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1.
Medicine (Baltimore) ; 99(26): e20803, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590764

RESUMO

RATIONALE: Voiding difficulty is more common in males, although it is not uncommon in females. Female voiding difficulty can be caused by iatrogenic, anatomic, and neurogenic factors, and specifically urethra stricture, impaired detrusor contractility, primary bladder neck obstruction, and detrusor-external sphincter dyssynergia. Labial adhesion is a rare cause of female voiding difficulty.The incidence of labial fusion has been reported to be 0.6% to 1.4% in children; however, the incidence in the elderly has yet to be fully elucidated. PATIENT CONCERNS: We present the case of a postmenopausal and sexually inactive 76-year-old female patient who had nearly total vaginal and urethral occlusion due to labial adhesion. She had no underlying diseases and came to our clinic with a 10-month history of voiding difficulty, postmicturition dribbling, and involuntary urinary leakage when getting up. DIAGNOSIS: A genital examination revealed nearly total fusion of the labia minor with only a 3-mm pinhole opening at the posterior end. INTERVENTIONS: Treatment included surgical separation, the local application of estrogen cream, and self-dilatation. She also received an antimuscarinic agent to treat overactive bladder secondary to bladder outlet obstruction which was caused by labial adhesion. OUTCOMES: No surgical complications occurred. Moreover, no labial adhesion or voiding dysfunction was found immediately after the surgery or after 6 months of follow-up. LESSONS SUBSECTIONS: Genital examinations are a basic but very important noninvasive skill for physicians. This case report highlights that genital examinations should be a priority for patients with gynecological or urological symptoms.


Assuntos
Estrogênios/administração & dosagem , Obstrução do Colo da Bexiga Urinária , Bexiga Urinária Hiperativa , Procedimentos Cirúrgicos Urogenitais/métodos , Doenças da Vulva , Idoso , Feminino , Humanos , Antagonistas Muscarínicos/uso terapêutico , Pós-Menopausa , Resultado do Tratamento , Uretra/patologia , Uretra/fisiopatologia , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Obstrução do Colo da Bexiga Urinária/cirurgia , Bexiga Urinária Hiperativa/tratamento farmacológico , Bexiga Urinária Hiperativa/etiologia , Micção , Cremes, Espumas e Géis Vaginais/administração & dosagem , Doenças da Vulva/complicações , Doenças da Vulva/diagnóstico , Doenças da Vulva/fisiopatologia , Doenças da Vulva/cirurgia
2.
J Obstet Gynaecol ; 39(1): 82-85, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29884087

RESUMO

The aim of this study was to assess the efficacy of a postoperative steroid regimen in maintaining vulvovaginal architecture and vaginal patency following surgical adhesiolysis in severe erosive lichen planus (ELP) and genital graft versus host disease (GVHD). Sixteen women applied potent topical steroids to the vulva and vagina from 48 hours after surgery. Sexual and urinary function and vulvovaginal anatomy were assessed at 6 weeks, 6, 12 and 24 months. All of the patients had failed sexual function due to vaginal stenosis. Eleven patients were unable to have cervical smears and three had associated haematocolpos. Vaginal adhesiolysis achieving complete patency occurred in all patients with stenosis. Fifteen (93.7%) patients were compliant with the regimen. After two years, 12 (75%) patients had maintained complete vaginal patency. Four patients (25%) developed vaginal restenosis. This study demonstrates that the potent topical steroids used post-operatively are very effective in maintaining vaginal patency and function. Impact statement What is already known on this subject? Potent topical steroids are the first line treatment for ELP and GVHD and have been reported to be helpful after surgery to release adhesions. What do the results of this study add? Topical steroids used immediately after surgical adhesiolysis in patients with vulvo-vaginal lichen planus and graft-versus-host disease improves the outcomes and maintains function, which can give a prolonged benefit. What are the implications of these findings for clinical practice and/or further research? The use of potent topical steroids should be considered as routine practice after surgery in erosive inflammatory disease to control inflammation and improve the long term outcomes for these patients.


Assuntos
Anti-Inflamatórios/administração & dosagem , Clobetasol/administração & dosagem , Hidrocortisona/análogos & derivados , Líquen Plano/tratamento farmacológico , Doenças da Vulva/tratamento farmacológico , Administração Cutânea , Feminino , Doença Enxerto-Hospedeiro/complicações , Doença Enxerto-Hospedeiro/fisiopatologia , Humanos , Hidrocortisona/administração & dosagem , Líquen Plano/etiologia , Líquen Plano/fisiopatologia , Líquen Plano/cirurgia , Cuidados Pós-Operatórios/reabilitação , Estudos Retrospectivos , Disfunções Sexuais Fisiológicas/etiologia , Doenças Vaginais/terapia , Doenças da Vulva/etiologia , Doenças da Vulva/fisiopatologia , Doenças da Vulva/cirurgia
3.
Aesthet Surg J ; 39(1): 83-93, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29726916

RESUMO

Background: Increasingly, women have sought alternatives to traditional options (lubricants, estrogen products, and hormone replacement therapy) for unwelcome vaginal changes of menopause. Objectives: This study evaluated whether a series of three monthly fractional CO2 laser treatments significantly improves and maintains vaginal health indices of elasticity, fluid volume, pH level, epithelial integrity, and moisture. Self-reported symptoms of vaginal atrophy were also measured. Biopsy samples after a series of three treatments were evaluated for histological changes to vaginal canal tissue. Methods: Forty postmenopausal women were treated extravaginally and internally with a fractional CO2 laser. Objective measurements of vaginal health index, as well as subjective measurements of symptoms of vulvovaginal atrophy (VVA), urinary incontinence, and sexual function were reported at baseline. Follow-up evaluations were at one, three, six, and 12 months after the third treatment. Results: Vaginal health index improved significantly after the first treatment and was maintained with mean improvement of 9.6 ± 3.3 (P < 0.001) and 9.5 ± 3.3 (P < 0.001) at the 6- and 12-month follow ups, respectively. Vaginal symptoms of dryness, itching, and dyspareunia improved significantly (P < 0.05) at all evaluations. Histological findings showed increased collagen and elastin staining, as well as a thicker epithelium with an increased number of cell layers and a better degree of surface maturation. Conclusions: Fractional CO2 laser treatments were well tolerated and were associated with improvement in vaginal health and amelioration of symptoms of VVA. Histological changes in the epithelium and lamina propria, caused by fractional CO2 laser treatments, correlated with clinical restoration of vaginal hydration and pH to premenopausal levels.


Assuntos
Lasers de Gás/uso terapêutico , Terapia com Luz de Baixa Intensidade/instrumentação , Pós-Menopausa/fisiologia , Doenças Vaginais/radioterapia , Doenças da Vulva/radioterapia , Adulto , Idoso , Atrofia/fisiopatologia , Atrofia/cirurgia , Biópsia , Fracionamento da Dose de Radiação , Feminino , Seguimentos , Humanos , Terapia com Luz de Baixa Intensidade/métodos , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Vagina/patologia , Vagina/efeitos da radiação , Doenças Vaginais/patologia , Doenças Vaginais/fisiopatologia , Vulva/patologia , Vulva/efeitos da radiação , Doenças da Vulva/patologia , Doenças da Vulva/fisiopatologia
4.
Gynecol Endocrinol ; 35(2): 150-154, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30132350

RESUMO

The aim of this study is to evaluate the sexual functionality before and after treatment of Bartholin's gland diseases (BGD) with CO2 laser and to compare our results to patients who underwent surgical cold knife and to a healthy control group (HCG). Consecutive patients (n = 15) affected by BG cyst or abscess who underwent CO2 laser treatment were evaluated. Patients were asked to complete the Italian translation of the Female Sexual Functioning Index (FSFI) before and 4 weeks after treatment. Results after CO2 laser were compared with two control groups: patients affected by BG cyst (n = 15) or abscess treated with surgical cold knife treatment and a HCG (n = 18). A statistically significant advantage of CO2 laser versus cold knife treatment in terms of lubrication, pain and global score were recorded. Both the single scores of five domains and total score of FSFI were globally higher after any treatment compared to before (CO2 and cold knife) of BGD. According to our data, CO2 laser therapy is often well tolerated by patients and correlated with a favorable sexual health recovery.


Assuntos
Abscesso/cirurgia , Glândulas Vestibulares Maiores/cirurgia , Cistos/cirurgia , Disfunções Sexuais Fisiológicas/fisiopatologia , Saúde Sexual , Doenças da Vulva/cirurgia , Abscesso/fisiopatologia , Adulto , Glândulas Vestibulares Maiores/fisiopatologia , Estudos de Casos e Controles , Cistos/fisiopatologia , Dispareunia/fisiopatologia , Feminino , Humanos , Terapia a Laser , Lasers de Gás , Medidas de Resultados Relatados pelo Paciente , Projetos Piloto , Recuperação de Função Fisiológica , Resultado do Tratamento , Doenças da Vulva/fisiopatologia
5.
Dermatol Ther ; 31(6): e12678, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30411455

RESUMO

Vulvovaginal atrophy is a condition that affects women, although it is mainly associated with the onset of menopause mainly due to hormonal changes vulvovaginal laxity and mucosal atrophy can also affect women at different life stages such as after pregnancy or for cancer patients who have undergone chemo or endocrine therapy. This condition negatively influence quality of life, sexual desire, and self-confidence. Many therapies have been considered mainly with inconclusive or transient results in terms of benefit factor. Recently, a new non-invasive product, containing hyaluronic acid, oligopeptides, and antioxidants was introduced to the market. Its name is "Primavera," by Renaissance, Italy. The aim of this product is to allow a vulvo-vaginal biostimulation and considered simple, safe, and satisfactory.


Assuntos
Rejuvenescimento , Vagina/efeitos dos fármacos , Doenças Vaginais/tratamento farmacológico , Vulva/efeitos dos fármacos , Doenças da Vulva/tratamento farmacológico , Antioxidantes/efeitos adversos , Antioxidantes/uso terapêutico , Atrofia , Feminino , Humanos , Oligopeptídeos/efeitos adversos , Oligopeptídeos/uso terapêutico , Recuperação de Função Fisiológica , Resultado do Tratamento , Vagina/patologia , Vagina/fisiopatologia , Doenças Vaginais/patologia , Doenças Vaginais/fisiopatologia , Vulva/patologia , Vulva/fisiopatologia , Doenças da Vulva/patologia , Doenças da Vulva/fisiopatologia
7.
BMJ Case Rep ; 20182018 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-29880620

RESUMO

Lipschütz ulcers (LU) are non-sexually related genital ulcers, rarely reported. We describe a healthy 11-year-old girl, who presented with fever and a painful vulvar ulcer associated with erythematous tonsillitis. Throat swab test for Group A Streptococcus (GAS) was positive. She was treated with amoxicillin. Further investigation was negative, including Herpes Simplex virus DNA from ulcer swab and serology for Epstein-Barr virus, cytomegalovirus and Mycoplasma pneumoniae Antistreptolysin O titre was high. The ulcer healed in 2 weeks, with no recurrence in a 1 year follow-up period. The association of LU with GAS tonsillitis is very rare.


Assuntos
Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Infecções Estreptocócicas/microbiologia , Tonsilite/microbiologia , Úlcera/microbiologia , Doenças da Vulva/microbiologia , Criança , Feminino , Febre , Humanos , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/fisiopatologia , Tonsilite/tratamento farmacológico , Resultado do Tratamento , Úlcera/tratamento farmacológico , Úlcera/fisiopatologia , Doenças da Vulva/tratamento farmacológico , Doenças da Vulva/fisiopatologia
8.
Climacteric ; 21(3): 286-291, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29553288

RESUMO

OBJECTIVES: The primary objective of the European Vulvovaginal Epidemiological Survey (EVES) was to assess, at a country level, the prevalence of postmenopausal women with vulvovaginal atrophy (VVA) confirmed by gynecological clinical assessment among all postmenopausal women attending menopause centers. METHOD: Women aged 45-75 years old with their last menstrual period more than 12 months before and who attended menopause or gynecology centers were included. If they had at least one VVA symptom, women filled a number of questionnaires including the EuroQoL-EQ-5D3L and Day-to-Day Impact of Vaginal Aging (DIVA). Then a gynecological examination was performed to confirm the VVA diagnosis. RESULTS: A total of 2160 evaluable patients were included in the study. VVA was confirmed in 90% of the patients. Compared with patients without confirmed VVA (n = 206), patients with confirmed VVA (n = 1954) were significantly older (p < 0.001), had more severe symptoms (p < 0.001 for vaginal and vulvar symptoms, p < 0.05 for urinary ones) and had a lower quality of life as assessed by EQ-5D3L (p = 0.012) and DIVA (p < 0.001). CONCLUSION: VVA is highly prevalent among postmenopausal women. Gynecological clinical assessment of VVA is associated with severe symptoms and impaired quality of life and therefore should be promoted for appropriate clinical assessment and early therapeutic intervention.


Assuntos
Pós-Menopausa , Doenças Vaginais/epidemiologia , Doenças da Vulva/epidemiologia , Idoso , Atrofia/epidemiologia , Atrofia/fisiopatologia , Estudos Transversais , Feminino , Humanos , Itália/epidemiologia , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Espanha/epidemiologia , Inquéritos e Questionários , Vagina/patologia , Doenças Vaginais/fisiopatologia , Vulva/patologia , Doenças da Vulva/fisiopatologia
9.
Clin Obstet Gynecol ; 61(2): 260-268, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29419532

RESUMO

For women at elevated risk of thrombosis, clinicians are challenged to relieve menopausal symptoms without increasing the risk of thrombosis. Oral menopausal hormone therapy increases the risk of venous thromboembolism by 2-fold to 3-fold. Observational studies suggest less thrombotic risk with transdermal therapies and with progesterone over synthetic progestogens (progestins), but the data are limited. Beneficial nonpharmacologic therapies include cognitive behavioral therapy and clinical hypnosis, whereas beneficial nonhormonal pharmacologic therapies include selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. For treatment of the genitourinary syndrome of menopause, vaginal lubricants and moisturizers, low-dose vaginal estrogen, and intravaginal dehydroepiandrosterone are options.


Assuntos
Fogachos/prevenção & controle , Menopausa/fisiologia , Trombose/prevenção & controle , Doenças Vaginais/terapia , Doenças da Vulva/terapia , Administração Intravaginal , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Atrofia/fisiopatologia , Atrofia/terapia , Dispareunia/fisiopatologia , Dispareunia/terapia , Estrogênios/administração & dosagem , Antagonistas de Aminoácidos Excitatórios/uso terapêutico , Feminino , Terapia de Reposição Hormonal/efeitos adversos , Fogachos/fisiopatologia , Humanos , Terapia a Laser , Lubrificantes/uso terapêutico , Fitoterapia , Prurido/fisiopatologia , Prurido/terapia , Risco , Inibidores de Captação de Serotonina/uso terapêutico , Sudorese/fisiologia , Trombose/etiologia , Doenças Vaginais/fisiopatologia , Doenças da Vulva/fisiopatologia
10.
Gynecol Endocrinol ; 34(2): 110-114, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28749253

RESUMO

The aim of the study was to verify the efficacy of vulvar Visnadine spray in premenopausal women affected by female sexual arousal disorder (FSAD). Thirty-eight women aged 25-40 years affected by FSAD were enrolled in the randomized crossover study, by two possible sequences: on-demand, washout, daily (A sequence); and daily, washout, on-demand (B sequence). The Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) were used to assess sexual function and sexual distress, respectively. Color Doppler ultrasonography was used to measure clitoral blood flow. The study had two follow-ups at 30 (T1) and 60 days (T2). Thirty-one women completed the study. Mean (SD) sexual activity and vulvar Visnadine spray usage was 1 ± 0.9 weekly during on-demand administration for both the sequences (Vs T0, p = NS). The mean sexual activity during daily usage was 2 ± 0.9 (Vs T0, p < .004) and 2 ± 0.8 (Vs T0, p < .001) for A and B sequences, respectively. FSFI total score, particularly genital arousal, improved more during the daily than during on-demand phases of both sequences (p < .001). Finally, clitoral blood flow improved significantly during daily usage of both the sequences (p < .001). Our study suggests that vulvar Visnadine spray could improve sexual performance of women affected by FSAD, producing changes in subjective and objective sexual aspects.


Assuntos
Cromanos/uso terapêutico , Disfunções Sexuais Fisiológicas/prevenção & controle , Vagina/efeitos dos fármacos , Doenças Vaginais/tratamento farmacológico , Vasodilatadores/uso terapêutico , Vulva/efeitos dos fármacos , Doenças da Vulva/tratamento farmacológico , Administração Cutânea , Administração através da Mucosa , Adulto , Aerossóis , Cromanos/administração & dosagem , Clitóris/irrigação sanguínea , Clitóris/efeitos dos fármacos , Clitóris/fisiopatologia , Clitóris/cirurgia , Estudos Cross-Over , Manual Diagnóstico e Estatístico de Transtornos Mentais , Esquema de Medicação , Feminino , Seguimentos , Humanos , Pacientes Desistentes do Tratamento , Escalas de Graduação Psiquiátrica , Fluxo Sanguíneo Regional/efeitos dos fármacos , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/psicologia , Estresse Psicológico/etiologia , Estresse Psicológico/prevenção & controle , Ultrassonografia Doppler em Cores , Vagina/irrigação sanguínea , Vagina/metabolismo , Vagina/fisiopatologia , Doenças Vaginais/diagnóstico por imagem , Doenças Vaginais/fisiopatologia , Vasodilatadores/administração & dosagem , Vulva/irrigação sanguínea , Vulva/metabolismo , Vulva/fisiopatologia , Doenças da Vulva/diagnóstico por imagem , Doenças da Vulva/fisiopatologia
11.
Scand J Pain ; 17: 302-308, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28927649

RESUMO

BACKGROUND AND AIMS: Chronic vulvovaginal pain is strikingly common and has a serious impact on women's lives. Nevertheless, there are few longitudinal studies focusing on mechanisms involved in the pain development. One area of interest is how women cope with sexual activities and how this affects their pain. In this study, avoidance and endurance coping behaviors were explored as possible mediators of the relation between catastrophizing and pain, cross-sectionally and longitudinally. METHODS: 251 women (18-35 years old) with vulvovaginal pain were recruited in university settings and filled out questionnaires about their pain, catastrophizing and coping behaviors at two occasions, with five months in between. Multiple mediation models were tested, exploring avoidance and endurance as mediators of the relation between catastrophizing and pain. RESULTS: The results showed that avoidance was an influential mediator of the link between catastrophizing and pain. Using multiple mediation models we found that although the indirect effects of both avoidance and endurance were significant cross-sectionally, only avoidance was a significant mediator in the combined model exploring associations over time. CONCLUSIONS: This study indicates that the strategies women with vulvovaginal pain use for coping with sexual activities are important for the course of pain. Avoidance and, to a lesser degree, endurance strategies were identified as important mediators of the effects of catastrophizing on pain. When exploring the links over time, only avoidance emerged as a significant mediator. IMPLICATIONS: In this longitudinal study, catastrophizing was linked to vulvovaginal pain, via avoidance and endurance of sexual activities. Hence, targeting catastrophizing early on in treatment, as well as addressing coping, may be important in clinical interventions.


Assuntos
Adaptação Psicológica/fisiologia , Catastrofização/fisiopatologia , Dor Pélvica/fisiopatologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Doenças Vaginais/fisiopatologia , Doenças da Vulva/fisiopatologia , Adolescente , Adulto , Feminino , Humanos , Estudos Longitudinais , Adulto Jovem
13.
Semin Reprod Med ; 35(1): 98-101, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27992931

RESUMO

Extrapelvic endometriosis is a rare and complex phenomenon. The pathologic mechanism of intrapelvic endometriosis is generally accepted as being largely due to retrograde menstruation through the fallopian tubes; however, the mechanism by which extrapelvic endometriosis forms has proven to be much more elusive. This article reviews the pathophysiology, clinical signs and symptoms, diagnostic techniques, and treatment recommendations for extrapelvic endometriosis of the umbilicus, abdominal wall, thorax, and vulva.


Assuntos
Parede Abdominal , Endometriose , Doenças Torácicas , Umbigo , Doenças da Vulva , Parede Abdominal/fisiopatologia , Endometriose/diagnóstico , Endometriose/fisiopatologia , Endometriose/terapia , Feminino , Humanos , Prognóstico , Doenças Torácicas/diagnóstico , Doenças Torácicas/fisiopatologia , Doenças Torácicas/terapia , Umbigo/fisiopatologia , Doenças da Vulva/diagnóstico , Doenças da Vulva/fisiopatologia , Doenças da Vulva/terapia
14.
Am J Obstet Gynecol ; 215(6): 704-711, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27472999

RESUMO

Genitourinary syndrome of menopause, a new term for a condition more renowned as atrophic vaginitis, is a hypoestrogenic condition with external genital, urological, and sexual implications that affects >50% of postmenopausal women. Due to sexual embarrassment and the sensitive nature of discussing symptoms, genitourinary syndrome of menopause is greatly underdiagnosed. The most up-to-date literature pertaining to clinical manifestations, pathophysiology, etiology, evaluation, and management of genitourinary syndrome of menopause is comprehensively reviewed. Early detection and individually tailored pharmacologic (eg, estrogen therapy, selective estrogen receptor modulator, synthetic steroid, oxytocin, and dehydroepiandrosterone) and/or nonpharmacologic (eg, laser therapies, moisturizers and lubricants, homeopathic remedies, and lifestyle modifications) treatment is paramount for not only improving quality of life but also for preventing exacerbation of symptoms in women with this condition.


Assuntos
Vaginite Atrófica/fisiopatologia , Dispareunia/fisiopatologia , Menopausa , Incontinência Urinária/fisiopatologia , Doenças da Vulva/fisiopatologia , Vaginite Atrófica/diagnóstico , Vaginite Atrófica/metabolismo , Vaginite Atrófica/terapia , Desidroepiandrosterona/uso terapêutico , Dispareunia/diagnóstico , Dispareunia/metabolismo , Dispareunia/terapia , Terapia de Reposição de Estrogênios/métodos , Feminino , Humanos , Estilo de Vida , Terapia com Luz de Baixa Intensidade/métodos , Lubrificantes/uso terapêutico , Ocitócicos/uso terapêutico , Ocitocina/uso terapêutico , Qualidade de Vida , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Síndrome , Incontinência Urinária/diagnóstico , Incontinência Urinária/metabolismo , Incontinência Urinária/terapia , Doenças da Vulva/diagnóstico , Doenças da Vulva/metabolismo , Doenças da Vulva/terapia
15.
Curr Oncol Rep ; 18(5): 32, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27074843

RESUMO

There are increasing numbers of breast cancer survivors. Chemotherapy or endocrine therapy result in effects on vaginal health that may affect quality of life. These effects may impact sexual function, daily comfort, or the ability to perform a pelvic examination. Vulvovaginal atrophy, or genitourinary syndrome of menopause, may be treated with nonhormonal or hormonal measures. Breast cancer survivors who are menopausal and/or on endocrine therapy should be screened for issues with vaginal health and counseled about treatment options.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Qualidade de Vida , Vagina/efeitos dos fármacos , Neoplasias da Mama/fisiopatologia , Feminino , Humanos , Menopausa , Sobreviventes , Vagina/fisiopatologia , Doenças Vaginais/diagnóstico , Doenças Vaginais/fisiopatologia , Doenças da Vulva/diagnóstico , Doenças da Vulva/fisiopatologia
16.
Obstet Gynecol ; 127(4): 745-51, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27008217

RESUMO

INTRODUCTION: In 2014, the executive council of the International Society for the Study of Vulvovaginal Disease, the boards of directors of the International Society for the Study of Women's Sexual Health, and the International Pelvic Pain Society acknowledged the need to revise the current terminology of vulvar pain, on the basis of the significant increase in high-quality etiologic studies published in the last decade. MATERIALS AND METHODS: The new terminology was achieved in the following 4 steps. The first involved a terminology consensus conference with representatives of the 3 societies, held in April 2015. Then, an analysis of the relevant published studies was used to establish a level of evidence for each factor associated with vulvodynia. The terminology was amended on the basis of feedback from members of the societies. Finally, each society's board accepted the new terminology. RESULTS AND CONCLUSIONS: In 2015,the International Society for the Study of Vulvovaginal Disease, International Society for the Study of Women's Sexual Health, and International Pelvic Pain Society adopted a new vulvar pain and vulvodynia terminology that acknowledges the complexity of the clinical presentation and pathophysiology involved in vulvar pain and vulvodynia, and incorporates new information derived from evidence-based studies conducted since the last terminology published in 2003.


Assuntos
Consenso , Dor Pélvica/classificação , Terminologia como Assunto , Doenças da Vulva/classificação , Vulvodinia/classificação , Feminino , Humanos , Dor Pélvica/etiologia , Sociedades Médicas , Doenças da Vulva/fisiopatologia , Vulvodinia/fisiopatologia
17.
J Womens Health (Larchmt) ; 25(3): 276-83, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26752153

RESUMO

BACKGROUND: Vulvodynia has been considered to be a chronic disorder. We sought to estimate the probability of and risk factors for remission, relapse, and persistence among women screening positive for vulvodynia. METHODS: Survey-based assessment in a longitudinal population-based study of women (the Woman to Woman Health Study) who screened positive for vulvodynia and completed at least four follow-up surveys. Outcome measures included remission without relapse, relapse (after remission), and persistence of a positive vulvodynia screen. Multinomial regression was used to assess factors associated with outcomes. RESULTS: Of 441 women screening positive for vulvodynia during the study, 239 completed 4 additional surveys. Of these, 23 (9.6%) had consistently positive vulvodynia screens, 121 (50.6%) remitted without relapse, and 95 (39.7%) relapsed following remission. Overall, factors associated with both relapse and persistence (compared with remission alone) included increased severity of pain ever (p < 0.001) or after intercourse (p = 0.03), longer duration of symptoms (p ≤ 0.001), and screening positive for fibromyalgia (p < 0.001). Factors associated with persistence (but not relapse) included more severe symptoms with intercourse (p = 0.001) and pain with oral sex (p = 0.003) or partner touch (p = 0.04). Factors associated with relapse (but not persistence) included having provoked pain (p = 0.001) or screening positive for interstitial cystitis (p = 0.05) at first positive vulvodynia screen. Demographic characteristics, age at pain onset, and whether vulvodynia was primary or secondary did not predict outcome. CONCLUSION: Remission of vulvodynia symptoms is common with approximately half of remitters experiencing a relapse within 6-30 months. Persistence without remission is the exception rather than the rule. Pain history and comorbid conditions were associated with the more severe outcomes of relapse and/or persistence compared with those who remitted only. These findings provide further support that vulvodynia is heterogeneous and often occurs in an episodic pattern.


Assuntos
Dor/epidemiologia , Recidiva , Remissão Espontânea , Vulvodinia/epidemiologia , Adolescente , Adulto , Comorbidade , Feminino , Fibromialgia/epidemiologia , Humanos , Estudos Longitudinais , Dor/complicações , Vigilância da População , Análise de Regressão , Fatores de Risco , Inquéritos e Questionários , Estados Unidos/epidemiologia , Doenças da Vulva/epidemiologia , Doenças da Vulva/fisiopatologia , Vulvodinia/complicações , Saúde da Mulher , Adulto Jovem
18.
Mo Med ; 112(4): 301-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26455062

RESUMO

The purpose of this article is to review six important inflammatory dermatoses of the vulva and to update readers on the new advancements in treatment of these mucosal conditions. Psoriasis, lichen sclerosis, lichen simplex chronicus and lichen planus are common vulvar conditions that cause pruritis and/or pain. PIasma cell vulvitis and desquamative inflammatory vaginitis are rare and challenging to be recognized, which often remain undiagnosed.


Assuntos
Corticosteroides/uso terapêutico , Dermatopatias/tratamento farmacológico , Dermatopatias/fisiopatologia , Doenças da Vulva/tratamento farmacológico , Doenças da Vulva/fisiopatologia , Administração Tópica , Feminino , Humanos , Líquen Plano/fisiopatologia , Líquen Plano/terapia , Psoríase/fisiopatologia , Psoríase/terapia , Dermatopatias/terapia , Doenças da Vulva/terapia , Líquen Escleroso Vulvar/fisiopatologia , Líquen Escleroso Vulvar/terapia , Vulvite/fisiopatologia , Vulvite/terapia
20.
Eur J Obstet Gynecol Reprod Biol ; 194: 106-10, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26342683

RESUMO

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.


Assuntos
Disfunções Sexuais Psicogênicas/etiologia , Sexualidade , Doenças da Vulva/fisiopatologia , Doenças da Vulva/psicologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Dor/etiologia , Satisfação Pessoal , Estudos Prospectivos , Inquéritos e Questionários , Doenças da Vulva/complicações
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