Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 25
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Obstet Gynecol ; 2020 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-32769643

RESUMO

OBJECTIVE: To evaluate pain reduction after two injections of 50 units botulinum toxin A compared with placebo for provoked vestibulodynia. METHODS: We conducted a double-blinded, placebo-controlled randomized trial of 50 units botulinum toxin A or placebo injected in the bulbocavernosus muscles twice, 3 months apart, in women with provoked vestibulodynia. Primary outcome was self-reported dyspareunia or pain at tampon use on a visual analog scale (VAS, 0-100). Secondary outcomes were pain at weekly tampon insertion (VAS score), reduction of pelvic floor hypertonicity (measured with a vaginal manometer), adverse events, and sexual function and distress. A sample size of 38 participants for each group was calculated to achieve a statistical power of 80% based on an effect size of 20 VAS units (0-100) (mean score range 56-76±31 SD). RESULTS: Between May 2016 and June 2018, 124 women with provoked vestibulodynia were assessed, and 88 were randomized to botulinum toxin A (BTA group, n=44) or placebo (placebo group, n=44). Primary outcome showed a lower but statistically nonsignificant pain rating by 7 VAS units (95% CI -15.0 to 0.4) in the BTA group compared with the placebo group. Secondary results showed a significant decrease in pain at weekly tampon insertion by 11 VAS units (95% CI -16.6 to 6.0) with botulinum toxin A injection. The vaginal manometer measured lower maximum contraction strength by 7 mm Hg (95% CI -12.7 to -2.4) and lower 10-second endurance strength by 4 mm Hg (95% CI -7.72 to -1.16) in the BTA group compared with the placebo group. No changes were observed for sexual function and distress, but there was a significant increase in women attempting vaginal intercourse in the BTA group (0.27, 95% CI 0.06-0.48). No severe adverse events were reported. CONCLUSION: Twice-repeated injections of 50 units of botulinum toxin A in women with provoked vestibulodynia did not reduce dyspareunia or pain at tampon use, but secondary outcomes suggested positive effects of the treatment. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02773641.

2.
Nat Rev Dis Primers ; 6(1): 36, 2020 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-32355269

RESUMO

Vulvodynia is a condition that occurs in 8-10% of women of all ages and is characterized by pain at the vulva that is present during sexual and/or non-sexual situations. Diagnosis is established through careful medical history and pelvic examination, including the cotton-swab test. The onset and maintenance of vulvodynia involves a complex interplay of peripheral and central pain mechanisms, pelvic floor muscle and autonomic dysfunction, anxiety, depression and childhood maltreatment as well as cognitive-affective, behavioural and interpersonal factors. Given the absence of empirically supported treatment guidelines, a stepwise approach of pelvic floor physical therapy and cognitive behavioural therapy as well as medical management is suggested, with surgery as the last option. Vulvodynia has a negative effect on the quality of life of women and their partners, and imposes a profound personal and societal economic burden. In addition, women with vulvodynia are more likely to report other chronic pain conditions, which further alters their quality of life. Future efforts should aim to increase girls', women's and healthcare professionals' education and awareness of vulvodynia, phenotype different subgroups of women based on biopsychosocial characteristics among more diverse samples, conduct longitudinal studies and improve clinical trial designs.

3.
Acta Oncol ; 58(8): 1107-1115, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30957588

RESUMO

Background: Sex steroid hormones and their receptors are important in female sexual function. The aim of this study was to investigate the expression and distribution of estrogen receptor (ER)α, ERß, G-protein-coupled ER-1 (GPER), androgen receptor (AR), progesterone receptor (PR)A, PRB and connective tissue growth factor (CTGF) in the vaginal wall among women who had been treated for cervical cancer with radiotherapy. Material and methods: We included cervical cancer survivors treated with radiotherapy and premenopausal control women of the same age scheduled for benign gynecological surgery. We analyzed the expression and distribution of sex steroid hormone receptors and CTGF in biopsies from the vaginal wall, by real-time PCR and immunohistochemistry (IHC). Serum samples were analyzed for hormone levels and radiation dose at biopsy site were calculated and correlated to levels of the sex steroid hormone receptors. Results: In the cervical cancer survivors (n = 34), we found a lower expression of ERα at both mRNA and protein levels, compared to the control women (n = 37). In the survivors with high radiation dose at biopsy site, the immunostaining of ERα and AR was lower in the epithelium and the stroma, compared to survivors with minimal radiation dose. The later group showed expression of ERα comparable to the control women. The cancer survivors were sufficiently substituted with systemic estradiol with no difference in the serum estradiol levels compared to control women. Conclusions: We found that external radiation reduces the ERα and AR protein expression in the vaginal mucosa, indicating that the vaginal changes in irradiated cervical cancer survivors and the lack of response to hormonal treatment could be due to the decreases in sex steroid hormone receptor expression.


Assuntos
Receptor alfa de Estrogênio/metabolismo , Receptores Androgênicos/metabolismo , Neoplasias do Colo do Útero/terapia , Vagina/patologia , Doenças Vaginais/patologia , Adulto , Biópsia , Sobreviventes de Câncer/estatística & dados numéricos , Quimiorradioterapia/efeitos adversos , Quimiorradioterapia/métodos , Fator de Crescimento do Tecido Conjuntivo/metabolismo , Relação Dose-Resposta à Radiação , Resistência a Medicamentos , Estradiol/farmacologia , Estradiol/uso terapêutico , Terapia de Reposição de Estrogênios/métodos , Feminino , Humanos , Histerectomia , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/métodos , Progestinas/farmacologia , Progestinas/uso terapêutico , Dosagem Radioterapêutica , Resultado do Tratamento , Vagina/efeitos da radiação , Doenças Vaginais/etiologia , Doenças Vaginais/terapia
4.
J Low Genit Tract Dis ; 23(1): 33-38, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30247221

RESUMO

OBJECTIVES: Persistent infection with human papillomavirus causes cervical high-grade squamous intraepithelial lesions (HSILs). The role of antimicrobial peptides (AMPs) in premalignant and malignant transformation is not fully understood. In this study, we examined the expression of human ß-defensin 1 (HBD-1), HBD-2, HBD-3, LL37, psoriasin, and interleukin 8 (IL-8) in women with HSIL before and 6 months after surgery. MATERIALS AND METHODS: Biopsies and secretion samples from the cervical canal were collected from 19 patients with HSIL and 14 healthy controls. The mRNA expression of HBD-1, HBD-2, HBD-3, LL37, psoriasin, and IL-8 was analyzed before and 6 months after surgery excision using reverse transcriptase real time polymerase chain reaction. For protein analyses, ELISA and immunohistochemistry were used for psoriasin and ELISA for IL-8. RESULTS: The mRNA expression of psoriasin was lower in patients before treatment compared with healthy controls (p = .05). After surgery, when the infection was cleared, psoriasin increased on mRNA (p = .04) and protein (p = .03) levels compared with before treatment. Immunostaining for psoriasin after treatment was prominent and localized in the cytoplasm of the epithelial cells. After treatment, IL-8 mRNA was reduced compared with before treatment (p = .05), but not on the protein level. No changes in mRNA expression of the other AMPs analyzed were observed in pretreatment and posttreatment samples. CONCLUSIONS: In this study of AMP expression in human papillomavirus-induced HSIL, we observed lower psoriasin levels before surgery compared with after treatment, when both mRNA and protein levels were similar to healthy controls. Interleukin 8, on the other hand, was increased before treatment, indicating an inflammatory response.


Assuntos
Peptídeos Catiônicos Antimicrobianos/análise , Citocinas/análise , Infecções por Papillomavirus/complicações , Proteína A7 Ligante de Cálcio S100/análise , Lesões Intraepiteliais Escamosas Cervicais/patologia , Adulto , Biópsia , Ensaio de Imunoadsorção Enzimática , Feminino , Perfilação da Expressão Gênica , Humanos , Imuno-Histoquímica , RNA Mensageiro/análise , Reação em Cadeia da Polimerase em Tempo Real , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Adulto Jovem
5.
J Mol Med (Berl) ; 96(6): 537-545, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29736603

RESUMO

Candida albicans belongs to the normal microbial flora on epithelial surfaces of humans. However, under certain, still not fully understood conditions, it can become pathogenic and cause a spectrum of diseases, from local infections to life-threatening septicemia. We investigated a panel of antimicrobial proteins and peptides (AMPs), potentially involved in mucosal immunity against this pathogen. Out of six studied AMPs, psoriasin was most up-regulated during a mucosal infection, an acute episode of recurrent Candida vulvovaginitis, although candidacidal activity has not been demonstrated. We here show that psoriasin binds to ß-glucan, a basic component of the C. albicans cell wall, and thereby inhibits adhesion of the pathogen to surfaces and increases IL-8 production by mucosal epithelial cells. In conclusion, we show a novel mechanism of action of psoriasin. By inhibiting C. albicans adhesion and by enhancing cytokine production, psoriasin contributes to the immune response against C. albicans. KEY MESSAGES: The antimicrobial peptide psoriasin is highly up-regulated during a local mucosal infection, Candida albicans vulvovaginitis. Psoriasin binds to ß-glucan in the Candida albicans cell wall and thereby inhibits adhesion of the pathogen. Binding of psoriasin to Candida albicans induces an immune response by mucosal epithelial cells.


Assuntos
Candidíase/metabolismo , Proteína A7 Ligante de Cálcio S100/metabolismo , Adulto , Candida albicans/fisiologia , Candidíase/genética , Adesão Celular , Linhagem Celular , Feminino , Humanos , Proteína A7 Ligante de Cálcio S100/genética , Adulto Jovem , beta-Glucanas/metabolismo
6.
Acta Oncol ; 57(3): 338-345, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29140150

RESUMO

BACKGROUND: Women who have been treated for cervical cancer have persistent changes in their sexual function, which result in considerable distress. The aim of this study was to investigate the morphology of the vaginal epithelium in cervical cancer survivors treated with radiotherapy and its correlation to serum levels of sex steroid hormones and sexual function. MATERIAL AND METHODS: We included 34 patients treated for cervical cancer with radiotherapy and 37 healthy age-matched control women scheduled for benign gynecological surgery. After inspection and grading of vaginal atrophy, vaginal biopsies were taken. Epithelial structures were analyzed by measuring epithelial thickness as well as the number, height and width of the dermal papillae and the dermal papillae distance. Sex steroid hormone levels were analyzed and a questionnaire designed to assess sexual function was filled out. RESULTS: In the cervical cancer survivors treated with radiotherapy, the vaginal epithelium volume was reduced compared to control women. Longer distance between the dermal papillae (p < .001) and a shorter distance from basal layer to epithelial surface (p < .05) were measured. Mucosal atrophy was observed in 91% of the survivors. There was no difference in serum estradiol between cancer survivors and control women, implying that the cancer survivors were sufficiently substituted. The epithelial thickness correlated to serum levels of estradiol. The cervical cancer survivors reported more physical sexual symptoms. The highest relative risk (RR) was found for insufficient vaginal lubrication (RR 12.6), vaginal inelasticity (RR 6.5), reduced genital swelling when sexually aroused (RR 5.9), and for reduction of vaginal length during intercourse (RR 3.9). CONCLUSION: We found that cervical cancer treatment including radiotherapy is associated with vaginal epithelial atrophy and sexual dysfunction. To hamper the atrophic process affecting the sexual function, an early start of local estrogen after therapy might be of importance.


Assuntos
Epitélio/efeitos da radiação , Radioterapia/efeitos adversos , Disfunções Sexuais Fisiológicas/etiologia , Neoplasias do Colo do Útero/radioterapia , Vagina/efeitos da radiação , Adulto , Epitélio/patologia , Estradiol/sangue , Feminino , Humanos , Pessoa de Meia-Idade , Disfunções Sexuais Fisiológicas/patologia , Sobreviventes , Vagina/patologia
7.
Acta Oncol ; 56(5): 661-666, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28084859

RESUMO

BACKGROUND: Cervical cancer survivors treated with radiotherapy report vaginal inelasticity and decreased lubrication that may affect their sexual health, but it is unknown which normal tissue reactions mediate these symptoms. The aim of this study was to investigate the morphology of the connective tissue of the vaginal wall in cervical cancer survivors treated with radiotherapy. MATERIAL AND METHODS: We recruited 34 cervical cancer survivors treated with radiotherapy and 37 age-matched controls. Via clinical examination the degree of vaginal atrophy and pelvic fibrosis were estimated. We collected vaginal biopsies, which underwent morphometric analysis focused on elastin and collagen. Additionally, radiation dose at biopsy site were calculated and correlated to the clinical and morphological findings. RESULTS: The survivors had marked morphological vaginal changes, most prominent in the survivors that had received the highest radiation dose at the biopsy site. Mucosal atrophy was observed in 91% and pelvic fibrosis in 97%. A shorter vagina was measured; 7.0 cm versus 10.3 cm in controls (p < 0.001). The area fraction of elastin was greater in survivors; 10.0% (range 5.8-12.9), compared with controls; 3.4% (range 1.8-5.8), p < 0.001. The survivors had signs of elastosis with thick aggregated elastin fibers irregularly scattered throughout the connective tissue, while the controls had elastin fibers in a thin sub-epithelial layer. The area fraction of high density collagen in the connective tissue was larger among the survivors (p < 0.001). The collagen with the highest density (fibrosis) was more common in the group of cancer survivors that had received external radiation. CONCLUSIONS: We found drastic differences in the vaginal wall between the irradiated cervical cancer survivors and the controls, indicating that radiotherapy-induced vaginal symptoms are mediated by connective tissue fibrosis and elastosis. Our results also support that patients treated with external radiation have the highest risk of developing vaginal fibrosis with impairment of their sexual health.


Assuntos
Braquiterapia/efeitos adversos , Fibrose/etiologia , Neoplasias do Colo do Útero/radioterapia , Doenças Vaginais/etiologia , Adenocarcinoma/patologia , Adenocarcinoma/radioterapia , Adenocarcinoma de Células Claras/patologia , Adenocarcinoma de Células Claras/radioterapia , Adulto , Sobreviventes de Câncer , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/radioterapia , Estudos de Casos e Controles , Feminino , Fibrose/patologia , Seguimentos , Humanos , Pessoa de Meia-Idade , Prognóstico , Inquéritos e Questionários , Taxa de Sobrevida , Neoplasias do Colo do Útero/patologia , Doenças Vaginais/patologia
8.
Acta Obstet Gynecol Scand ; 96(3): 295-301, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28052314

RESUMO

INTRODUCTION: Recurrent vulvovaginal candidiasis is defined as having three to four episodes per year and causes substantial suffering. Little is known about the mechanisms leading to relapses in otherwise healthy women. Nitric oxide is part of the nonspecific host defense and is increased during inflammation. Nitric oxide levels were measured and the expression of inducible nitric oxide synthase was analyzed in the vagina during an acute episode of recurrent vulvovaginal candidiasis and after treatment with fluconazole. MATERIAL AND METHODS: Twenty-eight women with symptoms of recurrent vulvovaginal candidiasis were enrolled together with 31 healthy controls. Nitric oxide was measured with an air-filled 25-mL silicon catheter balloon incubated in the vagina for five minutes and then analyzed by chemiluminescence technique. Vaginal biopsies were analyzed for the expression of inducible nitric oxide synthase. Symptoms and clinical findings were surveyed using a scoring system. The measurements and biopsies were repeated in patients after six weeks of fluconazole treatment. RESULTS: Nitric oxide levels were increased during acute infection (median 352 ppb) compared with controls (median 6 ppb), p < 0.0001. The levels decreased after treatment (median 18 ppb) but were still higher than in controls. Increased expression of inducible nitric oxide synthase was observed in the epithelial basal layer in patients before and after treatment compared with controls. Before treatment, there were positive correlations between nitric oxide and symptom (rs  = 0.644) and examination scores (rs  = 0.677), p < 0.001. CONCLUSIONS: Nitric oxide is significantly elevated in patients with recurrent vulvovaginal candidiasis during acute episodes of infection and decreases after antifungal treatment. The results illustrate the pronounced inflammatory response in recurrent vulvovaginal candidiasis correlating to symptoms of pain and discomfort.


Assuntos
Candidíase Vulvovaginal/metabolismo , Óxido Nítrico Sintase Tipo II/metabolismo , Óxido Nítrico/metabolismo , Adolescente , Adulto , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Candidíase Vulvovaginal/tratamento farmacológico , Estudos de Casos e Controles , Feminino , Fluconazol/administração & dosagem , Fluconazol/uso terapêutico , Humanos , Recidiva , Inquéritos e Questionários , Adulto Jovem
9.
J Sex Med ; 11(12): 3064-71, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25174699

RESUMO

INTRODUCTION: Provoked vestibulodynia (PVD) is a common type of dyspareunia among young women. The patho-physiology remains largely unclear. Women with PVD have general pain hypersensitivity and often report additional pain symptoms. Signs point towards PVD being a chronic pain disorder similar to other syndromes of longstanding pain, including a common comorbidity of anxiety and depression. Polymorphism in the serotonin receptor gene, 5HT-2A, has been associated with other chronic pain disorders such as fibromyalgia but has not been investigated in PVD patients. AIM: We aimed to investigate a possible contribution of polymorphism in the 5HT-2A gene to the etiology of PVD as well as a potential influence on pain sensitivity. METHODS: In this case-control study 98 women with PVD and 103 healthy controls between 18 and 44 years and in the same menstrual cycle phase completed questionnaires and underwent quantitative sensory testing. Venous blood samples were collected for DNA isolation. MAIN OUTCOME MEASURES: Concomitant pain was reported, a bodily pain score was created and pressure pain thresholds (PPTs) on the arm, leg, and in the vestibule were measured. Intensity of coital pain was rated on a visual analog scale, range 0-100. The T102C (rs6313) and A-1438G (rs6311) single nucleotide polymorphisms (SNPs) in the 5HT-2A gene were analyzed. RESULTS: The probability of PVD was elevated in participants carrying the 1438G- and 102C-alleles of the 5HT-2A gene (OR 2.9). The G-/C- genotypes were also associated with more concomitant bodily pain in addition to the dyspareunia, but not with experimental PPTs or coital pain ratings. PVD patients reported more concomitant bodily pain and had lower PPTs compared with controls. CONCLUSION: The results indicate a contribution of alterations in the serotonergic system to the patho-genesis of PVD and gives further evidence of PVD being a general pain disorder similar to other chronic pain disorders.


Assuntos
Dispareunia/genética , Polimorfismo de Nucleotídeo Único/genética , Receptor 5-HT2A de Serotonina/genética , Vulvodinia/genética , Adolescente , Adulto , Ansiedade/genética , Estudos de Casos e Controles , Dor Crônica/genética , Feminino , Humanos , Dor/epidemiologia , Medição da Dor , Limiar da Dor , Pressão , Serotonina/fisiologia , Inquéritos e Questionários , Adulto Jovem
10.
Scand J Pain ; 5(1): 10-16, 2014 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29913664

RESUMO

Background and aims Provoked vestibulodynia (PVD) is the most common cause of dyspareunia among young women. The aetiology is largely unknown and treatment is often extensive and longstanding with varying outcomes. Patients display general pain hypersensitivity and there are correlations with other chronic pain syndromes such as fibromyalgia later in life. The A118G polymorphism in the µ-opioid receptor (OPRM1) gene influences endogenous pain regulation and pain sensitivity, but has not been studied in this patient group before. We aimed to investigate a possible association between A118G polymorphism and PVD, with correlation to plasma levels of ß-endorphin, and to explore relationships between this polymorphism and pain sensitivity among women with PVD and healthy controls. Methods This case-control study included 98 women with PVD and 103 controls. Participants filled out study-specific questionnaires and underwent quantitative sensory testing of pressure pain thresholds on the arm, leg and in the vestibular area. Levels of ß-endorphin were analyzed by radioimmunoassay using the EURIA-beta-endorphin kit, and the A118G single-nucleotide polymorphism (SNP; rs1799971) in the OPRM1 gene was analyzed using the TaqMan SNP genotyping assay. Results The 118G allele was more common in controls (44%) than in patients (30%) (p = 0.042). The odds ratio of having PVD was 1.8 in participants carrying the 118A allele compared to participants hetero- or homozygous for the 118G allele (OR = 1.846, CI: 1.03-3.31, p = 0.039). Pressure pain thresholds on the leg were higher for participants carrying the 118G allele (mean 480 kPa, SD 167.5) than for those carrying the 118A allele (mean 419, SD 150.4, p = 0.008). Levels of ß-endorphin were higher in patients (mean 17.9 fmol/ml, SD 4.71) than in controls (mean 15.8 fmol/ml, SD 4.03) (p < 0.001). Conclusion We found an association between the A118G polymorphism in the OPRM1 gene and an increased risk of PVD and increased pain sensitivity among participants carrying the 118A allele. PVD patients were more sensitive to pressure pain and had higher levels of plasma ß-endorphin than controls. The results indicate that differences in endogenous pain modulation involving the opioid system could contribute to the pathophysiology of PVD and the general pain hypersensitivity seen in these women. Implications The data support the conceptualization of PVD as part of a general pain disorder with a possible genetic predisposition. The age of onset of PVD is usually between 18 and 25 years and already at this age general pain hypersensitivity is present but rarely causing disability. We believe that early recognition and treatment, with the risk of further development of chronic pain taken into consideration, might prevent future aggravated pain problems in this patient group.

11.
J Sex Med ; 10(1): 83-93, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22970822

RESUMO

INTRODUCTION: Female genital sexual pain (GSP) is a common, distressing complaint in women of all ages that is underrecognized and undertreated. Definitions and terminology for female GSP are currently being debated. While some authors have suggested that GSP is not per se a sexual dysfunction, but rather a localized genial pain syndrome, others adhere to using clearly sexually related terms such as dyspareunia and vaginismus. AIM: The aims of this brief review are to present definitions of the different types of female GSP. Their etiology, incidence, prevalence, and comorbidity with somatic and psychological disorders are highlighted, and different somatic and psychological assessment and treatment modalities are discussed. METHODS: The Standard Operating Procedures (SOP) committee was composed of a chair and five additional experts. No corporate funding or remuneration was received. The authors agreed to survey relevant databases, journal articles and utilize their own clinical experience. Consensus was guided by systematic discussions by e-mail communications. MAIN OUTCOME/RESULTS: There is a clear lack of epidemiological data defining female GSP disorders and a lack of evidence supporting therapeutic interventions. However, this international expert group will recommend guidelines for management of female GSP. CONCLUSIONS: GSP disorders are complex. It is recommended that their evaluation and treatment are performed through comprehensive somato-psychological multidisciplinary approach.


Assuntos
Dispareunia/diagnóstico , Protocolos Clínicos/normas , Dispareunia/epidemiologia , Dispareunia/etiologia , Dispareunia/terapia , Feminino , Humanos , Exame Físico/métodos , Exame Físico/normas , Guias de Prática Clínica como Assunto/normas , Vaginismo/diagnóstico , Vaginismo/terapia , Vulvodinia/diagnóstico , Vulvodinia/terapia , Vulvovaginite/diagnóstico , Vulvovaginite/terapia
12.
Mol Pain ; 8: 68, 2012 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-22971341

RESUMO

BACKGROUND: Provoked vestibulodynia (PVD) is a pain disorder localized in the vestibular mucosa. It is the most common cause of dyspareunia among young women and it is associated with general pain hypersensitivity and other chronic pain conditions. Polymorphism in the guanosine triphosphate cyclohydrolase (GCH1) gene has been found to influence general pain sensitivity and the risk of developing a longstanding pain condition. The aim of this study was to investigate GCH1-polymorphism in women with PVD and healthy controls, in correlation to pain sensitivity. RESULTS: We found no correlation between the previously defined pain-protective GCH1-SNP combination and the diagnosis of PVD. Nor any correlation with pain sensitivity measured as pressure pain thresholds on the arm, leg and in the vestibule, coital pain scored on a visual analog scale and prevalence of other bodily pain conditions among women with PVD (n = 98) and healthy controls (n = 102). However, among patients with current treatment (n = 36), there was a significant interaction effect of GCH1-gene polymorphism and hormonal contraceptive (HC) therapy on coital pain (p = 0.04) as well as on pressure pain thresholds on the arm (p = 0.04). PVD patients carrying the specified SNP combination and using HCs had higher pain sensitivity compared to non-carriers. In non-HC-users, carriers had lower pain sensitivity. CONCLUSIONS: The results of this study gave no support to the hypothesis that polymorphism in the GCH1-gene contributes to the etiology of PVD. However, among patients currently receiving treatment an interaction effect of the defined SNP combination and use of hormonal contraceptives on pain sensitivity was found. This finding offers a possible explanation to the clinically known fact that some PVD patients improve after cessation of hormonal contraceptives, indicating that PVD patients carrying the defined SNP combination of GCH1 would benefit from this intervention.


Assuntos
GTP Cicloidrolase/genética , Predisposição Genética para Doença , Limiar da Dor , Polimorfismo de Nucleotídeo Único/genética , Vulvodinia/enzimologia , Vulvodinia/genética , Adolescente , Adulto , Anticoncepcionais Orais Hormonais/uso terapêutico , Feminino , Frequência do Gene/genética , Heterozigoto , Humanos , Modelos Lineares , Medição da Dor , Vulvodinia/tratamento farmacológico , Vulvodinia/fisiopatologia , Adulto Jovem
13.
J Sex Med ; 9(5): 1400-6, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22376009

RESUMO

INTRODUCTION: Provoked vestibulodynia (PVD) is the most common cause of dyspareunia in young women. The etiology is unclear, and there is little knowledge of how to predict treatment outcome. AIM: The aim of this study was to identify medical factors associated with treatment outcome and coital pain in women with PVD. METHODS: Seventy women previously treated for PVD at a vulvar open care unit completed questionnaires and a quantitative sensory testing session. MAIN OUTCOME MEASURES: Concomitant bodily pain and treatment outcome were surveyed using a study specific questionnaire. Coital pain was rated on a visual analog scale (VAS), range 0-100. Psychometric screening was carried out using the Hospital Anxiety and Depression Scale. Pressure pain thresholds on the arm, leg, and in the vestibulum were measured using pressure algometers. RESULTS: Major improvement/complete recovery was more likely in PVD patients with a maximum of one other concomitant pain disorder compared with patients with four or more (odds ratio = 7.8, confidence interval: 1.2-49.4, P = 0.03). In a multiple linear regression model, the number of other pain disorders (P < 0.01) and a diagnosis of primary PVD (P = 0.04) were positively associated with the coital VAS pain score. Women with secondary PVD reported major improvement/complete recovery to a higher extent than women with primary PVD (z = 2.11, P = 0.04). CONCLUSION: A successful treatment outcome was more likely in PVD patients with fewer other concomitant pain conditions. The number of other bodily pain conditions was also associated to the intensity of the coital pain. Additionally, the results indicate higher incomplete response rates to treatment in women with primary PVD compared with secondary PVD.


Assuntos
Vulvodinia/terapia , Adulto , Coito/fisiologia , Comorbidade , Feminino , Humanos , Dor/epidemiologia , Medição da Dor , Inquéritos e Questionários , Resultado do Tratamento , Vulva/fisiopatologia , Vulvodinia/diagnóstico , Vulvodinia/epidemiologia , Vulvodinia/fisiopatologia , Adulto Jovem
14.
Acta Obstet Gynecol Scand ; 89(12): 1504-10, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21080898

RESUMO

Vulvodynia in young women is a significant clinical challenge. This overview focuses on localized provoked vulvodynia (LPV) with regard to medical and physical predictors of the condition. Several causative factors have been proposed and one major conceptual issue is the role of inflammation. Trauma to the vestibular mucosa causes an initial inflammatory response which may result in peripheral and central pain sensitization. In women with LPV, evidence of mucosal nerve fiber proliferation and enhanced systemic pain perception has been found. A dysfunction of the pelvic floor muscles is common and many patients also suffer from other bodily pain. In general, the level of scientific quality in published studies on vulvodynia is low. Further research on epidemiology, etiology and conduction of clinical trials with high evidence grade is desired.


Assuntos
Dor/fisiopatologia , Vulvodinia/etiologia , Vulvodinia/terapia , Adulto , Feminino , Humanos , Medição da Dor , Percepção da Dor , Exame Físico/métodos , Valor Preditivo dos Testes , Prognóstico , Qualidade de Vida , Fatores de Risco , Índice de Gravidade de Doença , Estresse Psicológico , Vulvodinia/fisiopatologia , Adulto Jovem
15.
J Sex Med ; 7(1 Pt 2): 615-31, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20092455

RESUMO

INTRODUCTION: Women's sexual pain disorders include dyspareunia and vaginismus and there is need for state-of-the-art information in this area. AIM: To update the scientific evidence published in 2004, from the 2nd International Consultation on Sexual Medicine pertaining to the diagnosis and treatment of women's sexual pain disorders. METHODS: An expert committee, invited from six countries by the 3rd International Consultation, was comprised of eight researchers and clinicians from biological and social science disciplines, for the purpose of reviewing and grading the scientific evidence on nosology, etiology, diagnosis, and treatment of women's sexual pain disorders. MAIN OUTCOME MEASURE: Expert opinion was based on grading of evidence-based medical literature, extensive internal committee discussion, public presentation, and debate. Results. A comprehensive assessment of medical, sexual, and psychosocial history is recommended for diagnosis and management. Indications for general and focused pelvic genital examination are identified. Evidence-based recommendations for assessment of women's sexual pain disorders are reviewed. An evidence-based approach to management of these disorders is provided. CONCLUSIONS: Continued efforts are warranted to conduct research and scientific reporting on the optimal assessment and management of women's sexual pain disorders, including multidisciplinary approaches.


Assuntos
Dispareunia/fisiopatologia , Vaginismo/fisiopatologia , Dispareunia/etiologia , Dispareunia/terapia , Feminino , Humanos , Cooperação Internacional , Pelve/anatomia & histologia , Pelve/fisiopatologia , Encaminhamento e Consulta , Vaginismo/etiologia , Vaginismo/terapia
16.
J Psychosom Obstet Gynaecol ; 30(1): 73-9, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19308786

RESUMO

BACKGROUND: Localised provoked vulvodynia (former vulvar vestibulitis syndrome) is the most common cause of superficial dyspareunia among young women. In a clinical setting, it is obvious that many women with localised provoked vulvodynia show signs of chronic stress. The objective of this study was to compare chronic stress in a group of women with localised provoked vulvodynia, referred to the vulvar unit at the Division of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden with control women of the same age and educational level, using two independent methods. METHODS: Forty-three women with localised provoked vulvodynia and 35 healthy control women underwent a gynecological examination, filled in a health questionnaire, and self-collected saliva for analysis of cortisol at awakening and after 15, 30 and 45 min (morning awakening cortisol). Thirty-three patients and 28 controls completed a stress questionnaire. RESULTS: Morning awakening cortisol was blunted in women with localised provoked vulvodynia (p < 0.05), indicating chronic stress. The stress questionnaire showed more signs of burnout (p < 0.005), and emotional (p < 0.05) and bodily symptoms of stress (p < 0.005) in women with localised provoked vulvodynia compared with control subjects (students t-test). CONCLUSION: More women with localised provoked vulvodynia showed blunted morning awakening cortisol and reported more symptoms of stress compared with healthy control women of the same age.


Assuntos
Dor/fisiopatologia , Dor/psicologia , Estresse Psicológico/etiologia , Vulva/fisiopatologia , Adaptação Psicológica , Adulto , Feminino , Humanos , Hidrocortisona/análise , Hidrocortisona/metabolismo , Saliva/química , Estresse Psicológico/diagnóstico , Estresse Psicológico/metabolismo , Inquéritos e Questionários
17.
J Sex Res ; 45(4): 378-85, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18937129

RESUMO

Our objective is to standardize and evaluate a combined physical and psychosexual therapy for women with provoked vestibulodynia. Twenty-four patients underwent the treatment program. Sessions with a psychosexual counselor included issues on sexual functioning, psychological adjustments, and stress elimination. Exercises for mucosal desensitization and reestablishment of pelvic floor function were supervised by a midwife. A questionnaire was used for evaluation at a minimum of 6 months after the treatment. The mean number of appointments to the counselor was 12 (4-24) and 15 (9-26) to the midwife during a mean period of 53 weeks (19-92). Nineteen women (79%) considered themselves to be cured or having greatly improved. Intercourse frequency was increased (p = 0.001) and coital pain was reduced (p = 0.02) after completing the treatment. Improvements in sexual functioning and coping strategies for psychological impairment and stress were reported. Women with provoked vestibulodynia benefit from a multidisciplinary treatment model including desensitization of the vestibular mucosa, rehabilitation of the pelvic floor, and psychosexual adjustments.


Assuntos
Dispareunia/terapia , Psicoterapia Breve/métodos , Aconselhamento Sexual/métodos , Educação Sexual/métodos , Disfunções Sexuais Fisiológicas/terapia , Doenças da Vulva/terapia , Adulto , Coito/psicologia , Terapia Combinada , Dispareunia/complicações , Feminino , Humanos , Satisfação do Paciente , Disfunções Sexuais Fisiológicas/etiologia , Resultado do Tratamento , Doenças da Vulva/complicações , Saúde da Mulher , Adulto Jovem
18.
J Reprod Med ; 53(2): 83-9, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18357798

RESUMO

OBJECTIVE: To evaluate the long-term results of vestibulectomy in women with localized, provoked vestibulodynia. STUDY DESIGN: A retrospective questionnaire survey was filled out by 67 Swedish women who underwent surgery for localized, provoked vestibulodynia during 1992-2003. The questionnaire was completed a minimum of 12 months after the operation. Coital pain, quality of sexual life and psychologic well-being were evaluated. RESULTS: The mean age at the time of surgery was 27 years (18-56) and the median follow-up time 41 months (12-120). Coital pain, rated with Visual Analogue Scales (VAS(neg)) (0-10), was 8.0 (median) before surgery, 5.0 (p < 0.001) 6 months after surgery and 2.0 (p < 0.001) at follow-up. Quality of sexual life, using VAS(pos) (10-0), was 6.5 (median) before dyspareunia, 0.5 (p < 0.001) prior to surgery and 6.5 (p < 0.001) at followup. Complete or major improvement was reported by 56% of women with secondary vestibulodynia and 17% of women with primary vestibulodynia (p = 0.03). Improved psychologic well-being was reported by 79%. CONCLUSION: Women with secondary localized provoked vestibulodynia will often benefit from surgery when other treatments fail. Surgical outcome should include both pain relief and psychosexual well-being. In this study women with primary vestibulodynia were less likely to benefit from surgery.


Assuntos
Procedimentos Cirúrgicos em Ginecologia , Qualidade de Vida , Vulva/cirurgia , Doenças da Vulva/cirurgia , Adolescente , Adulto , Dispareunia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento
19.
Am J Obstet Gynecol ; 198(3): 311.e1-6, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18177837

RESUMO

OBJECTIVE: This study was undertaken to survey the steroid receptor expression and morphology in the vulvar vestibular mucosa in women with provoked vestibulodynia. STUDY DESIGN: Fourteen patients and 25 controls without oral contraceptives were included. Vestibular biopsy specimens were obtained and analyzed by using immunohistochemistry, followed by computerized image analysis of estrogen receptors alpha and beta, progesterone receptors A and B, glucocorticoid receptor, androgen receptor, and the proliferation marker Ki67. The morphology was estimated by measuring 4 parameters in the epithelium. RESULTS: There was a significantly higher expression of estrogen receptor alpha in both the epithelium (P = .04) and the stroma (P = .02) in the patient specimens compared with the controls. There were no significant differences in the other analyses performed. CONCLUSION: There is an increased expression of estrogen receptor alpha in the vestibular mucosa but the epithelial morphology seems unaffected in women with provoked vestibulodynia. Further studies regarding plausible associations to neurogenic inflammation are needed.


Assuntos
Dispareunia/metabolismo , Dispareunia/patologia , Receptores de Esteroides/biossíntese , Vulva/metabolismo , Vulva/patologia , Adulto , Feminino , Humanos , Membrana Mucosa/metabolismo
20.
Contraception ; 76(4): 319-25, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17900445

RESUMO

BACKGROUND: The objective was to evaluate the influence of combined oral contraceptives (COC) and of the menstrual cycle on the steroid receptor expression in the vulvar vestibular mucosa of healthy women. STUDY DESIGN: Forty-five healthy women (20 with COC and 25 without) were included. Vestibular biopsies were obtained during the menstrual cycle. Estrogen receptors (ER) alpha and beta, progesterone receptors (PR) A and B, glucocorticoid receptor and androgen receptor as well as the proliferation marker Ki67 were analyzed using immunohistochemistry followed by computerized image analysis. RESULTS: The vestibular stromal tissue of women using COC expressed more ERbeta (p=.024) than that of women without COC. In the follicular phase, PRB was more abundant in the stromal tissue than in the luteal phase (p=.01). CONCLUSIONS: ERbeta is more abundant in the vulvar vestibular mucosa of women using COC than in that of women without COC. There is a cyclic variation in PRB in the vestibular mucosa in healthy women without COC.


Assuntos
Anticoncepcionais Orais Combinados/farmacologia , Receptor beta de Estrogênio/metabolismo , Fase Folicular/metabolismo , Membrana Mucosa/metabolismo , Receptores de Progesterona/metabolismo , Vulva/metabolismo , Adolescente , Adulto , Estudos de Casos e Controles , Receptor alfa de Estrogênio/metabolismo , Feminino , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA