Acupuncture for the treatment of vulvar vestibulitis: a pilot study.

BACKGROUND: The study was conducted to obtain a preliminary indication of the effectiveness of acupuncture in the treatment of vulvar vestibulitis but also to obtain information how well the women tolerate the treatment. METHODS: Fourteen young women with vulvar vestibulitis according to Friedrich's criteria were enrolled in the study and 13 fulfilled the acupuncture treatment a total of 10 times. For evaluation quality of life (QOL) assessments were made before starting the treatment and then at one week and at three months after it was completed. RESULTS: The treatment was well tolerated and the QOL measurements were all significantly higher after both the last acupuncture and three months later, compared to before the treatment was started. CONCLUSION: The results seem promising, but a larger controlled randomized study should be carried out before the treatment can be recommended for use in clinical practice.

Vulvar vestibulitis: a multi-factorial condition.

OBJECTIVE: To study differences in somatic symptoms and personality dimensions between women with vulvar vestibulitis and a non-symptomatic control group. DESIGN: A case-control study conducted in 1998. SETTING: Two clinics in northern Sweden. SAMPLE: Thirty-eight women, 18-25 years of age, suffering from vulvar vestibulitis, and 70 healthy controls. METHODS: The women completed two questionnaires: the temperament and character inventory to study personality aspects, and the Giessen subjective complaints list, which is a checklist of subjective bodily complaints. RESULTS: Regarding personality aspects the women with vulvar vestibulitis scored significantly higher than the control group, on exclusively one out of seven subscales of the temperament and character inventory (i.e. harm avoidance). This trait is considered to be partly inherited and stable throughout life, and to give the person a tendency to react to problems with pessimistic thoughts, increased anxiety and fatigue. On the Giessen subjective complaints list the women with vestibulitis reported a significantly higher number of somatic complaints in several areas. CONCLUSIONS: The findings that women suffering from vulvar vestibulitis have more bodily complaints than the controls is interpreted as an indication of a psychosomatic element in their illness, which could be primary or secondary. Furthermore, these women are characterised by a particular personality trait, and it is suggested that this trait might influence their experience and management of pain and stress. A multi-factorial origin of vulvar vestibulitis is advocated and a multimodal interdisciplinary treatment approach is suggested. To elucidate further the mechanisms behind this health problem, prospective controlled studies are urgently needed.

Vulvar vestibulitis: medical, psychosexual and psychosocial aspects, a case-control study.

BACKGROUND: Vulvar vestibulitis is suspected to be increasingly prevalent among young women, but the etiology is still unclear. The aim of this study was to explore the differences in medical, psychosexual and psychosocial factors between women with vulvar vestibulitis and a control group. METHODS: A case-control study was made with 38 women with vulvar vestibulitis and 71 healthy age-matched controls. All the women answered a structured questionnaire about their medical and gynecological history which included psychosexual and psychosocial background factors and current aspects as well. RESULTS: Women with vulvar vestibulitis have very much the same psychosocial and sexual background factors as their controls, whereas there are many differences in their medical background factors, both gynecological and others. It is very clear that they suffer from many other somatic symptoms more often than their controls. CONCLUSIONS: There are no indications of a primary sexual disturbance in women with vulvar vestibulitis. However, the finding that women with vulvar vestibulitis have many different somatic symptoms indicates a psychosomatic strain in the illness. Regardless of whether this is primary or secondary, it should be taken into consideration when treating the patients.

A population-based study of human papillomavirus deoxyribonucleic acid testing for predicting cervical intraepithelial neoplasia.

OBJECTIVE: Our purpose was to determine the predictive values of primary or secondary screening for cervical human papillomavirus infection for cytologic detection of cervical intraepithelial neoplasia. STUDY DESIGN: Most of the 254 women referred for colposcopy in Västerbotten County in Sweden during October 1993 through December 1995 and 320 age-matched women from the general population were screened for human papillomavirus deoxyribonucleic acid by nested general-primer polymerase chain reaction. RESULTS: Ninety-six percent of women with high-grade cervical intraepithelial neoplasia had human papillomavirus, compared with 4% of women with normal findings (odds ratio 606; 95% confidence interval 137 to 5607). Thirty-seven percent of referred women and 48% of referred women >39 years old had mostly minor cytologic abnormalities with no human papillomavirus. The human papillomavirus-associated positive predictive value for cervical intraepithelial neoplasia was 76% in the colposcopy group and 11% in the general population, whereas the negative predictive value was >97% in both populations. CONCLUSION: Testing for human papillomavirus deoxyribonucleic acid seems diagnostically useful among women referred for colposcopy.

[Vulvar complaints in young girls need instant professional evaluation]. / Vulvabesvär hos småflickor kräver snabb, professionell undersökning.

As vulvovaginal disease are nog very common in prepubescent girls, it may seem reasonable to suspect sexual abuse when a small girl presents with complaints in the genital area. However, the very fact that there are visible changes suggests that it is no a case of sexual abuse, the signs of which are usually more subtle. To arrive at a correct diagnosis, and avoid unnecessary, traumatic investigation into the possibility of sexual abuse, it is essential that such patients be examined from the outset by physicians experienced in this field.

Is vulvar vestibulitis an inflammatory condition? A comparison of histological findings in affected and healthy women.

Vulvar vestibulitis, as defined by Friedrich, is considered to be inflammatory, despite the fact that the normal histology of this specific area has previously not been characterized. The aim of the present study was to compare the normal histology of the vulvar vestibulum with findings in localized vulvar vestibulitis. Biopsies were taken at the area of the vestibulitis, i.e. at the openings of the Bartholin's duct. Eleven control specimens were examined histologically and compared to 24 specimens obtained from 20 patients. All samples were also tested for human papillomavirus, and they were all negative. In control specimens, as well as in specimens from patients, subepithelial inflammatory cells, sometimes aggregated into lymph follicles and/or small groups of lymphocytes were found. The conclusion is reached that the occurrence of inflammatory cells in vestibular tissue is a normal finding and cannot serve as a histological indicator of vulvar vestibulitis.

Vulvar vestibulitis in the north of Sweden. An epidemiologic case-control study.

OBJECTIVE: To determine the epidemiologic characteristics of patients with vulvar vestibulitis. STUDY DESIGN: During the years 1992-1994, 32 women with vulvar vestibulitis were referred to the Vulva Clinic, University Hospital, Umeå, Sweden. They were asked questions regarding age, age at first intercourse, pregnancies, number of lifetime partners, use of oral contraceptives and past gynecologic history, including infections and previous treatments. The cases were compared to 17 healthy controls. For statistical evaluation, the two-tailed Wilcoxon rank sum test was used. RESULTS: There were no differences between the groups regarding age, age at first intercourse, pregnancies, number of lifetime partners or history of genital infections, with the exception of human papillomavirus. The cases had been treated significantly more often for suspected papillomavirus infection and had also used oral contraceptives for a significantly longer period. CONCLUSION: This study provided support for the hypothesis of a steroidal etiology of the syndrome.

Influence of phenoxymethylpenicillin on the vaginal ecosystem.

The effects of phenoxymethylpenicillin on the bacterial flora of the vagina were investigated in 6 women who fulfilled the criteria of 'normality': predominance of lactobacilli, and absence of Enterobacteriaceae and fungi. Fourteen healthy women were enrolled and followed longitudinally; 8 of these were subsequently excluded because of divergence from normality. Following penicillin treatment, Gram-negative rods appeared in 4 of the remaining 6 women, and in 1 subject heavy growth of Candida albicans resulted. In 5 of the women there was no change in the lactobacillus count and a rise in pH was found in 4 subjects. In 1 woman, lactobacilli disappeared completely and were replaced by Escherichia coli. Concomitantly, high concentrations of endotoxins were found in the vaginal fluid. Treatment with penicillin may interfere with the normal vaginal bacterial flora and provide an environment favorable for Enterobacteriaceae and fungi.