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Boero V, Cetera GE, Caia C, Merli CEM, Gramegna G, Pesce E, Barbara G, Ermelinda M, Vercellini P. Beyond vulvodynia: from a correct diagnosis to a multidisciplinary care program. A referral center experience. Arch Gynecol Obstet 2024:10.1007/s00404-024-07496-0. [PMID: 38634899 DOI: 10.1007/s00404-024-07496-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Vulvodynia is a chronic pain condition without an identifiable cause. As such, it is a diagnosis of exclusion, and all other causes of vulvar pain should be excluded. Although a standard treatment for vulvodynia has not been established yet, multidisciplinary care programs appear to be effective. PUROPOSE The aim of this retrospective monocentric study was to analyze the prevalence of vulvodynia among women referred to our institution for a suspected diagnosis and to evaluate the efficacy of a multidimensional treatment plan. The primary outcome was the prevalence of vulvodynia following differential diagnosis. Secondary outcomes included: prevalence of the differential diagnoses, symptom resolution rate following treatment, and the relation between persistence of symptoms and (a) patients' age; (b) coexisting chronic overlapping pain conditions (COPCs). RESULTS After having ruled out all other causes of vulvar pain, only 40.1% of women were considered as affected by vulvodynia. The most frequent differential diagnoses included lower genital tract infections (25.3%), vulvar lichen sclerosus (17.6%) and vulvovaginal atrophy (8.2%). Following a multidisciplinary care program, resolution of symptoms was observed in 13.6% cases, improvement in 64.3% and persistence in 21.9%. We did not find a statistically significant association between persistence of symptoms and age > 38 years (OR 2.10; p = 0.30). Women with one or more COPCs other than vulvodynia had a 75% increased risk of not obtaining a resolution of symptoms (OR 1.75; p = 0.44). CONCLUSION A thorough differential diagnosis and a multidisciplinary care program may represent a first way out of the muddle in the management of these patients.
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Affiliation(s)
- Veronica Boero
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Emily Cetera
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Carlotta Caia
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | | | - Giada Gramegna
- Obstetric and Gynecological Emergency Unit and SVSeD (Service for Sexual and Domestic Violence), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Pesce
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giussy Barbara
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Monti Ermelinda
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Mocini E, Donini LM, Isidori AM, Minnetti M. Nutritional and metabolic aspects related to vulvodynia: What do we really know? Nutrition 2024; 117:112232. [PMID: 37856898 DOI: 10.1016/j.nut.2023.112232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/17/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES Vulvodynia is an emerging health problem, still insufficiently studied, that causes a significant reduction in quality of life in many women and individuals assigned female sex at birth. Little is known about the effects of diet and metabolic disorders on this condition. The objective of this study was to review currently available evidence on the diet and the nutritional and metabolic status of patients affected by vulvodynia. METHODS Published articles were systematically searched in the PubMed, Scopus, and Web of Science databases. RESULTS The few available studies that reported data on patients' body mass index (BMI) described a BMI within the normal range in most patients affected by vulvodynia, showing no difference or a slightly lower BMI with respect to control individuals. Data on the relationship between metabolic diseases and vulvodynia are lacking. Regarding nutrition, the few available data do not support the prescription of a low-oxalate diet in women with vulvodynia. To date, studies on other dietary behaviors are also lacking. CONCLUSIONS This review emphasizes-for the first time, to our knowledge-the lack of data and the importance of conducting prospective studies investigating the nutritional and metabolic aspects related to the onset, maintenance, and therapy of vulvodynia.
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Affiliation(s)
- Edoardo Mocini
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Marianna Minnetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
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Sánchez S, Baquedano L, Cancelo MJ, Jurado AR, Molero F, Nohales F, Mendoza N, Palacios S. Managing vulvar and vestibular pain in postmenopausal women: recommendations from the Spanish Menopause Society, Sociedad Española de Ginecología y Obstetricia, Sociedad Española de Medicos de Atención Primaria y Federación Española de Sociedades de Sexología. Gynecol Endocrinol 2022; 38:263-266. [PMID: 34519600 DOI: 10.1080/09513590.2021.1963954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Background: Relieving vulvar pain caused by atrophy in postmenopausal women is a challenge in our clinical practice. We know more and more about the vulva, its anatomy and physiology and we are realizing that it is different from the vagina. The importance of the vulvar approach in the management of vulvar or vestibular pain (VP) due to atrophy in postmenopausal women is becoming increasingly important. A panel of experts from several Spanish scientific societies (Spanish Menopause Society, AEEM; Spanish Federation of Sexology Societies, FESS; Spanish Society of Primary Care Physicians, SEMERGEN; and the Spanish Society of Gynecology and Obstetrics) held a meeting to discuss treatment recommendations for women with vulvar and VP based on the best available evidence, creating a report to describe grades of recommendations.
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Affiliation(s)
- Sonia Sánchez
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia -AEEM), Barcelona, Spain
- Sociedad Española de Ginecología y Obstetricia (SEGO), Zaragoza, Spain
| | - Laura Baquedano
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia -AEEM), Barcelona, Spain
- Sociedad Española de Ginecología y Obstetricia (SEGO), Zaragoza, Spain
| | - Ma Jesús Cancelo
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia -AEEM), Barcelona, Spain
- Sociedad Española de Ginecología y Obstetricia (SEGO), Zaragoza, Spain
| | - Ana Rosa Jurado
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia -AEEM), Barcelona, Spain
- Sociedad Española de Ginecología y Obstetricia (SEGO), Zaragoza, Spain
| | - Francisca Molero
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia -AEEM), Barcelona, Spain
- Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Madrid, Spain
- Federación Española de Sociedades de Sexología (FESS), Madrid, Spain
| | - Francisco Nohales
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia -AEEM), Barcelona, Spain
- Sociedad Española de Ginecología y Obstetricia (SEGO), Zaragoza, Spain
| | - Nicolás Mendoza
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia -AEEM), Barcelona, Spain
- Sociedad Española de Ginecología y Obstetricia (SEGO), Zaragoza, Spain
| | - Santiago Palacios
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia -AEEM), Barcelona, Spain
- Sociedad Española de Ginecología y Obstetricia (SEGO), Zaragoza, Spain
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Rey Novoa M, Muñoz-Sellart M, Catalán Soriano M, Vinyes D. Treatment of Localized Vulvar Pain with Neural Therapy: A Case Series and Literature Review. Complement Med Res 2021; 28:571-577. [PMID: 33845481 DOI: 10.1159/000514945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 01/27/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Localized vulvar pain (LVP) is a common condition among fertile women, with physical and psychosexual implications. Treatment is complex with limited benefits. Neural therapy is a regulatory therapy that uses injections of local anesthetics in low concentrations in specific points to treat different conditions. CASE PRESENTATION We present the cases of 5 women, ages 33-44 years, with LVP treated with procaine 0.5% injections in painful points. Complete relief from pain occurred in 2 patients, and significant improvement in 3. Only 1 or 2 sessions were required. Initial VAS score was ≥70 and decreased to ≤30 after the intervention. The improvement was maintained over time, with a minimum follow-up period of 6 months. None of the patients were able to have sex or use tampons due to pain, but they were able to resume after the intervention. CONCLUSIONS In this case series, local injections of procaine showed a favorable outcome. Future randomized clinical trials could help elucidate the role of this intervention in LVP.
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Affiliation(s)
- Modesto Rey Novoa
- Department of Obstetrics and Gynecology, Hospital Universitario de Burgos, Burgos, Spain.,Campus Docent de Sant Joan de Déu, Barcelona, Spain
| | - Montserrat Muñoz-Sellart
- Campus Docent de Sant Joan de Déu, Barcelona, Spain.,Neural Therapy Research Foundation, Barcelona, Spain.,Institute of Neural Therapy and Regulatory Medicine, Sabadell, Barcelona, Spain
| | - Marta Catalán Soriano
- Campus Docent de Sant Joan de Déu, Barcelona, Spain.,Department of Obstetrics and Gynecology, Hospital del Vendrell, Tarragona, Spain
| | - David Vinyes
- Campus Docent de Sant Joan de Déu, Barcelona, Spain.,Neural Therapy Research Foundation, Barcelona, Spain.,Institute of Neural Therapy and Regulatory Medicine, Sabadell, Barcelona, Spain
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Graziottin A, Murina F, Gambini D, Taraborrelli S, Gardella B, Campo M; VuNet Study Group. Vulvar pain: The revealing scenario of leading comorbidities in 1183 cases. Eur J Obstet Gynecol Reprod Biol 2020; 252:50-5. [PMID: 32563924 DOI: 10.1016/j.ejogrb.2020.05.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study set out to investigate the epidemiological characteristics and comorbidities of chronic vulvar pain. Secondary goals were to identify the preferred approaches for managing vulvodynia in Italy. STUDY DESIGN A cross-sectional study (the VuNet -Vulvodynia Network project) was performed in consecutive female patients with chronic vulvar pain attending 21 Italian medical centers (public hospitals, university clinics and private outpatient services) in the period December 2016 to November 2018. Study data were entered by healthcare professionals in a special web-based medical record system (PRIDE- Progetto Rete Italiana Dolore vulvarE). These data covered epidemiological aspects, demographic characteristics, obstetric and gynecological history, presence and duration of current and/or past symptoms, associated disorders, details of physical examination and treatment approaches. RESULTS A total of 1183 subjects with a diagnosis of chronic vulvar pain were included in the study. The main reason for consultation was superficial dyspareunia, present in 64.2 % of the women. 43.4 % of the sample reported comorbid sexual disorders (of desire in 22.1 % and arousal in 21.3 %). 48.3 % of the patients reported prolonged pain lasting between one and five years. Factors associated with vulvar pain included a relatively high family history of diabetes mellitus (father = 8.6 %; mother = 8.4 %), recurrent vulvovaginal candidiasis (32 %), and urinary tract infections (37.4 %: recurrent cystitis in 19.5 % and post-coital cystitis in 17.9 %). Irritable bowel syndrome (28 %), constipation (23.5 %), headache (25.7 %: migraine in 18.0 % and menstrual headache in 7.7 %), allergies (17.5 %: food allergies in 10.1 %, respiratory allergies in 7.4 %), anxiety (15.0 %), dyschezia (11.7 %), invalidating dysmenorrhea/endometriosis (11.1 %), and major depression (7.6 %) were also reported. Vestibulodynia was diagnosed in 837 of the 1183 patients (70.8 %) and generalized vulvodynia in 323 (27.3 %). Notably, 69.1 % of the patients stated that previous therapies had not changed their pain. CONCLUSIONS The diagnoses of vestibulodynia and vulvodynia must be considered in patients with chronic vulvar pain. The VuNet study contributes to a more comprehensive reading of the predisposing, precipitating and maintaining factors that contribute to vulvar pain, and of the key comorbidities.
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Abstract
Vulvodynia - Diagnostics and Management Strategies Abstract. Vulvodynia is characterized by chronic, idiopathic vulvar pain lasting for at least three months. After exclusion of other, specific diseases associated with vulvar pain, which can be treated accordingly, realistic therapy goals for this chronic disease should be defined. The therapy concept is multimodal, interdisciplinary as well as individualized and includes the combination of general recommendations with physiotherapeutic and psychotherapeutic measures. Pharmacological therapy, which is indispensable, is carried out off-label and includes the topical and/or systemic use of various substances and substance combinations. Surgical measures may be regarded as a possible option, especially in women with therapy-resistant and provocable vulvodynia. Alternative therapy options such as acupuncture, hypnosis and transcutaneous electrical nerve stimulation are also worth investigating.
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Dunford A, Rampal D, Kielly M, Grover SR. Vulval Pain in Pediatric and Adolescent Patients. J Pediatr Adolesc Gynecol 2019; 32:359-362. [PMID: 30923024 DOI: 10.1016/j.jpag.2019.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To describe the experience of a tertiary pediatric and adolescent gynecology service that provides care to children and adolescents who present with vulval pain. Their presentation, associated symptoms, and management is described. DESIGN A retrospective analysis of all girls younger than 18 years of age who presented to the gynecology clinic of our tertiary referral Children's Hospital between Jan 2010 and July 2016. Electronic medical records were reviewed and parameters recorded using a standardized data sheet. SETTING Gynecology clinic of a tertiary referral children's hospital and private rooms of our director of gynecology. PARTICIPANTS Young women younger than 18 years who presented with symptoms suggestive of vulvodynia. INTERVENTIONS AND MAIN OUTCOME MEASURES Presenting symptoms, characteristics of associated features, treatment options, and treatment outcomes. RESULTS Forty-seven patients with a mean age of 11 years (range, 3-18 years) were identified. At the time of diagnosis 31/47 (65.9%) were premenarchal. Many presented with a symptom other than pain alone. In particular, 35/47 (74.4%) presented with coexisting or previous urinary symptoms. Of patients examined, most had positive cotton tip examination findings (16/17 (94.1%) and 11/13 (84.6%) for pre- and postmenarchal, respectively) with clinical inspection otherwise unremarkable. CONCLUSION Children and adolescents with vulval pain have varied presentations. Many of the pre- and postmenarchal patients had coexisting urinary tract symptomatology at the time of diagnosis. This review of patients seen over 5.5 years at a pediatric tertiary referral center provides information on the presenting symptoms, examination features, and response to clinical management.
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Affiliation(s)
- Angela Dunford
- Department of Maternity and Gynaecology, John Hunter Hospital, Newcastle, Australia; Department of Gynaecology, Royal Children's Hospital Melbourne, Melbourne, Australia.
| | - Deepti Rampal
- Department of Gynaecology, Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Maria Kielly
- Department of Maternal and Child Care, Brockville General Hospital, Brockville, Ontario, Canada
| | - Sonia R Grover
- Department of Gynaecology, Royal Children's Hospital Melbourne, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Murdoch Children's Research Institute, Melbourne, Australia
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Vieira-Baptista P, Lima-Silva J, Pérez-López FR, Preti M, Bornstein J. Vulvodynia: A disease commonly hidden in plain sight. Case Rep Womens Health 2018; 20:e00079. [PMID: 30245974 PMCID: PMC6142188 DOI: 10.1016/j.crwh.2018.e00079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 01/16/2023] Open
Abstract
•Vulvodynia affects at least 6% of women, and can be found at any age and in all ethnic groups.•The diagnosis is one of exclusion but is very often missed.•Women with vulvodynia are frequently misdiagnosed as having vaginismus.•Failure to make the diagnosis often leads to irrelevant or deleterious examinations and treatments.
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Affiliation(s)
- Pedro Vieira-Baptista
- Hospital Lusíadas Porto, Portugal
- Unidade de Tracto Genital Inferior, Serviço de Ginecologia e Obstetrícia, Centro Hospitalar de São João, Porto, Portugal
| | - Joana Lima-Silva
- Unidade de Tracto Genital Inferior, Serviço de Ginecologia e Obstetrícia, Centro Hospitalar de São João, Porto, Portugal
| | - Faustino R. Pérez-López
- Department of Obstetrics and Gynecology, University of Zaragoza, Faculty of Medicine, Lozano-Blesa University Hospital, Zaragoza, Spain
| | - Mario Preti
- Department of Obstetrics and Gynecology, University of Torino, Torino, Italy
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya and Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Murina F, Felice R, Di Francesco S, Oneda S. Vaginal diazepam plus transcutaneous electrical nerve stimulation to treat vestibulodynia: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2018; 228:148-53. [PMID: 29960200 DOI: 10.1016/j.ejogrb.2018.06.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 05/20/2018] [Accepted: 06/12/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the effectiveness of vaginal diazepam in addition to transcutaneous electrical nerve stimulation (TENS) in the treatment of vestibulodynia (VBD). STUDY DESIGN This study was a randomized, double-blind, placebo-controlled trial. Forty-two patients with VBD were randomized, 21 underwent diazepam and TENS (diazepam group) and 21 received placebo and TENS (placebo group). Vulvar pain was assessed on a on a 10-cm visual analogue scale (VAS) and dyspareunia according to the Marinoff dyspareunia scale. Vaginal surface electromyography (EMG) and vestibular current perception threshold (CPT) testing were performed at baseline and 60 days after treatment. The primary endpoints included the change in pain and dyspareunia from baseline to 60 days of pain and dyspareunia. The secondary endpoints was the variation in objectivity of pelvic floor muscle (PFM) function and vestibular nerve fiber current perception threshold (CPT). RESULTS The VAS scores for pain from basal values of 7.5 and 7.2 for the diazepam and placebo, respectively, showed significant (p 0.01) decreases from 4.7 to 4.3, but this difference was not statistically significant. The Marinoff dyspareunia scores in the diazepam group showed a significant difference (p 0.05) from values measured in the placebo group. The ability to relax the PFM after contraction (difference between maximal contraction and rest tone) was significantly greater for the diazepam group versus the placebo group (3.8 μv and 2.4 μv, respectively, p 0.01). The CPT values for all of the nerve fibers increased after the treatment, but this increase was significant in the diazepam group only for the values at a 5-Hz stimulation (C fibers) with a change of 47.8% vs 26.9% (p < 0.05). Only two patients reported a mild drowsiness in the diazepam group. CONCLUSIONS The present study provided indications that vaginal diazepam plus TENS is useful to improve pain and PFM instability in women with VBD.
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11
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Ezebialu I, Okafo O, Oringanje C, Ogbonna U, Udoh E, Odey F, Meremikwu MM. Surgical and nonsurgical interventions for vulvar and clitoral pain in girls and women living with female genital mutilation: A systematic review. Int J Gynaecol Obstet 2017; 136 Suppl 1:34-37. [PMID: 28164286 DOI: 10.1002/ijgo.12048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Vulvar and clitoral pain are known complications of female genital mutilation (FGM). Several interventions have been used to treat these conditions. This review focuses on surgical and nonsurgical interventions to improve vulvar and clitoral pain in women living with FGM. OBJECTIVE To evaluate the impact of nonsurgical and surgical interventions for alleviating vulvar and clitoral pain in women living with any type of FGM and to assess the associated adverse events. SEARCH STRATEGY The search included the following major databases: Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, Scopus, Web of Science, and ClinicalTrials.gov. These were searched from inception until August 10, 2015 without any language restrictions. SELECTION CRITERIA Study designs included randomized controlled trials, cluster randomized trials, nonrandomized trials, cohort studies, case-control studies, controlled before-and-after studies, historical control studies, and interrupted time series with reported data comparing outcomes among women with FGM who were treated for clitoral or vulvar pain with either surgical or nonsurgical interventions. DATA COLLECTION AND ANALYSIS Two team members independently screened studies for eligibility. RESULTS No studies were included. CONCLUSION Limited information exists on management of vulvar and clitoral pain in women living with FGM. This constitutes an important area for further research. PROSPERO REGISTRATION CRD42015024521.
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Affiliation(s)
- Ifeanyichukwu Ezebialu
- Department of Obstetrics and Gynecology, Faculty of Clinical Medicine, College of Medicine, Anambra State University, Awka, Nigeria
| | | | - Chukwudi Oringanje
- Institute of Tropical Disease, Research and Prevention, Calabar, Nigeria
| | - Udoezuo Ogbonna
- Department of Family Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ekong Udoh
- Institute of Tropical Disease, Research and Prevention, Calabar, Nigeria.,Department of Pediatrics, University of Uyo Teaching Hospital, Uyo, Akwa-Ibom, Nigeria
| | - Friday Odey
- Department of Pediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Martin M Meremikwu
- Institute of Tropical Disease, Research and Prevention, Calabar, Nigeria.,Department of Pediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
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Valente K, Montgomery K, Schultenover S, Desouki MM. Acquired vulvar lymphangioma circumscriptum after cervical cancer treatment: Case report. Gynecol Oncol Rep 2016; 16:31-3. [PMID: 27331134 PMCID: PMC4899408 DOI: 10.1016/j.gore.2016.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 03/10/2016] [Accepted: 03/24/2016] [Indexed: 11/28/2022] Open
Abstract
Vulvar lymphangioma circumscriptum (LC) is a rare entity which may present as a painful, warty lesion. In contrast to the congenital form, which occurs in children, the acquired form arises in older adults and may be associated with infection, Crohn's disease, or prior pelvic/regional surgery. We present a case of acquired LC of the vulva in a 55-year-old woman who presented with a 3-4 year history of vulvar pain following chemotherapy, radiation, and brachytherapy for cervical cancer. Vulvar shave biopsies followed by excision revealed a thickened dermis with epidermal hyperkeratosis, parakeratosis, elongated rete ridges and dilated lymphatic channels containing eosinophilic material and scattered thrombi. The differential diagnosis for this unusual lesion includes more common conditions such as condyloma acuminatum, fungating squamous cell carcinoma and molluscum contagiosum. It is important to recognize the clinical presentation as well as the distinct histological appearance of this rare benign entity.
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Affiliation(s)
- Kari Valente
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kathleen Montgomery
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Stephen Schultenover
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mohamed Mokhtar Desouki
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States
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Flink IK, Thomtén J, Engman L, Hedström S, Linton SJ. Coping with painful sex: Development and initial validation of the CHAMP Sexual Pain Coping Scale. Scand J Pain 2015; 9:74-80. [PMID: 29911654 DOI: 10.1016/j.sjpain.2015.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 05/16/2015] [Indexed: 10/23/2022]
Abstract
Background and purpose Recurrent vulvar pain is a common and debilitating condition which has received remarkably little attention in pain research. For instance, little is known about how these women cope with sexual activities, and there are no structured assessment tools. The purpose of this study was to explore coping strategies in this group, with a view to develop a measure to assess how women with vulvar pain cope with sexual activities. Methods The current study is based on a subsample from a longitudinal study about vulvar pain in a student sample consisting of women between 18 and 35 years old (N = 964). Only data from the ones reporting recurrent vulvar pain during the last six months (N = 289) were used in the analyses. First, the CHAMP Sexual Pain Coping Scale (CSPCS) was created, with the aim of assessing how women with vulvar pain cope with sexual activities. The scale was inspired by previous research on women with vulvar pain as well as well-known coping strategies in other pain populations. Second, the psychometric properties of the scale were explored by analyzing the factor structure and internal reliability. Third, validity features were examined in terms of criterion validity and construct validity. Results The analyses supported a three-factor solution, embracing the strategies endurance, avoidance and alternative coping. The internal reliability of the subscales turned out to be good, and the criterion validity was supported for all three subscales. The construct validity was clearly supported for the endurance and the avoidance subscales, but not for the alternative coping subscale. Conclusions The findings support the CSPCS as an instrument for assessing how women with vulvar pain cope with sexual activities. The strategies endurance, avoidance and alternative coping correspond with findings from earlier research. Endurance reflects a tendency to engage in and continue with sexual activities despite pain, while attempting to minimize or suppress thoughts of pain. Avoidance, on the other hand, involves efforts to stay away from sexual activities, in particular vaginal penetration, because of fear of pain. Alternative coping refers to endeavours to find alternative sexual activities that do not necessarily involve vaginal penetration. Even though this first study indicates that the CSPCS may be psychometrically sound, more studies are needed to confirm the psychometric properties and clinical application of this instrument. In particular, the construct validity of the alternative coping subscale needs to be further evaluated. Implications A valid instrument for assessing strategies for coping with sexual activities in this population has important clinical implications, since it provides a method that may enhance assessment procedures, be used in research, and stimulate the development of treatment.
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Affiliation(s)
- Ida K Flink
- Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
| | - Johanna Thomtén
- Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden.,Department of Psychology, Mid Sweden University, Östersund, Sweden
| | - Linnéa Engman
- Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
| | - Stina Hedström
- Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
| | - Steven J Linton
- Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
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