Relationship Between Childhood Sexual Abuse, Obesity, and Vulvodynia in Adulthood.

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.

Looking for a way forward for the cryopreservation of orchid diversity.

The family Orchidaceae, with over 25,000 species, includes five subfamilies and nearly 700 genera. Loss of plants in the wild has resulted from clearing of forests and excessive collection for various purposes. Moreover, the requirement of symbiotic association during seed germination under natural conditions adds a certain level of difficulty in retaining the orchid resources in the wild. Cryopreservation is an important arena in conservation science due to its potential of storing genetic resources without altering the genetic makeup. Cryopreserved orchids are a very small percentage of the species, and are also not representative of most genera. Finding effective protocols for the various explant types is of prime importance in conserving orchid diversity. Seed is the most commonly stored and directly useful explant, and direct plunging in liquid nitrogen or PVS2 vitrification appear to be suitable for most tested species. The myriad of other species should be screened as they become available, with special emphasis on seed maturity and moisture content. Studies of protocorms and protocorm-like bodies mostly employ desiccation, PVS2 vitrification or encapsulation-dehydration. Pollinia are generally stored successfully following desiccation or slow cooling. There are too few examples of shoot tip cryopreservation to make a determination, however vitrification techniques are likely the most useful for a range of genera. A systematic and coordinated effort is needed to screen all available species in as many taxa as possible, initially with seed, protocorms and pollinia. It is a charge to the orchid research community to organize this effort and fill in the required data for the large number of untested taxa. In addition, providing stored samples to established orchid cryo collections would greatly increase preservation of these endangered treasures.

Partnering With Patients to Bridge Gaps in Consent for Acute Care Research.

Clinical trials for acute conditions such as myocardial infarction and stroke pose challenges related to informed consent due to time limitations, stress, and severe illness. Consent processes should be sensitive to the context in which trials are conducted and to needs of patients and surrogate decision-makers. This manuscript describes a collaborative effort between ethicists, researchers, patients, and surrogates to develop patient-driven, patient-centered approaches to consent for clinical trials in acute myocardial infarction and stroke.Our group identified important ways in which existing consent processes and forms for clinical trials fail to meet patients' and surrogates' needs in the acute context. We collaborated to create model forms and consent processes that are substantially shorter and, hopefully, better-matched to patients' and surrogates' needs and expectations from the perspective of content, structure, and tone. These changes, however, challenge some common conventions regarding consent.

Cryopreservation of shoot tips of recalcitrant and tropical species: Advances and strategies.

There is a pressing need for practical and successful conservation efforts to establish long-term germplasm collections of recalcitrant and tropical species, given the challenge and threat that these plants are facing. Cryopreservation is the only way of conserving some of these species, especially those with temperature or desiccation sensitive (recalcitrant) seeds. This review covers reports on cryopreservation studies of shoot tips (apical and axillary) of tropical and subtropical plants. Since many of these species have recalcitrant seeds, the cryopreservation successes, failures and problems involved with these seeds are also discussed. The methodologies, important factors and steps involved in successful cryopreservation protocols are analyzed. Finally strategies are suggested to develop a successful cryopreservation protocol for new plant species, in particular those with tropical recalcitrant seeds.

Nerve Growth Factor and Selected Cytokines in Women With and Without Vulvodynia.

OBJECTIVE: The aim of the study was to assess the association between cytokines/neurokines after in vitro stimulation with Candida antigen or lipopolysaccharide (LPS) in blood samples among women with and without vulvodynia. MATERIALS AND METHODS: Women with vulvodynia and asymptomatic controls at three offices at the University of Michigan were examined clinically and completed a comprehensive survey in this cross-sectional study. Cytokine/neurokine levels were determined on blood samples using established ELISA protocols. Analysis of 48 cases and 42 ethnically matched controls included descriptive statistics (median, minimal, and maximal levels of cytokines/neurokines), overall and in cases and controls. Because of left-censored measurements, interval censored survival analysis was used to assess the association between case/control status and pain characteristics with cytokine/neurokine levels. RESULTS: Participants ranged in age from 19 to 60 years. Levels of IL1ß, IL1-RA, TNFα, IL-6, and IL-8 increased substantially after LPS stimulation, whereas no response was seen on IFNγ or nerve growth factor (NGF). Each increased after Candida antigen stimulation, although responses to Candida antigen stimulation of IL1ß, IL-6, and TNFα were less robust than after LPS. Only NGF was significantly increased in vulvodynia cases compared with controls (Exp ß (95% CI) = 2.08 [1.08-3.98]) after 24-hour Candida antigen stimulation and persisted when controlled for age, use of oral contraceptives, or history of Candida vulvovaginitis. No association between cytokine/neurokine levels and pain characteristics was found. CONCLUSIONS: Compared with that of control women, whole blood from women with vulvodynia demonstrates an enhanced production of NGF, but not of a set of inflammation-related cytokines, in response to Candida antigen stimulation.

Factors associated with socio-demographic characteristics and antenatal care and iron supplement use in Ethiopia, Kenya, and Senegal.

Antenatal care (ANC) offers remarkable opportunities to reach a large number of women with effective nutrition and health interventions, including iron (Fe) supplementation. However, all women do not equally seek nor benefit from ANC. We aimed to identify characteristics associated with ANC and Fe use among women in hard-to-reach areas in Afar, Ethiopia; Sedhiou and Kolda, Senegal; and Kakamega, Kenya. Women who gave birth within 1 year preceding the survey (n = 4,575) from 15 different sub-regions were randomly selected and surveyed. Multivariable logistic regression was used to identify associations of socio-demographic characteristics with ANC and Fe use. Factors that showed positive associations with ANC uptake included education, income, possession of a mobile phone, and the occupation of the mother or another household member. Beginning ANC in the first trimester associated positively with achievement of 4 or more ANC visits, and having any ANC visits related positively with Fe intake. Distance to the nearest health facility was negatively associated, and type of nearest facility and counselling and health education were positively associated with some outcomes. The results from these surveys demonstrate the need to ensure access of services across all population groups and can help identify ANC programming needs.

Multimodal Vulvar and Peripheral Sensitivity Among Women With Vulvodynia: A Case-Control Study.

OBJECTIVE: To assess differences in vulvar and peripheral sensitivity between women with and without vulvodynia. METHODS: Women with vulvodynia (n = 41) and age-matched controls (n = 43) seen in the outpatient setting were evaluated via surveys, clinical examination, and multimodal sensory testing (pressure, heat, cold, vibration, and electrical stimulation). The relationships between sensitivity to various sensory modalities and case/control status, as well as by vulvodynia subgroups, were assessed using logistic regression. RESULTS: Women with vulvodynia were more sensitive to pressure and to electrical stimuli than were control women at the vulva (median, 22 vs 230 g and 0.495 vs 0.769 mA, respectively; P < 0.001 for each) and at the thumb (median, 2500 vs 4250 g and 0.578 vs 0.764 mA, respectively; P = 0.006 for pressure, P < 0.001 for electrical stimulation). Heat, cold, and vibration detection thresholds did not differ significantly between these groups (P > 0.025). Those reporting spontaneous pain versus provoked pain had greater pressure sensitivity to the thumb (median, 1850 vs 2690 g; P = 0.020) and greater electrical sensitivity at the introitus (0.450 vs 0.608 mA; P = 0.011), and those with primary versus secondary vulvodynia had substantially greater pressure sensitivity to the thumb (median, 2438 vs 3125 g, P = 0.004). However, having localized versus generalized vulvodynia was not associated with differences in pressure or electrical sensitivity. CONCLUSIONS: Sensitivities to pressure and electrical stimuli are greater among vulvodynia cases than among controls and support 2 previously defined subgroups-those reporting spontaneous pain versus those whose pain only occurred when provoked, and those with primary versus secondary vulvodynia.

Presence of Spontaneous Pain and Comorbid Pain Conditions Identifies Vulvodynia Subgroups.

OBJECTIVE: The aims of the study were to define the heterogeneity of vulvodynia by determining data-driven subgroups within the vulvodynia diagnosis using exploratory cluster analysis and to characterize the subgroups identified. MATERIALS AND METHODS: Included were participants in the longitudinal population-based study of vulvodynia in southeast Michigan who screened positive for vulvodynia at least once during the study. A cluster analysis using variables reflecting vulvar pain characteristics and comorbid pain conditions was conducted. Variables reflecting best separation of clusters were used to assign participants to subgroup categories. Demographic, psychiatric, general health, and other vulvar pain characteristics were summarized for each subgroup, followed by multinomial regression and pairwise comparisons of subgroups on these factors. RESULTS: Of 441 women screening positive for vulvodynia during the course of the study, 393 were eligible on the basis of data requirements. Cluster analysis suggested that best subgroup separation was based on the following 2 variables: (1) presence or absence of spontaneous vulvar pain and (2) presence or absence of other comorbid pain conditions. Subgroups did not differ by age or ethnicity. The subgroup having spontaneous pain and other comorbid conditions demonstrated greatest morbidity in general health measures, psychiatric disorders, and other vulvar pain measures. Primary versus secondary vulvodynia did not vary between subgroups and did not assist in subgroup separation in the cluster analysis. DISCUSSION: Subgroups based on exploratory cluster analysis demonstrated that presence of spontaneous pain and the presence of comorbid pain conditions resulted in best separation of groups. Presence of both spontaneous pain and other comorbid pain conditions identified the group with greatest morbidity.

Vestibular Mast Cell Density in Vulvodynia: A Case-Controlled Study.

OBJECTIVES: To identify whether mast cell densities in vulvar biopsies from the vestibule are associated with vulvodynia. METHODS: We enrolled 100 women aged 19 to 59 years with confirmed vulvodynia cases, 100 racially matched controls, and 100 black control women. All had vulvar biopsies performed at the 7 o'clock position of the vestibule, which were then immunostained to detect c-KIT protein. The numbers of c-KIT positive mast cells per ×400 magnification field were manually counted, and t tests and logistic regression were used to assess the association with case-control status. RESULTS: Of the biopsies, 235 were adequate samples for c-KIT testing for mast cells. The mast cell density was substantially lower in black control women (13.9 ± 10.9) in comparison to white control women (22.5 ± 13.2 p < 0.001): hence the analysis was confined to white cases and racially matched control women. Compared with racially matched controls, cases were younger, more likely to be married, and reported a higher household income. The average number of mast cells per ×400 magnification field overall was 19.1 ± 13.2 (range, 0-62). There was no difference in the mast cell count between racially matched cases (22.4 ± 13.9 per ×400 field) and controls (22.5 ± 13.2) in either the univariate or multivariable analyses. Within the group of cases, there was no difference in mast cell density based on the presence or absence of a variety of urogenital symptoms. CONCLUSIONS: No difference in mast cell density in biopsies of the vestibule was found between white cases and racially matched controls. Black control women have a lower mast cell density compared with white control women.

CRYOTHERAPY AS A METHOD FOR REDUCING THE VIRUS INFECTION OF APPLES (Malus sp.).

BACKGROUND: There is an urgent need in Kazakhstan for virus-free nursery stock to reinvigorate the industry and preserve historic cultivars. An in vitro collection of apples could be used for virus testing and elimination and to provide virus-free elite stock plants to nurseries. METHODS: Malus sieversii Ledeb. M. Roem. and Malus domestica Borkh. accessions were initiated in vitro for virus identification and elimination. Reverse transcription and multiplex PCR were used to test for five viruses. PVS2 vitrification was used as a tool for cryotherapy. RESULTS: Four viruses, Apple chlorotic leaf spot virus (ACLSV), Apple stem pitting virus (ASPV), Apple stem grooving virus (ASGV) and Apple mosaic virus (ApMV) were detected in 17 accessions. Tomato ringspot virus (ToRSV) was not detected. ACLSV affected 53.8% of the accessions, ASPV 30.8%, ASGV 5.1%, and ApMV was found only in 'Aport Alexander'. Cryotherapy produced virus-free shoot tips for seven of nine cultivars tested. Six cultivars had 60-100% elimination of ACLSV. CONCLUSIONS: An in vitro collection of 59 accessions was established. Virus elimination using cryotherapy produced virus-free shoots for seven of nine cultivars and is a promising technique for developing a virus-free apple collection.

Transcriptomic profiling revealed the regulatory mechanism of Arabidopsis seedlings response to oxidative stress from cryopreservation.

KEY MESSAGE: Elevated antioxidant status and positive abiotic stress response in dehydration enhance cell resistance to cryoinjury, and controlling oxidative damage via reactive oxygen species homeostasis maintenance leads to high survival. Cryoprotectants are important for cell survival in cryopreservation, but high concentrations can also cause oxidative stress. Adding vitamin C to the cryoprotectant doubled the survival ratio in Arabidopsis thaliana 60-h seedlings (seedlings after 60-h germination) cryopreservation. In this study, the metabolites and transcriptional profiling of 60-h seedlings were analyzed in both the control cryopreservation procedure (CCP) and an improved cryopreservation procedure (ICP) to reveal the mechanism of plant cell response to oxidative stress from cryopreservation. Reactive oxygen species (ROS) and peroxidation levels reached a peak after rapid cooling-warming in CCP, which were higher than that in ICP. In addition, gene regulation was significantly increased in CCP and decreased in ICP during rapid cooling-warming. Before cryogenic treatment, the number of specifically regulated genes was nearly 10 times higher in ICP dehydration than CCP dehydration. Among these genes, DREBs/CBFs were beneficial to cope with cryoinjury, and calcium-binding protein, OXI1, WRKY and MYB family members as key factors in ROS signal transduction activated the ROS-producing and ROS-scavenging networks including AsA-GSH and GPX cycles involved in scavenging H2O2. Finally, elevated antioxidant status and oxidative stress response in the improved dehydration enhanced seedling resistance to cryogenic treatment, maintained ROS homeostasis and improved cell recovery after cryopreservation.

ROS-induced oxidative stress and apoptosis-like event directly affect the cell viability of cryopreserved embryogenic callus in Agapanthus praecox.

KEY MESSAGE: Oxidative stress and apoptosis-like programmed cell death, induced in part by H 2 O 2 , are two key factors that damage cells during plant cryopreservation. Their inhibition can improve cell viability. We hypothesized that oxidative stress and apoptosis-like event induced by ROS seriously impact plant cell viability during cryopreservation. This study documented changes in cell morphology and ultrastructure, and detected dynamic changes in ROS components (O 2 (·-) , H2O2 and OH·), antioxidant systems, and programmed cell death (PCD) events during embryonic callus cryopreservation of Agapanthus praecox. Plasmolysis, organelle ultrastructure changes, and increases in malondialdehyde (a membrane lipid peroxidation product) suggested that oxidative damage and PCD events occurred at several early cryopreservation steps. PCD events including autophagy, apoptosis-like, and necrosis also occurred at later stages of cryopreservation, and most were apoptosis. H2O2 is the most important ROS molecule mediating oxidative damage and affecting cell viability, and catalase and AsA-GSH cycle are involved in scavenging the intracellular H2O2 and protecting the cells against stress damage in the whole process. Gene expression studies verified changes of antioxidant system and PCD-related genes at the main steps of the cryopreservation process that correlated with improved cell viability. Reducing oxidative stress or inhibition of apoptosis-like event by deactivating proteases improved cryopreserved cell viability from 49.14 to 86.85 % and 89.91 %, respectively. These results verify our model of ROS-induced oxidative stress and apoptosis-like event in plant cryopreservation. This study provided a novel insight into cell stress response mechanisms in cryopreservation.

Cryopreservation affects ROS-induced oxidative stress and antioxidant response in Arabidopsis seedlings.

Plant recovery status after cryopreservation by vitrification had a negative relationship to the oxidative stress induced by reactive oxygen species (ROS). Arabidopsis thaliana seedlings germinated for 48 h or 72 h with different survival tolerances were examined at five steps of cryopreservation, to determine the role of ROS (O2(-), H2O2 and OH) and antioxidant systems (SOD, POD, CAT, AsA and GSH) in cryo-injury. In addition, the effects of the steps on membrane lipid peroxidation were studied using malondialdehyde (MDA) as an indicator. The results indicated that H2O2-induced oxidative stress at the steps of dehydration and rapid warming was the main cause of cryo-injury of 48-h seedlings (high survival rate) and 72-h seedlings (no survival). The H2O2 was mainly generated in cotyledons, shoot tips and roots of seedlings as indicated by Amplex Red staining. Low survival of 72-h seedlings was associated with severe membrane lipid peroxidation, which was caused by increased OH generation activity and decreased SOD activity. The antioxidant-related gene expression by qRT-PCR and physiological assays suggested that the antioxidant system of 48-h seedlings were activated by ROS, and they mounted a defense against oxidative stress. A high level of ROS led to the weakening of the antioxidant system of 72-h seedlings. Correlation analysis indicated that enhanced antioxidant enzymes activities contributed to the high survival rate of 48-h seedlings, which could reflect by cryopreservation of antioxidant mutant seedlings. This model system indicated that elevated CAT activity and AsA content were determinants of cryogenic stress tolerance, whose manipulation could improve the recovery of seedlings after cryopreservation.

Cryopreservation of native Kazakhstan apricot (Prunus armeniaca l) seeds and embryonic axes.

BACKGROUND: Preserving the genetic diversity of Central Asia includes conserving wild apricots found in the foothills of several mountain ranges. These include primitive and genetically diverse populations with important characteristics for crop improvement. Apricot seeds have a short storage life, so cryopreservation of the seeds of wild populations is important for conserving the genetic diversity. OBJECTIVE: This study was to determine a suitable protocol for long-term storage. METHODS: This study tested a range of protocols using embryos and embryonic axes for storage of an important population of wild apricots and to determine if seed size and the distribution of moisture in the seed play a role in successful cryopreservation. RESULTS: Germination of scarified whole seed from trees in the Jungar population of Prunus armeniaca varied from 63 to 90 percent after 1 h in liquid nitrogen (LN) and was generally better at 7 % moisture content (MC) than at the original 14 percent MC. Embryos (4 percent MC) from stratified seed had only 33 % germination after LN exposure. Isolated embryonic axes from non-stratified seed germinated at 86 to 100 % following drying to 4 % or 7 % MC. Examination of three seed sizes determined that the MC of whole seed, embryos and isolated axes varied with the seed size and shape. MC of whole seeds and embryos decreased as size decreased, however, the axis MC did not. MC of medium-size seed was more evenly distributed between the axis and endosperm than in the larger or smaller samples. Cryopreservation of axes from medium-sized seed was good at any moisture content and a 1-h drying time was significantly better than 90 min. for axes of all seed sizes. Cryopreservation of axes using vitrification protocols initially designed for shoot tips produced germination similar to or lower than seed and axis drying techniques. CONCLUSION: We recommend storing apricot germplasm as unstratified seed dried to 7 % MC or as isolated embryonic axes.

Race/Ethnicity and Incidence of Pelvic Organ Prolapse in Midlife Women: The Study of Women's Health Across the Nation.

Background: Pelvic organ prolapse (POP) affects a considerable proportion of women. Limited information exists regarding the incidence of POP as women transition through menopause. Using data from the Study of Women's Health Across the Nation (SWAN), this diverse community-based longitudinal cohort study assessed the incidence of symptomatic POP and risk by race/ethnicity. Methods: Self-reported POP was ascertained by questionnaire at 11 approximately annual SWAN visits over a median of 13.3 years of follow-up. We estimated probabilities for reporting POP using interval-censored Kaplan-Meier survival plots. We estimated hazard ratios (HR) and 95% confidence intervals (CI) using interval-censored Cox proportional hazards models. Results: The estimated cumulative probability of POP increased linearly from 2.1% at age 45 to 10.1% by age 65 (4.0% per decade). At age 65, the probability was 4.2%, 4.8%, 8.9%, 9.7%, and 33.9% for Japanese, Chinese, Black, White, and Hispanic women, respectively. Compared with White women, the unadjusted HR for POP was 3.09 (95% CI = 2.18-4.39), 0.96 (0.71-1.31), 0.43 (0.22-0.85), and 0.48 (0.26-0.88) for Hispanic, Black, Chinese, and Japanese women, respectively. After adjustment for financial strain and vaginal birth, the low hazards among Chinese and Japanese women and the high hazard for Hispanic women remained significant. Conclusion: Incidence of symptomatic POP increased as women aged through midlife. Risks varied by race and ethnicity and were not accounted for by population differences in socioeconomic life contexts or the probability of having had a vaginal birth. Although not associated with menopause, health providers should incorporate screening for and information about POP when treating menopausal symptoms and health needs of midlife women. Research on pathophysiological factors associated with increasing POP in midlife is warranted.

Melatonin enhances the recovery of cryopreserved shoot tips of American elm (Ulmus americana L.).

Climate change and global migrations of people and goods have exposed trees to new diseases and abiotic challenges that threaten the survival of species. In vitro germplasm storage via cryopreservation is an effective tool to ensure conservation of tree species, but plant cells and tissues are exposed to multiple stresses during the cryopreservation process. The current study was designed to evaluate the potential of melatonin to improve survival through the process of cryopreservation. Shoot tips of in vitro-grown plantlets and dormant winter buds of American elm were successfully cryopreserved in liquid nitrogen (LN) at -196°C under controlled environmental conditions following melatonin treatment and cold acclimation with either vitrification or encapsulation­vitrification protocols. Explants had optimal regrowth following cryopreservation when treated with the plant vitrification solution#2 (PVS2) for 10 min. Supplementation of both preculture and regrowth media with melatonin significantly enhanced regrowth of frozen shoots compared with the untreated control (P < 0.05). Approximately 80­100% of shoot explants grew under optimized conditions using melatonin-enriched media. Shoot tips of dormant winter buds consistently produced nearly 100% regrowth with both techniques. The main steps of the optimized protocol are14-day cold-acclimated cultures exposed to preculture medium with 0.1­0.5 lM melatonin for 24 hr, application of PVS2 for 10 min, rapid cooling in LN, rapid rewarming, removal of cryoprotectants, and recovery on a medium supplemented with 0.1­0.5 lM melatonin. Our results demonstrate the usefulness of the antioxidant melatonin for long-term storage of naturally resistant elm germplasm.

Deaf persons' english reading levels and associations with epidemiological, educational, and cultural factors.

One hundred six Michigan d/Deaf persons, part of a study evaluating how to improve d/Deaf persons' understanding of cancer prevention recommendations, had reading levels determined using the Test of Reading Comprehension, Syntactic Sentences. Respondents averaged 52 years old, 59% female, 84% Caucasian, 58% married, and 75% Deaf community members. The mean Test of Reading Comprehension, Syntactic Sentences score was 6.1 (women: 6.2, men: 6.0). Higher scores were associated with greater income (p = .02), employment (p = .01), education (high school p = .002, some college p < .001), English use (child at home, teacher in school, at home now: all p < .001), a hearing spouse (p = .003), hard of hearing/d/Deaf father (p = .02), losing hearing after age 20 years, believing smoking is bad (p < .001), speaking with and satisfaction with physicians and nurses (p < .001), good communication with (p = .01), and comfort discussing cancer with doctors (p < .001). Lower scores were associated with using American Sign Language with physicians and nurses (.019) and Deaf community membership (p = .02). In multivariate analysis, higher scores were associated with higher income, college degree, and teacher using English. Reading levels of a predominantly Deaf population were low. Higher income, college degree, and teacher using English were associated with higher reading levels.

Postoperative sexual concerns and functioning in patients who underwent lysis of vulvovaginal adhesions.

OBJECTIVE: This study aimed to determine satisfaction and functioning before and after surgery among women with lichen planus, who have undergone lysis of vulvovaginal adhesions, and to compare their sexual functioning with those of women without this disorder. MATERIALS AND METHODS: The study was approved by the University of Michigan Internal Review Board. A retrospective self-administered survey was completed by 22 women (50-76 years). Eleven women who had undergone surgery to release vulvovaginal adhesions from lichen planus answered a mailed, 75-item questionnaire about health, sexual functioning (using the Female Sexual Function Index), and satisfaction with surgical outcomes 6 months to 6 years after their lysis of vulvovaginal adhesions followed by long-term vaginal dilation. They were compared with 11 age-matched normal controls. We used descriptive statistics such as mean and SDs to describe the population and χ and t tests to determine significant differences between groups. RESULTS: Surgery in women with lichen planus scarring allowed intercourse in 55% and decreased urination difficulties in 75%. Of the patients, 91% stated they were happy with the surgery and would recommend it to others. However, sexual difficulties may persist even after surgery. Approximately 50% of the patients continue to fear pain. There continues to be differences between cases and controls in sexual discomfort and sexual satisfaction. CONCLUSIONS: After surgery for lichen planus, women tend to be more likely to have intercourse, to have less urinary symptoms or infections, and to have fewer genital symptoms. However, for some, sexual difficulties persisted. It may be wise to consider sexual counseling for this population. Nevertheless, most of the patients stated that they were happy with the surgery and would recommend it to others.

Interpretation of the Sexual Functioning Questionnaire in the presence of vulvar pain.

OBJECTIVE: This study aimed to assess whether the domains identified by items on the Sexual Functioning Questionnaire (SFQ) apply to women with vulvodynia. MATERIALS AND METHODS: Forty-one women with vulvodynia and 43 asymptomatic controls, between the ages 18 and 70 years, were assessed with a physician evaluation and a written survey that included the SFQ. RESULTS: Women with vulvodynia had a higher likelihood of female sexual dysfunction than did controls as indicated by 5 of the seven individual SFQ domains (desire, arousal-lubrication, pain, enjoyment, and partner domains, p < .05). Scored on individual items relating to pain or penetrative sex differed more by vulvodynia presence than did items related to arousal and emotions. Compared with published SFQ psychometrics, factor analysis among women with vulvodynia demonstrated similar factor loadings in 6 of the 7 domains of the SFQ (desire, arousal-sensation, arousal-lubrication, orgasm, partner, and pain), but the enjoyment domain intermingled substantially with these other domains. CONCLUSIONS: The SFQ factor structure is generally valid among women with vulvodynia. However, vulvodynia may impact responses to individual items on questions about pain and/or penetration, which may potentially result in erroneous interpretations.