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Mardon AK, Leake HB, Szeto K, Moseley GL, Chalmers KJ. Recommendations for patient education in the management of persistent pelvic pain: a systematic review of clinical practice guidelines. Pain 2024; 165:1207-1216. [PMID: 38112691 DOI: 10.1097/j.pain.0000000000003137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/01/2023] [Indexed: 12/21/2023]
Abstract
ABSTRACT Patient education has a critical role in the management of pain. There is considerable heterogeneity in patient education for females with persistent pelvic pain (PPP), and it remains unclear what is considered best clinical practice. Therefore, this systematic review identified and summarised recommendations for patient education in the management of benign gynaecological and urological conditions associated with PPP, as endorsed by international guidelines. Academic and relevant guideline databases were searched from inception to May 2022. Included guidelines were those for the management of benign gynaecological and urological conditions associated with PPP in adult females published in English, of any publication date, and endorsed by a professional organisation or society. Two independent reviewers screened 3097 records; 17 guidelines were included in the review. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) tool. Recommendations were pooled using descriptive synthesis. Persistent pelvic pain guideline quality was generally poor. Three guidelines were classified as "excellent" (The NICE, RANZCOG, and ESHRE endometriosis guidelines) and therefore recommended for use. Eleven guidelines (64.7%) recommended patient education for females with PPP. Recommendations for education content were variable, however most frequently covered treatment strategies and pelvic pain diagnoses. For education delivery, the most frequent recommendations were for support groups and written/printed materials. Further research into tailored education interventions is needed for females with PPP.
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Affiliation(s)
- Amelia K Mardon
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
- NICM Health Research Institute, Western Sydney University, Sydney, Australia
| | - Hayley B Leake
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - Kimberley Szeto
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- Alliance for Research in Exercise, Nutrition and Activity, Kaurna Country, University of South Australia, Adelaide, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - K Jane Chalmers
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
- Western Sydney University, Campbelltown, Australia
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2
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Patla G, Mazur-Bialy AI, Humaj-Grysztar M, Bonior J. Chronic Vulvar Pain and Health-Related Quality of Life in Women with Vulvodynia. Life (Basel) 2023; 13:life13020328. [PMID: 36836685 PMCID: PMC9967635 DOI: 10.3390/life13020328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
The aim of this study was to investigate the severity of chronic vulvar pain in women with vulvodynia and its impact on their health-related quality of life (QL). The study group consisted of 76 women aged 19 to 58. The study was carried out using the diagnostic survey method, i.e., (1) the questionnaire technique, comprising (A) the author's questionnaire (76 questions) and (B) the WHOQOL-BREF questionnaire, and (2) the VAS. When analyzing the severity of vulvar pain on the VAS, the highest proportion of women rated it at level 6 (23.68%). This was significantly determined by certain personal characteristics (age < 25 years old) and sociodemographic characteristics (marital status: unmarried women, divorcees, widows; high school education), each at p < 0.05. Vulvodynia causes a significant deterioration (64.47%) in QL, which is mainly caused by a reduction in the ability to perform activities of daily living (27.63%) and a decrease in sexual satisfaction (27.63%). The level of stress significantly exacerbates pain (p < 0.05). The severity correlates significantly (p < 0.05) and negatively (r < 0) with QL perception, which was rated worst in the physical domain. The use of treatment resulted in a significant improvement in the physical and psychological domains (p < 0.05), and the latter was particularly influenced by physiotherapy (p < 0.05).
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Affiliation(s)
- Gabriela Patla
- Department of Medical Physiology, Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 12 Michałowskiego Street, 31-126 Krakow, Poland
| | - Agnieszka I. Mazur-Bialy
- Department of Biomechanics and Kinesiology, Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 8 Skawińska Street, 31-066 Krakow, Poland
| | - Magdalena Humaj-Grysztar
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 58 Zamoyskiego Street, 31-501 Krakow, Poland
| | - Joanna Bonior
- Department of Medical Physiology, Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 12 Michałowskiego Street, 31-126 Krakow, Poland
- Correspondence: ; Tel.: +48 012-634-33-97
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Zwickl S, Burchill L, Wong AFQ, Leemaqz SY, Cook T, Angus LM, Eshin K, Elder CV, Grover SR, Zajac JD, Cheung AS. Pelvic Pain in Transgender People Using Testosterone Therapy. LGBT Health 2023; 10:179-190. [PMID: 36603056 PMCID: PMC10079239 DOI: 10.1089/lgbt.2022.0187] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose: This descriptive study aimed to assess the characteristics of pelvic pain and explore predictive factors for pelvic pain in transgender (trans) individuals using testosterone therapy. Methods: An online cross-sectional survey was open between August 28, 2020, and December 31, 2020, to trans people presumed female at birth, using testosterone for gender affirmation, living in Australia, and >16 years of age. The survey explored characteristics of pelvic pain following initiation of testosterone therapy, type and length of testosterone therapy, menstruation history, and relevant sexual, gynecological, and mental health experiences. Logistic regression was applied to estimate the effect size of possible factors contributing to pain after starting testosterone. Results: Among 486 participants (median age = 27 years), 351 (72.42%) reported experiencing pelvic pain following initiation of testosterone therapy, described most commonly as in the suprapubic region and as "cramping." Median duration of testosterone therapy was 32 months. Persistent menstruation, current or previous history of post-traumatic stress disorder, and experiences of pain with orgasm were associated with higher odds of pelvic pain after testosterone therapy. No association was observed with genital dryness, intrauterine device use, previous pregnancy, penetrative sexual activities, touching external genitalia, or known diagnoses of endometriosis, vulvodynia, vaginismus, depression, anxiety, or obesity. Conclusions: Pelvic pain is frequently reported in trans people following initiation of testosterone therapy. Given the association with persistent menstruation and orgasm, as well as the known androgen sensitivity of the pelvic floor musculature, further research into pelvic floor muscle dysfunction as a contributor is warranted.
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Affiliation(s)
- Sav Zwickl
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia
| | - Laura Burchill
- Physiotherapy Department, The Royal Women's Hospital, Melbourne, Australia
| | - Alex Fang Qi Wong
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia
| | - Shalem Y Leemaqz
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | | | - Lachlan M Angus
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia.,Gender Clinic, Department of Endocrinology, Austin Health, Melbourne, Australia
| | - Kalen Eshin
- Department of Community and Clinical Health, La Trobe University, Melbourne, Australia
| | - Charlotte V Elder
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Mercy Hospital for Women, Melbourne, Australia.,Austin Health, Melbourne, Australia
| | - Sonia R Grover
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Mercy Hospital for Women, Melbourne, Australia.,Austin Health, Melbourne, Australia
| | - Jeffrey D Zajac
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia.,Gender Clinic, Department of Endocrinology, Austin Health, Melbourne, Australia
| | - Ada S Cheung
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia.,Gender Clinic, Department of Endocrinology, Austin Health, Melbourne, Australia
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Mardon AK, Leake HB, Szeto K, Astill T, Hilton S, Moseley GL, Chalmers KJ. Treatment recommendations for the management of persistent pelvic pain: A systematic review of international clinical practice guidelines. BJOG 2021; 129:1248-1260. [PMID: 34919325 DOI: 10.1111/1471-0528.17064] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/30/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Females with persistent pelvic pain (PPP) report great variability in treatments they are recommended despite the availability of clinical practice guidelines (CPGs) that aim to standardise care. A clear consensus for the best practice care for PPP is required. OBJECTIVE Identify and summarise treatment recommendations across CPGs for the management of PPP, and appraise their quality. SEARCH STRATEGY MEDLINE, CENTRAL, EMBASE, EmCare, SCOPUS, the Cochrane Database of Systematic Reviews, Web of Science Core Collection, and relevant guideline databases were searched from their inception to June 2021. SELECTION CRITERIA Included CPGs were those for the management of urogynaecological conditions in adult females published in English, of any publication date, and endorsed by a professional organisation or society. DATA COLLECTION AND ANALYSIS We screened 1,379 records and included 20 CPGs. CPG quality was assessed using The Appraisal of Guidelines for Research and Evaluation II (AGREE-II) tool. Descriptive synthesis compiled treatment recommendations across CPGs. MAIN RESULTS CPGs for seven conditions provided 281 individual recommendations. On quality appraisal, guidelines on average scored 'excellent' for the domains 'scope and purpose' (80.6%, SD=13.3) and 'clarity and presentation' (74.4%, SD=12.0); for other domains, average scores were satisfactory or poor. Four guidelines (Endometriosis, NICE, RANZCOG, ESHRE; PCOS, Teede et al. 2018) were deemed recommended for use. Recommendations were most frequent for pharmaceutical and surgical interventions. Recommendations were variable for psychological, physiotherapy, and other conservative interventions. CONCLUSIONS The quality of CPGs for PPP is generally poor. Several CPGs endorse the consideration of biopsychosocial elements of PPP. Yet most recommend pharmaceutical, surgical, and other biomedical interventions.
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Affiliation(s)
- Amelia K Mardon
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Hayley B Leake
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia.,Centre for IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Kimberley Szeto
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia.,Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, SA, Australia
| | - Thomas Astill
- Brain Stimulation and Rehabilitation (BrainSTAR) Lab, Western Sydney University, Campbelltown, NSW, Australia
| | | | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - K Jane Chalmers
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia.,Western Sydney University, Campbelltown, NSW, Australia
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Glayzer JE, McFarlin BL, Castori M, Suarez ML, Meinel MC, Kobak WH, Steffen AD, Schlaeger JM. High rate of dyspareunia and probable vulvodynia in Ehlers-Danlos syndromes and hypermobility spectrum disorders: An online survey. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2021; 187:599-608. [PMID: 34747110 PMCID: PMC8665058 DOI: 10.1002/ajmg.c.31939] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 08/31/2021] [Accepted: 10/16/2021] [Indexed: 12/15/2022]
Abstract
Vulvodynia is debilitating vulvar pain accompanied by dyspareunia (pain with sexual intercourse). Ehlers-Danlos syndromes (EDS) and hypermobility spectrum disorders (HSD) may represent a predisposing factor for vulvodynia given a high rate of dyspareunia in these conditions. We conducted an online survey of women with EDS or HSD to assess rates of dyspareunia and estimate rates of vulvodynia, report rates of comorbid conditions common to EDS or HSD and vulvodynia, and examine rates of conditions contributing to dyspareunia in women with EDS or HSD. Women with EDS or HSD (N = 1,146) recruited via social media were 38.2 ± 11.5 years old, primarily White (94.4%), and resided in the United States (78.5%). 63.7% of participants reported dyspareunia and 50% screened positive for vulvodynia. The rate of comorbid conditions common to EDS or HSD and vulvodynia were: irritable bowel syndrome, 6.5%; fibromyalgia, 40.0%; temporomandibular joint dysfunction, 56.4%; migraine, 6.7%; interstitial cystitis, 1.7%; and mast cell activation syndrome, 10.2%. Participants reporting dyspareunia also reported ovarian cysts, fibroids, or abdominal or pelvic scars, 47.5%; endometriosis, 26.5%; and genital lacerations, 19.3%. Women with EDS or HSD may have a higher rate of vulvodynia (50.0%) than women in the U.S. population at large (8%) and should be assessed for dyspareunia and vulvodynia.
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Affiliation(s)
- Jennifer E Glayzer
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Barbara L McFarlin
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Marco Castori
- Division of Medical Genetics, Fondazione IRCCS-Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Marie L Suarez
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Monya C Meinel
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - William H Kobak
- Department of Obstetrics and Gynecology, College of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | - Alana D Steffen
- Department of Population Health Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Judith M Schlaeger
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
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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
Chronic pelvic pain is a common, burdensome, and costly condition that disproportionately affects women. Diagnosis and initial management of chronic pelvic pain in women are within the scope of practice of specialists in obstetrics and gynecology. The challenging complexity of chronic pelvic pain care can be addressed by increased visit time using appropriate coding modifiers, as well as identification of multidisciplinary team members within the practice or by facilitated referral. This Practice Bulletin addresses the diagnosis and management of chronic pelvic pain that is not completely explained by identifiable pathology of the gynecologic, urologic, or gastrointestinal organ systems. When evidence on chronic pelvic pain treatment is limited, recommendations are extrapolated from treatment of other chronic pain conditions to help guide management. The evaluation and management of potential gynecologic etiologies of pelvic pain (ie, endometriosis, adenomyosis, leiomyomas, adnexal pathology, vulvar disorders) are discussed in other publications of the American College of Obstetricians and Gynecologists (1-4).
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Abstract
Chronic pelvic pain is a common, burdensome, and costly condition that disproportionately affects women. Diagnosis and initial management of chronic pelvic pain in women are within the scope of practice of specialists in obstetrics and gynecology. The challenging complexity of chronic pelvic pain care can be addressed by increased visit time using appropriate coding modifiers, as well as identification of multidisciplinary team members within the practice or by facilitated referral. This Practice Bulletin addresses the diagnosis and management of chronic pelvic pain that is not completely explained by identifiable pathology of the gynecologic, urologic, or gastrointestinal organ systems. When evidence on chronic pelvic pain treatment is limited, recommendations are extrapolated from treatment of other chronic pain conditions to help guide management. The evaluation and management of potential gynecologic etiologies of pelvic pain (ie, endometriosis, adenomyosis, leiomyomas, adnexal pathology, vulvar disorders) are discussed in other publications of the American College of Obstetricians and Gynecologists ().
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9
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Aetiology, diagnosis, and clinical management of vulvodynia. MENOPAUSE REVIEW 2020; 19:44-48. [PMID: 32699543 PMCID: PMC7258372 DOI: 10.5114/pm.2020.95337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 02/20/2020] [Indexed: 11/22/2022]
Abstract
Chronic vulvar pain or discomfort for which no obvious aetiology can be found, i.e. vulvodynia, can affect up to 16% of women, and it may be found in girls and women across all age groups and ethnicities. Most patients describe it as burning, stinging, irritation, or rawness. The symptoms may spread to the whole vulva (generalised vulvodynia) or only to part of it, such as the clitoris (clitorodynia) or the vestibule of the vagina (vestibulodynia). This condition is often underreported and underrecognised by health care providers. Vulvodynia is a significant burden to society, the health care system, the affected women, and their intimate partners. It has a negative impact on quality of life. Vulvodynia is a diagnosis of exclusion with unknown aetiology. The gynaecologist plays a key role in excluding other causes of vulvar pain, and collaborating with other health care providers to manage the patient’s pain. Although many therapeutic options are available, such as vulvar care measures, psychological approaches, local treatment, oral medications, surgical procedures, electrical nerve stimulation, and laser therapy, there is no single treatment effective for all patients. That is why individualised management is needed. An individualised, holistic, and often multidisciplinary approach is needed to effectively manage the patient’s pain and pain-related distress.
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11
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Diagnosis and Management of Vulvar Skin Disorders: ACOG Practice Bulletin Summary, Number 224. Obstet Gynecol 2020; 136:222-225. [PMID: 32590722 DOI: 10.1097/aog.0000000000003945] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Vulvar skin disorders include a variety of inflammatory conditions of the vulva that also may affect the extragenital area. Pruritus and pain are two of the most common presenting symptoms in vulvar clinics (). Vulvovaginal symptoms often are chronic and can adversely affect sexual function and sense of well-being. The purpose of this Practice Bulletin is to provide updated diagnostic and management recommendations for the most common vulvar skin conditions associated with inflammation: contact dermatitis, lichen simplex chronicus, lichen sclerosus, and lichen planus. Other vulvovaginal disorders such as vaginitis, vulvar low-grade squamous intraepithelial lesions and vulvar high-grade squamous intraepithelial lesions (previously termed vulvar intraepithelial neoplasia), genitourinary syndrome of menopause (vulvovaginal atrophy), and vulvar pain (vulvodynia) are addressed in other documents from the American College of Obstetricians and Gynecologists ().
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Abstract
OBJECTIVE To describe patient outcomes after modified vestibulectomy for vulvodynia. METHODS This is a mixed-methods study of patients who had undergone modified vestibulectomy for vulvodynia at a tertiary care hospital from 2009 through 2016. Demographics, preoperative and postoperative examinations, symptoms, and treatments were obtained through retrospective review. Prospective semistructured interviews were conducted from 2018 through 2019 to address patient-reported changes in pain and sexual function. Qualitative analysis was performed using a grounded theory approach. RESULTS Twenty-two patients underwent modified vestibulectomy from 2009 through 2016. Age ranged from 22 to 65 years and mean body mass index was 24.3±5.4. The majority of patients were premenopausal (57%), sexually active (68%), and partnered (76%). Postoperatively, data on pain improvement were retrieved on 18 patients, of which 17 (94%) reported improvement. Patients used pelvic floor physical therapy, medications, and lubricants both preoperatively and postoperatively. For the qualitative analysis, thematic saturation was achieved with 14 interviews. Of 14 participants interviewed, 13 (93%) reported improvement with pain after surgery, 11 (79%) reported satisfaction with surgery, 8 (57%) reported satisfaction with sexual function, and 11 (79%) reported recommending the surgery to others. The following lead themes were identified: vulvodynia symptoms significantly affect quality of life; there is difficulty and delay in diagnosis owing to lack of information and awareness among patients and health care providers; and surgical success and satisfaction are influenced by patient perceptions with sexual dysfunction often persisting despite vulvar pain improvement. CONCLUSION Vulvodynia patients report improvement in pain and high overall satisfaction after modified vestibulectomy, but more variable long-term effects on sexual function.
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13
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Female Sexual Dysfunction: ACOG Practice Bulletin Clinical Management Guidelines for Obstetrician-Gynecologists, Number 213. Obstet Gynecol 2020; 134:e1-e18. [PMID: 31241598 DOI: 10.1097/aog.0000000000003324] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Female sexual dysfunction encompasses various conditions that are characterized by reported personal distress in one or more of the following areas: desire, arousal, orgasm, or pain (). Although female sexual dysfunction is relatively prevalent, women are unlikely to discuss it with their health care providers unless asked (), and many health care providers are uncomfortable asking for a variety of reasons, including a lack of adequate knowledge and training in diagnosis and management, inadequate clinical time to address the issue, and an underestimation of the prevalence (). The purpose of this document is to provide an overview of female sexual dysfunction, to outline updated criteria for diagnosis, and to discuss currently recommended management strategies based on the best available evidence.
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Törnävä M, Koivula M, Helminen M, Suominen T. Web-based education about vulvodynia and its care among student healthcare staff: A quasi-experimental study. Nurse Educ Pract 2018; 31:194-199. [PMID: 29986313 DOI: 10.1016/j.nepr.2018.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 04/24/2018] [Accepted: 06/11/2018] [Indexed: 12/11/2022]
Abstract
Student healthcare providers are the type of primary healthcare professionals who usually have first contact with young women who have problems with intimacy, such as vulvar pain - known as vulvodynia. However, a need to increase healthcare professionals' level of knowledge of vulvodynia and its care has been identified. This study aimed to assess the awareness and knowledge of vulvodynia and its care among student healthcare providers, before and after Web-based education. The study design was national, descriptive and quasi-experimental, and was conducted across Finland. A total of 79 participants completed baseline measurements, 58 completed web-based education and 30 took part in a follow-up survey. A survey instrument called 'Awareness and knowledge of vulvodynia and its care' was developed for this study, and the data were collected using a web-based questionnaire. Descriptive statistical methods were used to evaluate the participants' awareness and knowledge of vulvodynia and its care before and after web-based education. The primary results indicated that the participants' awareness and knowledge of vulvodynia and its care was statistically significantly improved following web-based education.
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Affiliation(s)
- Minna Törnävä
- University of Tampere, Faculty of Social Sciences, Health Sciences, Finland; Tampere University Hospital, Pirkanmaa Hospital District, Finland.
| | - Meeri Koivula
- University of Tampere, Faculty of Social Sciences, Health Sciences, Finland
| | - Mika Helminen
- University of Tampere, Faculty of Social Sciences, Health Sciences, Finland; Tampere University Hospital, Pirkanmaa Hospital District, Finland
| | - Tarja Suominen
- University of Tampere, Faculty of Social Sciences, Health Sciences, Finland
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15
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Miranda Varella Pereira G, Soriano Marcolino M, Silveira Nogueira Reis Z, Vale de Castro Monteiro M. A systematic review of drug treatment of vulvodynia: evidence of a strong placebo effect. BJOG 2018; 125:1216-1224. [PMID: 29569822 DOI: 10.1111/1471-0528.15223] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Vulvodynia is the most common type of chronic pelvic pain and dyspareunia in premenopausal women. The effect of drugs for the treatment of vulvodynia remains poorly discussed. OBJECTIVES To conduct a systematic review of randomised controlled studies which assess medications used to treat vulvar pain in vulvodynia. SEARCH STRATEGY Web of Science, Cochrane Library, EBSCO Academic, LILACS and MEDLINE were searched from 1985 to September 2016. SELECTION CRITERIA Randomised controlled trials comparing any kind of medication for vulvodynia treatment with placebo or with another medication in adult patients were included. DATA COLLECTION AND ANALYSIS The two investigators independently conducted data extraction. The synthesis was provided by the pain reduction index. Study quality assessment was performed using the Cochrane Handbook for Systematic Reviews of Intervention and analysis of publication bias was conducted. MAIN RESULTS Five studies were included in qualitative synthesis. Number of participants varied from 30 to 133 participants among the eligible studies, resulting in a total of 297 patients. The pain reduction rates of patients with vulvodynia assessed by Q-tipped cotton test and visual analogue scale varied between studies. Placebo was shown to be as effective as any medication. CONCLUSIONS There is a need for further studies evaluating topical monotherapy for the treatment of vulvodynia, as they are the main drugs used in clinical practice. TWEETABLE ABSTRACT No medication has shown impact on vulvar pain in vulvodynia. There is evidence of a placebo effect.
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Affiliation(s)
- G Miranda Varella Pereira
- Department of Obstetrics and Gynaecology, Federal University de Minas Gerais, Belo Horizonte, Brazil
| | - M Soriano Marcolino
- Department of Internal Medicine, Federal University de Minas Gerais, Belo Horizonte, Brazil
| | - Z Silveira Nogueira Reis
- Department of Obstetrics and Gynaecology, Federal University de Minas Gerais, Belo Horizonte, Brazil
| | - M Vale de Castro Monteiro
- Department of Obstetrics and Gynaecology, Federal University de Minas Gerais, Belo Horizonte, Brazil
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16
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Sorensen J, Bautista KE, Lamvu G, Feranec J. Evaluation and Treatment of Female Sexual Pain: A Clinical Review. Cureus 2018; 10:e2379. [PMID: 29805948 PMCID: PMC5969816 DOI: 10.7759/cureus.2379] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/27/2018] [Indexed: 12/14/2022] Open
Abstract
Dyspareunia and vulvodynia are genital pain disorders that have devastating effects on women's quality of life. These disorders occur with high prevalence and place a significant financial burden on women and the health care system. Many women do not report genital pain, and most providers do not inquire about this type of pain. As a result, women also experience social isolation. Numerous treatments are thought to improve quality of life and decrease pain; however, more studies are needed. This review aims to provide an overview of clinical evaluation methods and to summarize treatment options for women suffering from dyspareunia and vulvodynia.
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Affiliation(s)
- James Sorensen
- University of Central Florida Ucf Com/hca Gme Consortium Obstetrics and Gynecology Residency Program, UCF/ Orlando Va Medical Center
| | | | - Georgine Lamvu
- Division of Surgery, Gynecology Section Orlando Va Medical Center, University of Central Florida College of Medicine , Orlando, USA
| | - Jessica Feranec
- Division of Surgery, Gynecology Section Orlando Va Medical Center, University of Central Florida College of Medicine, Orlando, USA
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Abstract
Provoked vestibulodynia (PVD) refers to vulvar pain of at least 3 months duration, localized to the vestibule, provoked by touch and sexual activity and occurring in the absence of a clear identifiable cause. The clinical spectrum ranges from mild with distressing discomfort through to severe and disabling pain. Current understanding is that PVD is one of many chronic pain conditions characterized by sensitization of peripheral and central nociceptive pathways, with pain arising due to dysfunctional neuronal activity in the absence of painful stimuli. Pathophysiology is not well understood but is likely a complex interplay of environmental, genetic, psychological and immune factors. Care is multidisciplinary and follows general principles of chronic pain management with the addition of specific therapy tailored to address pelvic floor overactivity, and sexual and relationship difficulties. More recently, the therapeutic use of placebo is gaining traction in chronic pain research and is a very promising adjunctive therapy. The majority of women with PVD are managed outside of tertiary clinic settings, and care depends on availability and affordability of specialized services; however, much can be done by the primary health provider. PVD is common, and highly treatable, especially with early intervention, but unfortunately, many clinicians are unaware of this condition, and the biggest hurdle for women accessing treatment is obtaining a diagnosis. With treatment, most women can expect significant improvement, often with fairly simple interventions, although some women will benefit from referral to specialized centers. The aims of this article are twofold: firstly, to summarize current literature concerning PVD pathophysiology and management; secondly, to provide a framework for clinicians unfamiliar with vulvar medicine to understand and manage PVD.
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Affiliation(s)
- Helen Henzell
- Melbourne Sexual Health Centre, Carlton.,Action Centre, Family Planning Victoria, Melbourne
| | - Karen Berzins
- Melbourne Sexual Health Centre, Carlton.,Dermatology/Vulval Conditions Clinic, Mercy Hospital for Women, Heidelberg
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Törnävä M, Koivula M, Helminen M, Suominen T. Women with vulvodynia: awareness and knowledge of its care among student healthcare staff. Scand J Caring Sci 2017; 32:241-252. [DOI: 10.1111/scs.12455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 02/08/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Minna Törnävä
- Faculty of Social Sciences, Health Sciences; University of Tampere; Tampere Finland
- Tampere University Hospital; Pirkanmaa Hospital District; Tampere Finland
| | - Meeri Koivula
- Faculty of Social Sciences, Health Sciences; University of Tampere; Tampere Finland
| | - Mika Helminen
- Faculty of Social Sciences, Health Sciences; University of Tampere; Tampere Finland
- Tampere University Hospital; Pirkanmaa Hospital District; Tampere Finland
| | - Tarja Suominen
- Faculty of Social Sciences, Health Sciences; University of Tampere; Tampere Finland
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