Is the 2003 ISSVD terminology and classification of vulvodynia up-to-date? A neurobiological perspective.

This paper aims to determine if the 2003 International Society for the Study of Vulvovaginal Disease (ISSVD) terminology and classification of vulval pain is up-to-date, according to a current and widely accepted neurobiological pain classification, which divides pain into nociceptive, inflammatory and pathological pain with the latter subdivided into neuropathic and dysfunctional pain. Nociceptive pain is protective, adaptive, high-threshold pain provoked by noxious stimuli. Inflammatory pain is protective, adaptive, low-threshold pain associated with peripheral tissue damage and inflammation. Pathological pain is non-protective, maladaptive, low-threshold pain caused by structural damage to the nervous system (neuropathic pain) or by its abnormal function (dysfunctional pain). The 2003 ISSVD vulval pain classification should be revised in terms of current neurobiological pain information. Inflammatory vulval pain occurs as a result of specific infectious, inflammatory and neoplastic disorders. Neuropathic vulval pain arises following a specific neurological disorder, responsible for structural damage to the nervous system. Vulvodynia is dysfunctional vulval pain, caused by abnormal function of the nervous system itself.

Premenstrual syndrome and beyond: lifestyle, nutrition, and personal facts.

AIM: The aim was to study prevalence of menstrual symptoms and their presenting patterns, and to assess nutrition and behaviours correlates. METHODS: The study enrolled 108 women, who were prospectively assessed for menstrual symptoms; a 212 items questionnaire about lifestyle and nutrition was administered. Diagnosis and intensity of symptoms were separately compared for dietary and other factors. The χ2 test or Fisher exact test as required and a multivariate analysis were performed. RESULTS: Seventeen percent of the sample reported no symptoms; core PMD was diagnosed in 14%, and related to symptoms of moderate intensity, to late menarche, irregular, long cycles, dysmenorrhoea, and to lower intake of complex carbohydrates, fibers, calcium; non-cyclical pattern in 27%, and related to symptoms of severe intensity, to young age, unemployed, to poor health, stress, traumatic events, abnormal BMI, to long, heavy menses, to lower intake of fibers, magnesium, vitamin B6, and to higher intake of fat, proteins, sodium, caffeine; variant PMD-premenstrual exacerbation in 42%, and related to symptoms of severe - moderate intensity, to young age, students, unemployed, sedentary work, abnormal BMI, stress, to cycle irregularities, heavy menses, to higher intake of simple sugars and sodium, and to lower intake of calcium, magnesium, and vitamin B6. Regardless of diagnosis, severe intensity of symptoms was associated with young age /students (P<0.001), lower education, unemployed, smoke, sedentary work, poor health, stress, heavy menses (P<0.01), dysmenorrhea, more unfavorable and less favorable nutrients. CONCLUSION: Lifestyle, nutrition, and general health considerations seem to be important issues in the management of menstrual symptoms, prospective symptoms chart being mandatory for diagnosis.

Provoked vestibulodynia: inflammatory, neuropathic or dysfunctional pain? A neurobiological perspective.

This paper aims to clarify the nature of the pain in provoked vestibulodynia (PV). It reviews published data about the nature of the pain in PV, employing a recent pain classification, which divides pain from a neurobiological perspective, into nociceptive, inflammatory and pathological pain, with the latter subdivided into neuropathic and dysfunctional pain. Nociceptive pain is high-threshold pain provoked by noxious stimuli; inflammatory pain is adaptive, low-threshold pain associated with peripheral tissue inflammation; pathological pain is maladaptive, low-threshold pain caused by structural damage to the nervous system (neuropathic) or by its abnormal function (dysfunctional). Most of the published data show that in PV, there is no active peripheral tissue inflammation. Similarly, no neural damage has been demonstrated. It is reasonable to consider PV as dysfunctional pain induced by exposure to acute physical or psychological precipitating events in the presence of an individual predisposition to produce or maintain abnormal central sensitisation.

The recurrent vulvovaginal candidiasis: proposal of a personalized therapeutic protocol.

Background. Recurrent vulvovaginal candidiasis (RVC) is an increasing challenge in clinical practice. Objective. The purpose of this study was to reduce the episodes of RVC through the intake of fluconazole 200 mg/dose with a personalized regimen at growing administration intervals with a probiotic. Method. 55 patients received a 200 mg fluconazole as an induction dose for 3 alternate days. Symptoms resolution after 10-14 days made the patients eligible to continue with a maintenance therapy of fluconazole weekly for one month, followed by 200 mg after 10, 15, 20 and 30 days. Patients were allowed to move on to the next level of maintenance therapy only if they were symptom free. Patients were also given a probiotic with Beta Glucan and Echinacea Purpurea. Results. Among the 55 patients enrolled, four (7%) have withdrawn after the induction phase. 51 patients completed the whole therapeutic maintenance period, and eight (15,6%) experienced a recurrence before the end of the therapy. Five women (9,8%) relapsed (two after 2 months and three after 6 months). Conclusion. The positive results of our study prove the effectiveness of an individualized protocol for a rather short period, with a slowly decreasing administration of fluconazole + probiotic.

Transcutaneous electrical nerve stimulation to treat vestibulodynia: a randomised controlled trial.

OBJECTIVE: To assess the efficacy of transcutaneous electrical nerve stimulation (TENS) in the treatment of vestibulodynia. DESIGN: Double-arm randomised placebo-controlled trial. SETTING: An outpatient department for vulval disease. POPULATION: Forty women with vestibulodynia, a vestibular discomfort mostly reported as a burning pain, occurring in the absence of relevant visible findings or a specific, clinically identifiable, neurological disorder. METHODS: Twice a week active TENS or sham treatment were delivered through a vaginal probe via a calibrated dual channel YSY-EST device. Women of both groups underwent 20 treatment sessions. MAIN OUTCOME MEASURES: Visual analogue scale (VAS), the short form of the McGill-Melzack Pain Questionnaire (SF-MPQ), the Marinoff Scale for dyspareunia and the Female Sexual Function Index questionnaire (FSFI) were assessed at baseline, at the end of treatment and at follow up 3 months after the end of treatment. RESULTS: The VAS and SF-MPQ scores (6.2 +/- 1.9 and 19.5 +/- 11.9 before treatment, respectively) improved significantly in the active TENS group (2.1 +/- 2.7, P= 0.004 and 8.5 +/- 10.7, P= 0.001, respectively), but not in the placebo group. The Marinoff dyspareunia scale and the FSFI also showed a significant improvement. CONCLUSIONS: TENS is a simple, effective and safe short-term (3 months) treatment for the management of vestibulodynia.