Vulvovaginal atrophy of menopause and its impact on sexual function in an Italian clinical cohort of post-menopausal women.

The aim of current study was to estimate the impact of vulvovaginal atrophy (VVA) on sexual function in a clinical population of Italian postmenopausal women. Women aged 45-75 years with at least one VVA symptom completed three questionnaires: Day-to-Day Impact of Vaginal Aging (DIVA), Female Sexual Function Index (FSFI) and Female Sexual Distress Scale revised (FSDS-R). A gynaecological examination was performed for VVA confirmation. Among the 1,066 evaluable patients, VVA was confirmed in around 90% of the sample. Sexual function impairment was significantly higher in patients with confirmed VVA as observed by significant differences in the sexual function component of the DIVA questionnaire (p = .014), the FSDS-R (p < .0005), and the FSFI (p < .0005), as well as for all the FSFI subdomains: desire (p < .0005), arousal (p < .0005), lubrication (p < .0005), orgasm (p < .0005), satisfaction (p < .0005) and pain (p < .0005). Significant impairment of sexual function was demonstrated in Italian postmenopausal women who were clinically confirmed with signs of VVA through gynaecological examination.IMPACT STATEMENTWhat is already known on this subject: At least half of postmenopausal women report VVA associated symptoms with significant impact on sexual function and ultimately on sexual activity.What the results of this study add: As compared with patients without confirmed VVA, the negative impact on sexual function was significantly higher in patients with confirmed VVA. This difference was observed for the sexual function component (DIVA-C) of the DIVA questionnaire, for the overall FSDS-R result, and for the overall FSFI score, as well as for all the FSFI subdomains (desire, arousal, lubrication, orgasm, satisfaction and pain).What the implications are of these findings for clinical practice and/or further research: An impairment of sexual function is significantly associated with VVA diagnosis in Italian post-menopausal women, especially when diagnosis was objectively confirmed by clinical signs of VVA visible in the gynaecological examination. In addition, this study demonstrates that inquiring about VVA using a structured questionnaire may increase the diagnosis of VVA related changes in sexual function.

Symptoms, attitudes and treatment perceptions of vulvo-vaginal atrophy in UK postmenopausal women: Results from the REVIVE-EU study.

OBJECTIVES: To describe the attitudes and perceptions of postmenopausal women from the United Kingdom regarding menopause, vulvo-vaginal atrophy and its therapeutic management. STUDY DESIGN: Post hoc analysis of the United Kingdom population from the REVIVE-EU Study. MAIN OUTCOME MEASURES: The survey contained questions about women's knowledge of menopause and vulvo-vaginal atrophy symptoms, impact on their life and sexual activities, communication with healthcare professionals and treatments. RESULTS: The most frequent symptom of menopause was hot flushes (75%). Vulvo-vaginal atrophy symptoms had a significant impact on participants' ability to enjoy sexual intercourse (66%), spontaneity (62%) and ability to be intimate (61%); however, only 68% of women had been to their healthcare professional for advice. Half of the sample expected that doctors would initiate a discussion of menopausal symptoms and sexual health, but was in fact rare (5%). Only 27% were under current treatment without a clear therapy pattern, of which 43% used vaginal over-the-counter treatments, 28% prescription (Rx), and 13% both. Efficacy was the main limitation for over-the-counter treatments, while for Rx products were side effects and safety. Women highlighted the restoring of the natural condition of the vagina as the main goal for a treatment (35%). Many United Kingdom women did not feel the need to see any healthcare professional for their gynaecological symptoms. Overall satisfaction with treatment was only 44%. CONCLUSIONS: Vulvo-vaginal atrophy remains underdiagnosed and undertreated in United Kingdom. There is a lack of coherent discussion about vulvo-vaginal atrophy symptoms with clinicians. Many United Kingdom healthcare professionals could improve proactive communication with patients about vulvo-vaginal atrophy.

Vulvar quality of life index (VQLI) - A simple tool to measure quality of life in patients with vulvar disease.

BACKGROUND/OBJECTIVES: Vulvar disease leads to significant disease burden and reduced quality of life (QOL). However, vulvar disease-specific instruments to measure QOL are lacking. We developed the Vulvar Quality of Life Index (VQLI) to comprehensively and reproducibly assess symptomatic, psychosexual and physical aspects of vulvar disease. METHODS: The VQLI was inferred from a review of the literature regarding QOL of vulvar disease, and responses from a cohort of patients attending specialist clinics. Seven domains and a 15-item questionnaire were developed. This was tested and optimised prior to validation on 248 women, using a control group as a baseline. The VQLI was further tested on 157 women, and the total VQLI score was compared to a self-determined Likert global score on how vulvar disease had impacted their overall health. RESULTS: The VQLI had excellent internal consistency (Cronbach's alpha, 0.93), and test-retest reliability showed that 9/15 questions had a substantial weighted kappa value of 0.5 or above, with good intraclass correlation coefficient (0.88; CI 0.8-0.93). Spearman correlations were consistently positive. Further testing on 157 women demonstrated a significant relationship between the total VQLI score and the effect of vulvar disease on overall health, with high levels of the impact of vulvar disease on overall health associated with high total VQLI score (P < 0.001). CONCLUSIONS: The VQLI is a validated, fast and reliable tool to measure the global impact of vulvar disease on QOL and can be used to monitor response to treatment or in a research setting.

Macro-regional variation in attitudes toward and experiences of vulvar and vaginal atrophy among Italian post-menopausal women: a post hoc analysis of REVIVE survey data.

Italian participants in the European REVIVE survey reported that vaginal and vulvar atrophy (VVA) impaired various aspects of their lives, notably the ability to enjoy sex. The aim of the present study was to explore regional differences in knowledge, experiences, and treatment of VVA in the Italian REVIVE sample (n = 1000), which was analyzed according to region of residence. While many respondents were unfamiliar with the VVA condition, most could relate their VVA symptoms to the menopause. The rate of diagnosis of VVA was twice as high in Central Italy as in the North-East. For individual VVA symptoms, 25.4-41.6% of respondents judged that the symptom had worsened over time. There were no significant regional differences for symptoms in terms of reported rate, change in severity, impact on sexual activity, or health-care visits. Testosterone cream and OTC medication based on hyaluronic acid showed significant regional differences in lifetime rates of use. In Italy, there are modest regional differences in knowledge, diagnosis, and treatment of VVA, some of which may be explained by inter-regional differences in health care. Further efforts are needed to ensure that Italian women are properly informed about VVA and have access to appropriate health care and treatments.

The Women's EMPOWER Survey: Identifying Women's Perceptions on Vulvar and Vaginal Atrophy and Its Treatment.

INTRODUCTION: Vulvar and vaginal atrophy (VVA) affects up to two thirds of postmenopausal women, but most symptomatic women do not receive prescription therapy. AIM: To evaluate postmenopausal women's perceptions of VVA and treatment options for symptoms in the Women's EMPOWER survey. METHODS: The Rose Research firm conducted an internet survey of female consumers provided by Lightspeed Global Market Insite. Women at least 45 years of age who reported symptoms of VVA and residing in the United States were recruited. MAIN OUTCOME MEASURES: Survey results were compiled and analyzed by all women and by treatment subgroups. RESULTS: Respondents (N = 1,858) had a median age of 58 years (range = 45-90). Only 7% currently used prescribed VVA therapies (local estrogen therapies or oral selective estrogen receptor modulators), whereas 18% were former users of prescribed VVA therapies, 25% used over-the-counter treatments, and 50% had never used any treatment. Many women (81%) were not aware of VVA or that it is a medical condition. Most never users (72%) had never discussed their symptoms with a health care professional (HCP). The main reason for women not to discuss their symptoms with an HCP was that they believed that VVA was just a natural part of aging and something to live with. When women spoke to an HCP about their symptoms, most (85%) initiated the discussion. Preferred sources of information were written material from the HCP's office (46%) or questionnaires to fill out before seeing the HCP (41%).The most negative attributes of hormonal products were perceived risk of systemic absorption, messiness of local creams, and the need to reuse an applicator. Overall, HCPs only recommended vaginal estrogen therapy to 23% and oral hormone therapies to 18% of women. When using vaginal estrogen therapy, less than half of women adhered to and complied with posology; only 33% to 51% of women were very to extremely satisfied with their efficacy. CONCLUSION: The Women's EMPOWER survey showed that VVA continues to be an under-recognized and under-treated condition, despite recent educational initiatives. A disconnect in education, communication, and information between HCPs and their menopausal patients remains prevalent. Kingsberg S, Krychman M, Graham S, et al. The Women's EMPOWER Survey: Identifying Women's Perceptions on Vulvar and Vaginal Atrophy and Its Treatment. J Sex Med 2017;14:413-424.

Quality of Life and Sexual Distress in Women With Erosive Vulvovaginal Lichen Planus.

OBJECTIVES: Erosive vulvovaginal lichen planus (EVLP) is a chronic and painful genital dermatosis. Little is published about its impact on quality of life. This study aimed to evaluate quality of life and sexual function in women with EVLP. MATERIALS AND METHODS: Women with genital dermatoses were surveyed using the Dermatology Life Quality Index (DLQI) and Hospital Depression and Anxiety Scales. A subgroup completed the Female Sexual Distress Scale and Female Sexual Function Index subscales. Patient characteristics including age, diagnosis, and current treatment were recorded. Results from women with EVLP were compared with other diagnoses. RESULTS: Data from 77 women who participated between March 2013 and March 2014 were analyzed. Of these, 17 had EVLP. Comparator groups included women with vulval lichen sclerosus (n = 48) and vulval dermatitis (n = 12). In women with EVLP, 59% reported at least moderate impact on quality of life; mean DLQI scores: EVLP, 7.18; lichen sclerosus, 3.79; dermatitis, 8.67; p = .008. Overall, scores suggested depression in 14% and anxiety in 16% of participants. Sexual distress scores 11 or higher were recorded by 69% of women with EVLP, 63% of women with lichen sclerosus, and 56% of women with dermatitis. In those completing all sections of the survey (n = 40), DLQI was significantly correlated with depression (p = .004), sexual distress (p = .001), and sexual satisfaction (p = .01). CONCLUSIONS: Sixty-nine percent of women with EVLP reported sexual distress. Women with EVLP reported lesser quality of life than those with lichen sclerosus. Quality of life, anxiety and depression, sexual distress, and sexual function were all related in these participants.

Systemic therapy for vulval Erosive Lichen Planus (the 'hELP' trial): study protocol for a randomised controlled trial.

BACKGROUND: Erosive lichen planus affecting the vulva (ELPV) is a relatively rare, chronic condition causing painful raw areas in the vulvovaginal region. Symptoms are pain and burning, which impact upon daily living. There is paucity of evidence regarding therapy. A 2012 Cochrane systematic review found no randomised controlled trials (RCTs) in this field. Topically administered corticosteroids are the accepted first-line therapy: however, there is uncertainty as to which second-line treatments to use. Several systemic agents have been clinically noted to show promise for ELPV refractory to topically administered corticosteroids but there is no RCT evidence to support these. The 'hELP' study is a RCT with an internal pilot phase designed to provide high-quality evidence. METHODS/DESIGN: The objective is to test whether systemic therapy in addition to standard topical therapy is a beneficial second-line treatment for ELPV. Adjunctive systemic therapies used are hydroxychloroquine, methotrexate, mycophenolate mofetil and prednisolone. Topical therapy plus a short course of prednisolone given orally is considered the comparator intervention. The trial is a four-armed, open-label, pragmatic RCT which uses a blinded independent clinical assessor. To provide 80 % power for each comparison, 96 participants are required in total. The pilot phase aims to recruit 40 participants. The primary clinical outcome is the proportion of patients achieving treatment success at 6 months. 'Success' is defined by a composite measure of Patient Global Assessment score of 0 or 1 on a 4-point scale plus improvement from baseline on clinical photographs scored by a clinician blinded to treatment allocation. Secondary clinical outcomes include 6-month assessment of: (1) Reduction in pain/soreness; (2) Global assessment of disease; (3) Response at other affected mucosal sites; (4) Hospital Anxiety and Depression Scale scores; (5) Sexual function; (6) Health-related quality of life using 'Short Form 36' and 'Skindex-29' questionnaires; (7) Days of topical steroid use; (8) Treatment satisfaction; (9) Discontinuation of medications due to treatment failure; (10) Per participant cost of intervention in each treatment group. Adverse events will also be reported. DISCUSSION: 'hELP' is the first RCT to address second-line treatment of ELPV. The trial has encountered unique methodological challenges and has required collaborative efforts of the UK Dermatology Clinical Trials Network alongside expert clinicians. CURRENT CONTROLLED TRIALS: ISRCTN 81883379 . Date of registration 12 June 2014.

Vulvovaginal symptoms prevalence in postmenopausal women and relationship to other menopausal symptoms and pelvic floor disorders.

OBJECTIVE: The primary objective of this study was to use the Vulvovaginal Symptom Questionnaire (VSQ) to estimate the prevalence and examine the emotional, lifestyle, and sexual impact of vulvovaginal symptoms in postmenopausal women. METHODS: We administered the VSQ, a previous validated instrument to 358 postmenopausal women recruited from primary care physician offices and local senior centers. The first seven questions of the VSQ comprise the symptom subscale (itching, burning, hurting, irritation, dryness, discharge, and odor). Women who answered "Yes" to any of the first seven symptom questions were considered to have vulvovaginal symptoms. RESULTS: Two hundred seventy-nine women were recruited from primary care offices and 79 women were recruited from senior centers. One hundred eighty-three postmenopausal women (51.1%; 95% CI 45.9%, 56.3%) reported at least one vulvovaginal symptom. The most common symptom was being dry 35.8% (n/N = 128/358). Ten percent of women (n/N = 38/358) reported five or more symptoms and 6% of women reported all seven symptoms in the last week. For women reporting one or more vulvovaginal symptoms, 40.4% (n/N = 74/183) reported emotional impact (Yes to ≥1 out of 4 emotional impact subscale items) and 32.8% (n/N = 60/183) reported lifestyle impact (Yes to ≥1 out of 5 lifestyle impact subscale items) from these symptoms. For sexually active women reporting vulvovaginal symptoms, 75.3% (n/N = 67/89) reported sexual impact (Yes to ≥1 out of 4 sexual impact subscale items). Vulvovaginal symptoms were associated with increased co-occurrence of specific pelvic floor disorders, including pelvic organ prolapse (P = 0.001), anal incontinence to solid stool (P = 0.001), urinary frequency (P = 0.02), urgency urinary incontinence (P = 0.001), and dysuria (P < 0.001). CONCLUSIONS: Vulvovaginal symptoms are common and present in over 50% of postmenopausal women. Sizeable proportions of women with vulvovaginal symptoms report emotional, lifestyle, and sexual impact from these symptoms.

Sexual well-being in patients with vulvar disease: results from a preliminary prospective matched case-control study.

INTRODUCTION: Only a few studies have focused on the description of sexual well-being in patients with vulvar disease (VD). The aim of this study was to test the hypothesis that VD patients have an overall impaired sexual well-being that varies depending on the type of VD. STUDY DESIGN: An observational, prospective, single center and 1:1 matched case-control study was conducted in Nantes University Hospital (France). All new patients attending the specific consultation for VD between June 2011 and January 2013 were included. A control group was randomly selected from women who had a scheduled consultation for gynecologic follow-up. A validated French version of the Female Sexual Function Index (FSFI) was used. This self-administered questionnaire was distributed to all case and control women. VD was classified into 4 groups: inflammatory, (pre)malignant, infectious, and other VD. Descriptive statistics and multivariate mixed analyses were performed. RESULTS: Seventy-two VD patients and seventy-two control women completed the FSFI questionnaire. The median FSFI score was 21.1 in the VD patients versus 28.1 in the control patients. In the multivariate analysis, the FSFI score was significantly decreased by an average of 4.5 points (p=0.003) in the VD patients. On the FSFI subscores, VD had significant impacts on items related to "arousal", "pain", "lubrication", "satisfaction", and "desire". When comparing the VD groups, the total FSFI score seemed lower for (pre)malignant VD. CONCLUSION: This preliminary study showed that VD patients had an impaired sexual well-being.

Psychosexual Aspects of Vulvar Disease.

Physically, the vulva is an anatomic location of convergence, which includes vascular, neural, hormonal, reproductive, dermatologic, and musculoskeletal systems. Psychosocially, the vulva represents privacy, femininity, sexuality, and intimacy. Because of this intertwined relationship, vulvar disease and dysfunction can significantly impact a woman's physical health as well as her relationships. This article elucidates the impact of vulvar disease on the individual psyche, sexual functioning, and intimate relationships. Psychological concepts are explained, psychological interventions are reviewed, and integrative approaches addressing psychological factors in the clinic are introduced.

The Association Between Vulvovaginal Atrophy Symptoms and Quality of Life Among Postmenopausal Women in the United States and Western Europe.

BACKGROUND: Vulvovaginal atrophy (VVA) is a condition associated with decreased estrogenization of the vaginal tissue, which can result in vaginal dryness, irritation, and dyspareunia. This study quantified the burden associated with VVA symptoms across the United States and Europe and compared this burden with other chronic conditions. METHODS: Data were analyzed from the International Women's Health Study, a cross-sectional Internet survey of women aged 40-75 years in the United States and Europe. All postmenopausal women aged 40-75 years were included in the analyses (Germany n=970, Spain n=294, France n=1054, Italy n=387, United Kingdom n=1096, United States n=3267). VVA symptom severity (none, mild, moderate, severe) was assessed using the Menopause Rating Scale and included in general linear models to predict EuroQol-5D (EQ-5D) quality of life scores. RESULTS: The prevalence of VVA symptoms varied between 40.00% (Germany) and 54.42% (Spain), with half of women reporting their symptoms as either moderate or severe. Pooling data from all countries together, each incremental level of severity (none through severe) was associated with a significant decrement in EQ-5D scores (none=0.84 vs. mild=0.81 vs. moderate=0.79 vs. severe=0.74; p<0.05). The decrements in EQ-5D scores associated with moderate to severe VVA symptoms were comparable to those observed in other serious conditions including arthritis, chronic obstructive pulmonary disease, asthma, and irritable bowel syndrome. CONCLUSIONS: VVA symptoms are associated with clinically meaningful decrements in quality of life that may be comparable to serious conditions such as arthritis, chronic obstructive pulmonary disease, asthma, and irritable bowel syndrome. Improved management of VVA symptoms may be required to alleviate the impact of VVA on the quality of life of affected women.

Does treatment for cervical and vulvar dysplasia impact women's sexual health?

Human papillomavirus-associated disease represents an immense public health burden worldwide. Persistent human papillomavirus infection can lead to the development of cervical dysplasia and vulvar dysplasia, both of which have been increasing in incidence in women in recent years. Numerous studies have focused on methods for screening and diagnosis of cervical dysplasia, but few have looked at the effects of treatment on women's psychological and sexual health. Even fewer studies have addressed these issues in women with vulvar dysplasia. The aim of this article was to provide a comprehensive review of the existing evidence concerning the impact of therapy for cervical and vulvar precancers on women's sexual function and sexual relationships. We performed a search of the medical literature for the time period up to and including August 2013 on PubMed. The findings from a limited number of studies to date indicate that psychosexual vulnerability increases after diagnosis and treatment of both cervical and vulvar dysplasia. More in-depth research is needed to better understand the effects of different treatment modalities on women's sexual health and relationships during and following treatment.

Therapies and nursing care of women with vulvar dermatologic disorders.

Vulvar dermatologic disorders are common among women, and prevalence increases with age. Treatment can provide women with symptomatic relief and can halt further progression of disease. Numerous therapies are available, and nurses who work with women across the life span should have an understanding of vulvar dermatologic disorders and therapeutic modalities. We provide an overview of general vulvar care, four vulvar dermatologic disorders, and common treatment modalities including topical and systemic pharmacologic management.

Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) survey.

INTRODUCTION: Vulvar and vaginal atrophy (VVA) is a chronic medical condition experienced by many postmenopausal women. Symptoms include dyspareunia (pain with intercourse), vaginal dryness, and irritation and may affect sexual activities, relationships, and activities of daily life. AIM: The aim of this study is to characterize postmenopausal women's experience with and perception of VVA symptoms, interactions with healthcare professionals (HCPs), and available treatment options. METHODS: An online survey was conducted in the United States in women from KnowledgePanel(®) , a 56,000-member probability-selected Internet panel projectable to the overall US population. Altogether, 3,046 postmenopausal women with VVA symptoms (the largest US cohort of recent surveys) responded to questions about their knowledge of VVA, impact of symptoms on their activities, communication with HCPs, and use of available treatments. MAIN OUTCOME MEASURES: Percent is calculated as the ratio of response over total responding for each question for all and stratified participants. RESULTS: The most common VVA symptoms were dryness (55% of participants), dyspareunia (44%), and irritation (37%). VVA symptoms affected enjoyment of sex in 59% of participants. Additionally, interference with sleep, general enjoyment of life, and temperament were reported by 24%, 23%, and 23% of participants, respectively. Few women attributed symptoms to menopause (24%) or hormonal changes (12%). Of all participants, 56% had ever discussed VVA symptoms with an HCP and 40% currently used VVA-specific topical treatments (vaginal over-the-counter [OTC] products [29%] and vaginal prescription therapies [11%]). Of those who had discussed symptoms with an HCP, 62% used OTC products. Insufficient symptom relief and inconvenience were cited as major limitations of OTC products and concerns about side effects and cancer risk limited use of topical vaginal prescription therapies. CONCLUSIONS: VVA symptoms are common in postmenopausal women. Significant barriers to treatment include lack of knowledge about VVA, reluctance to discuss symptoms with HCPs, safety concerns, inconvenience, and inadequate symptom relief from available treatments.

Vulval skin conditions: disease activity and quality of life.

OBJECTIVE: Chronic vulval skin conditions are known to cause a significant reduction in the quality of life. Validated scales exist to measure the disease impact of general dermatologic conditions; however, none have been specifically derived to assess vulval disease. This study aimed to identify what symptoms and aspects of their lives are important for women with vulval skin conditions and to assess their usefulness in developing an assessment measure for monitoring disease activity and quality of life in women with vulval skin conditions. MATERIALS AND METHODS: Participants were female patients attending a specialist vulval dermatology clinic at a tertiary referral center. Ten patients with a variety vulval skin conditions were interviewed to gain their experiences of living with a vulval skin condition. Using qualitative semistructured interviews, patients were asked open-ended questions about aspects of their disease that have affected them. These included the following: daily activities and social activities, physical functions, sexual activities, mobility, relationships, and an understanding of their vulval condition. Data was recorded, transcribed, and then analyzed thematically with all aspects regarding quality of life and symptoms identified. RESULTS: Results are presented according to common themes identified, specifically physical symptoms, body image, the impact of the condition on sexual and physical function, issues affecting daily activities, and the journey traveled when accessing medical care. CONCLUSIONS: This qualitative study adds to the evidence that chronic vulval conditions are distressing and cause significant morbidity. It highlights further the need to devise a validated questionnaire which can be used in clinical practice looking specifically at disease impact and quality of life. It can only enhance the clinical consultation and facilitate discussion which is disease and person specific.

[Immunotropic agents in therapy of chronic degenerative diseases of the vulva].

The prospective randomized study involved 60 patients with chronic dystrophic diseases of the vulva. The clinical efficacy of cycloferon in the complex treatment of the patients and its influence on the psychological and functional state and the dynamics of the life quality were investigation.

Recognition and management of vulvar dermatologic conditions: lichen sclerosus, lichen planus, and lichen simplex chronicus.

Lichen sclerosus, lichen planus, and lichen simplex chronicus are dermatologic conditions that can affect the vulva. Symptoms include vulvar itching, irritation, burning, and pain, which may be chronic or recurrent and can lead to significant physical discomfort and emotional distress that can affect mood and sexual relationships. With symptoms similar to common vaginal infections, women often seek care from gynecological providers and may be treated for vaginal infections without relief. Recognition and treatment of these vulvar conditions is important for symptom relief, sexual function, prevention of progressive vulvar scarring, and to provide surveillance for associated vulvar cancer. This article reviews these conditions including signs and symptoms, the process of evaluation, treatment, and follow-up, with attention to education and guidelines for vulvar care and hygiene.

Therapeutic principles in vulvovaginal dermatology.

The diagnosis and management of chronic vulvovaginal disease requires attention to several issues. Psychological factors are usually important, because women worry about malignancy, impaired sexuality and self-image, fertility, and sexually transmitted diseases. Multifactorial processes are common due to the risk of secondary candidiasis, contact dermatitis, effects of low estrogen in postmenopausal women and women on oral contraceptives, and so forth. Undertreatment of inflammatory dermatoses is common, because clinicians use topical corticosteroids that are of inadequate potency and for insufficient duration. All of these issues must be considered for optimal benefit in the therapy of chronic vulvovaginal diseases.

Quality of life in the vulvar clinic: a pilot study.

OBJECTIVE: This pilot study aimed to investigate baseline quality of life, anxiety, and depression scores in women attending a multidisciplinary vulvar clinic and to assess whether attendance was associated with improvement in quality of life and psychological symptoms. MATERIALS AND METHODS: Two well-validated questionnaires, namely, the Dermatology Life Quality Index (DLQI) and the Hospital Anxiety and Depression Score (HADS), were completed by women attending a vulvar clinic at their first and a subsequent review visit. Twenty-three women aged between 19 and 77 years completed the study, and their scores were calculated and compared. RESULTS: At the initial visit, 15 (65%) of 23 women scored 6 or higher on the DLQI, indicating that their vulvar disease affected their quality of life to a moderate, very large, or extremely large degree. On review, 12 (52%) of 23 women scored 6 or higher, showing a significant improvement in DLQI between visits (p <.005). The HADS-A (anxiety) score at the initial visit was 8 or higher in 12 (52%) of 23 women, suggesting clinically significant psychological distress. The anxiety score did not statistically change at the review visit. HADS-D (depression) score was initially 8 or higher in 6 (26%) of 23 women but, similar to the anxiety scores, was not statistically different at review. CONCLUSIONS: Most women attending the vulvar clinic have a reduced quality of life. Attending a dedicated multidisciplinary clinic is associated with an improvement in quality of life, but anxiety and depression scores are unchanged. This study is limited by small numbers, and further larger studies are required.

Fear avoidance and self-efficacy in relation to pain and sexual impairment in women with provoked vestibulodynia.

BACKGROUND: Provoked vestibulodynia is believed to be the most frequent cause of vulvodynia in women of childbearing age, with prevalence rates of up to 12% in the general population. Despite this high prevalence and the fact that vestibulodynia impacts negatively on quality of life, in particular sexual functioning, there has been a paucity of sound research to elucidate the condition's etiology. More specifically, few studies have focused on the role of psychologic factors in the experience of vulvo-vaginal pain and associated sexual impairment. OBJECTIVES: The present study aimed to determine the extent to which fear avoidance variables (catastrophizing, anxiety, fear of pain, hypervigilance) and self-efficacy differentially influenced changes in levels of induced and intercourse pain and also associated sexual dysfunction in these women. METHODS: Data were obtained from 75 vestibulodynia participants who completed a gynecologic examination, structured interview, and standardized questionnaires. RESULTS: The results of regression analyses revealed that higher catastrophizing, fear of pain, and hypervigilance in addition to lower self-efficacy together accounted for 15% of the variation in increased intercourse pain intensity. Among these, only catastrophizing contributed unique variance to intercourse pain. Results also showed that higher state anxiety and fear of pain (escape/avoidance) and also lower self-efficacy explained 22% of the variation in women's sexual impairment. However, only self-efficacy was found to be an independent correlate of sexual impairment. CONCLUSION: Findings support a theoretical model of vestibulodynia as a pain disorder influenced among others by cognitive and affective factors.