatterjea D, Nelson JA, Hibberd P, Harlow BL. Characterizing Differences in Thymic Function in Women With and Without Vulvodynia: A Community-Based Study. J Low Genit Tract Dis 2021; 25:296-302. [PMID: 34542085 PMCID: PMC10155502 DOI: 10.1097/lgt.0000000000000620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the association between vulvodynia and thymic function. MATERIALS AND METHODS In this case-control study of 200 clinically confirmed cases of vulvodynia and 205 general population controls residing in the Minneapolis/Saint Paul metropolitan area, we used DNA extracted from whole blood to measure levels of signal joint T-cell receptor excision circles (sjTRECs), a measure of thymic output. We used logistic regression to evaluate the association between vulvodynia and thymic function. RESULTS In 405 participants (aged 18-40 years), we observed an association between decreasing thymic function and increasing age. Women with vulvodynia had a steeper decline in sjTREC values across age categories compared with women without vulvodynia. In addition, at younger ages, women with vulvodynia had higher sjTREC values compared with women without vulvodynia. In older women, those with vulvodynia had lower sjTREC than those without vulvodynia. When accounting for recency of vulvar pain onset, women with a shorter time since pain onset had higher thymic function compared with women with a longer time since vulvar pain onset. CONCLUSIONS These findings suggest that at younger ages, women with vulvodynia have higher thymic output and a more precipitous decline of thymic function than those without vulvodynia. It also seems that a strong immune inflammatory response is present proximate to the onset of vulvar pain and may wane subsequently over time.
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Affiliation(s)
- Sydney K Willis
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Allison E Aiello
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | | | - Julie A. Nelson
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Patricia Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Bernard L. Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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Torres-Cueco R, Nohales-Alfonso F. Vulvodynia-It Is Time to Accept a New Understanding from a Neurobiological Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126639. [PMID: 34205495 PMCID: PMC8296499 DOI: 10.3390/ijerph18126639] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/13/2021] [Accepted: 06/16/2021] [Indexed: 12/12/2022]
Abstract
Vulvodynia is one the most common causes of pain during sexual intercourse in premenopausal women. The burden of vulvodynia in a woman's life can be devastating due to its consequences in the couple's sexuality and intimacy, in activities of daily living, and psychological well-being. In recent decades, there has been considerable progress in the understanding of vulvar pain. The most significant change has been the differentiation of vulvar pain secondary to pathology or disease from vulvodynia. However, although it is currently proposed that vulvodynia should be considered as a primary chronic pain condition and, therefore, without an obvious identifiable cause, it is still believed that different inflammatory, genetic, hormonal, muscular factors, etc. may be involved in its development. Advances in pain neuroscience and the central sensitization paradigm have led to a new approach to vulvodynia from a neurobiological perspective. It is proposed that vulvodynia should be understood as complex pain without relevant nociception. Different clinical identifiers of vulvodynia are presented from a neurobiological and psychosocial perspective. In this case, strategies to modulate altered central pain processing is necessary, changing the patient's erroneous cognitions about their pain, and also reducing fear avoidance-behaviors and the disability of the patient.
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Affiliation(s)
- Rafael Torres-Cueco
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Correspondence:
| | - Francisco Nohales-Alfonso
- Gynecology Section, Clinical Area of Women’s Diseases, La Fe University Hospital, 46010 Valencia, Spain;
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Paavonen J, Eschenbach DA. Localized Provoked Vulvodynia-An Ignored Vulvar Pain Syndrome. Front Cell Infect Microbiol 2021; 11:678961. [PMID: 34222047 PMCID: PMC8248677 DOI: 10.3389/fcimb.2021.678961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
Localized provoked vulvodynia (LPV) causes dyspareunia among reproductive aged women. We review the pathogenesis of LPV and suggest that LPV is an inflammatory pain syndrome of the vestibular mucosa triggered by microbial antigens in a susceptible host. Tissue inflammation and hyperinnervation are characteristic findings which explain symptoms and clinical signs. Education of health care providers of LPV is important since this condition is common, often unrecognized, and patients often become frustrated users of health care. Research is needed on the antigen triggers of the syndrome. Randomized clinical trials are needed to evaluate treatment modalities.
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Affiliation(s)
- Jorma Paavonen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - David A Eschenbach
- Department of Obstetrics and Gynecology, University of Washington, Women's Health Care Center- Roosevelt, Seattle, WA, United States
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Abstract
Vulvodynia is a heterogenous, chronic pain condition of unknown etiology that affects 7% to 15% of women. It affects sexual function and quality of life. Vulvodynia can be primary or secondary, localized or generalized, and spontaneous or provoked. Contributing factors for provoked vulvodynia might include vulvovaginal infections, low estrogen states, and underlying anxiety disorder. Generalized vulvodynia likely arises from underlying connective tissue or neurological dysfunction. Vulvodynia treatment must be individualized on the basis of the patient's presentation and physical examination findings. Surgical excision of the vulvar vestibule has high success rates but other modalities showing success include pelvic floor physical therapy and cognitive-behavioral therapy.
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The Variation of Peripheral Inflammatory Markers in Vocal Leukoplakia before and after Recurrence and Canceration. DISEASE MARKERS 2020; 2020:7241785. [PMID: 32831972 PMCID: PMC7422067 DOI: 10.1155/2020/7241785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/07/2020] [Accepted: 06/10/2020] [Indexed: 12/20/2022]
Abstract
Background This retrospective study aims at comparing the variation of peripheral inflammatory markers in recurrent and cancerous vocal fold leukoplakia (VFL) and at exploring the potential connection with pathological outcomes. Methods The patients undergoing carbon dioxide laser surgery with postoperative pathological diagnosis of recurrent vocal fold leukoplakia in the last 5 years were included. The clinical data were collected, and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocytes-to-lymphocyte ratio (MLR) before and after recurrence and canceration were calculated. Related comparison with two-grade pathological classification was made to evaluate their potential connection with postsurgical histopathology and clinical events. Results The data of 193 patients were engaged into research, as 111 in the recurrence group (Group A) and 82 in canceration group (Group B). The NLR, PLR, and MLR were significantly increased in canceration event compared to the first (P = 0.009, 0.004, 0.007, respectively) and penultimate (P = 0.013, 0.041, 0.006, respectively) time when the previous pathologies were leukoplakia. When redividing the Group A according to the two-grade pathological classification, the high-risk groups showed statistically higher NLR and PLR values than low-risk groups in the subgroups with grade changing (P = 0.016, 0.005, 0.007, 0.005, respectively) and subgroups without grade changing (P = 0.020, 0.027, 0.030, 0.029, respectively). Conclusions NLR, PLR, and MLR are reliable biomarkers in the circulation system which show significantly interrelation with the pathological progression of vocal fold leukoplakia. Presurgical evaluation of NLR, PLR, and MLR may have potential values to indicate the following treatment in clinical practice.
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Abstract
Vulvodynia is a condition that occurs in 8-10% of women of all ages and is characterized by pain at the vulva that is present during sexual and/or non-sexual situations. Diagnosis is established through careful medical history and pelvic examination, including the cotton-swab test. The onset and maintenance of vulvodynia involves a complex interplay of peripheral and central pain mechanisms, pelvic floor muscle and autonomic dysfunction, anxiety, depression and childhood maltreatment as well as cognitive-affective, behavioural and interpersonal factors. Given the absence of empirically supported treatment guidelines, a stepwise approach of pelvic floor physical therapy and cognitive behavioural therapy as well as medical management is suggested, with surgery as the last option. Vulvodynia has a negative effect on the quality of life of women and their partners, and imposes a profound personal and societal economic burden. In addition, women with vulvodynia are more likely to report other chronic pain conditions, which further alters their quality of life. Future efforts should aim to increase girls', women's and healthcare professionals' education and awareness of vulvodynia, phenotype different subgroups of women based on biopsychosocial characteristics among more diverse samples, conduct longitudinal studies and improve clinical trial designs.
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Features of the Vaginal and Vestibular Microbioma in Patients With Vestibulodynia: A Case-Control Study. J Low Genit Tract Dis 2020; 24:290-294. [DOI: 10.1097/lgt.0000000000000523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Leusink P, van de Pasch S, Teunissen D, Laan ET, Lagro-Janssen AL. The Relationship Between Vulvovaginal Candidiasis and Provoked Vulvodynia: A Systematic Review. J Sex Med 2018; 15:1310-1321. [DOI: 10.1016/j.jsxm.2018.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/02/2018] [Accepted: 07/13/2018] [Indexed: 11/30/2022]
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Zanotta N, Campisciano G, Scrimin F, Ura B, Marcuzzi A, Vincenti E, Crovella S, Comar M. Cytokine profiles of women with vulvodynia: Identification of a panel of pro-inflammatory molecular targets. Eur J Obstet Gynecol Reprod Biol 2018; 226:66-70. [DOI: 10.1016/j.ejogrb.2018.05.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/22/2018] [Accepted: 05/23/2018] [Indexed: 12/17/2022]
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Sharma H, Ji E, Yap P, Vilimas P, Kyloh M, Spencer NJ, Haberberger RV, Barry CM. Innervation Changes Induced by Inflammation in the Murine Vagina. Neuroscience 2018; 372:16-26. [DOI: 10.1016/j.neuroscience.2017.12.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 12/15/2017] [Accepted: 12/19/2017] [Indexed: 12/28/2022]
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Abstract
Vulvodynia refers to pain in the vulva of at least 3 months’ duration in the absence of a recognized underlying cause. Provoked, localized vestibulodynia is the term used to describe superficial pain confined to the vulvar vestibule, provoked by touch. This review will focus on provoked vestibulodynia with regard to its suggested causative factors and will discuss the role of inflammation, vulvovaginal infections, mucosal nerve fiber proliferation, hormonal associations, central pain mechanisms, pelvic floor muscle dysfunction, and genetic factors. Clinical observations, epidemiological studies, and data from basic research emphasize the heterogeneity of vulvar pain syndromes. There is a critical need to perform prospective, longitudinal studies that will allow better diagnostic criteria and subgrouping of patients that would lead to improvements in our understanding of provoked vestibulodynia and its treatment.
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Affiliation(s)
- Ahinoam Lev-Sagie
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Steven S Witkin
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
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