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1.
Obstet Gynecol ; 135(1): 113-121, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31809431

RESUMO

OBJECTIVE: To describe patient outcomes after modified vestibulectomy for vulvodynia. METHODS: This is a mixed-methods study of patients who had undergone modified vestibulectomy for vulvodynia at a tertiary care hospital from 2009 through 2016. Demographics, preoperative and postoperative examinations, symptoms, and treatments were obtained through retrospective review. Prospective semistructured interviews were conducted from 2018 through 2019 to address patient-reported changes in pain and sexual function. Qualitative analysis was performed using a grounded theory approach. RESULTS: Twenty-two patients underwent modified vestibulectomy from 2009 through 2016. Age ranged from 22 to 65 years and mean body mass index was 24.3±5.4. The majority of patients were premenopausal (57%), sexually active (68%), and partnered (76%). Postoperatively, data on pain improvement were retrieved on 18 patients, of which 17 (94%) reported improvement. Patients used pelvic floor physical therapy, medications, and lubricants both preoperatively and postoperatively. For the qualitative analysis, thematic saturation was achieved with 14 interviews. Of 14 participants interviewed, 13 (93%) reported improvement with pain after surgery, 11 (79%) reported satisfaction with surgery, 8 (57%) reported satisfaction with sexual function, and 11 (79%) reported recommending the surgery to others. The following lead themes were identified: vulvodynia symptoms significantly affect quality of life; there is difficulty and delay in diagnosis owing to lack of information and awareness among patients and health care providers; and surgical success and satisfaction are influenced by patient perceptions with sexual dysfunction often persisting despite vulvar pain improvement. CONCLUSION: Vulvodynia patients report improvement in pain and high overall satisfaction after modified vestibulectomy, but more variable long-term effects on sexual function.


Assuntos
Dispareunia/terapia , Avaliação de Resultados da Assistência ao Paciente , Qualidade de Vida , Vulvodinia/cirurgia , Adulto , Idoso , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Medição da Dor , Dor Intratável , Modalidades de Fisioterapia , Estudos Prospectivos , Centros de Atenção Terciária , Resultado do Tratamento , Adulto Jovem
2.
J Consult Clin Psychol ; 88(1): 48-64, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31841023

RESUMO

OBJECTIVE: Provoked vestibulodynia (PVD) is a chronic vulvo-vaginal pain condition affecting 8% of premenopausal women. Cognitive-behavioral therapy (CBT) is effective in managing pain and associated sexual and psychological symptoms, and a recent study found group mindfulness-based cognitive therapy (MBCT) to be equivalent. Our goal was to examine the long-term outcomes of these treatments and to explore mediators of change. METHOD: Participants were 130 women diagnosed with PVD who had participated in a clinical trial comparing 8 weeks of group CBT to 8 weeks of group MBCT. Data were collected at pretreatment, posttreatment, and at 6- and 12-month follow-up periods. Outcomes focused on (a) pain with vaginal penetration, (b) pain elicited with a vulvalgesiometer, and (c) sex-related distress. Mediators of interest included pain acceptance (both pain willingness and activities engagement), self-compassion, self-criticism, mindfulness, decentering, and pain catastrophizing. RESULTS: All improvements in the 3 outcomes were retained at 12-month follow-up, with no group differences. Pain catastrophizing, decentering, and chronic pain acceptance (both scales) were mediators of improvement common to both MBCT and CBT. Changes in mindfulness, self-criticism, and self-compassion mediated improvements only in the MBCT group. CONCLUSIONS: Both MBCT and CBT are effective for improving symptoms in women with PVD when assessed 12 months later. The findings have implications for understanding common and potentially distinct pathways by which CBT and MBCT improve pain and sex-related distress in women with PVD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental/métodos , Atenção Plena/métodos , Psicoterapia de Grupo/métodos , Vulvodinia/psicologia , Vulvodinia/terapia , Adulto , Catastrofização/psicologia , Catastrofização/terapia , Feminino , Seguimentos , Humanos , Comportamento Sexual/psicologia , Resultado do Tratamento
3.
Harefuah ; 158(12): 812-816, 2019 Dec.
Artigo em Hebraico | MEDLINE | ID: mdl-31823537

RESUMO

INTRODUCTION: We review the process of establishing the new terminology of persistent vulvar pain and vulvodynia. Three international scientific societies: the International Society for the Study of Vulvovaginal Disease - ISSVD, the International Society for The Study of Women's Sexual Health - ISSWSH, and the International Pelvic Pain Society - IPPS, prepared a consensus terminology of vulvar pain and vulvodynia. This terminology includes the definition of vulvodynia, descriptors of the clinical presentation of vulvodynia, and evidence-based data on the possible causes of vulvodynia. The controversy behind the introduction of the possible causes of vulvodynia, a condition which was considered an idiopathic condition, is revealed. The inclusion of these possible causes has changed the paradigm enabling tailoring treatment.


Assuntos
Dor Crônica , Vulvodinia/diagnóstico , Consenso , Feminino , Humanos , Dor Pélvica
4.
J Low Genit Tract Dis ; 23(4): 279-286, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31592976

RESUMO

OBJECTIVE: The aim of the study was to assess the feasibility and acceptability of acupuncture's augmentation of lidocaine therapy in the treatment of provoked localized vulvodynia (PLV). MATERIALS AND METHODS: For 12 weeks, women with moderate to severe PLV were randomized to either 18 sessions of traditional acupuncture (TA) or non-TA (NTA). All participants applied lidocaine 5% cream 4 times daily to the vestibule. Feasibility was assessed by recruitment, enrollment, assessment completion, and blinding. Acceptability was assessed by study visit attendance and satisfaction. The primary outcome was change in tampon test scores from baseline to week 12 and follow-up at week 24. RESULTS: Nineteen women enrolled and 14 completed the study. Five withdrew because of lidocaine reaction (n = 2), inability to insert tampon (n = 1), starting a new medication (n = 1), or change in vulvar diagnosis (n = 1). Participants in both groups reported pain reduction for 12 weeks. There was no statistically significant difference between groups. Women in the TA group (n = 7) experienced less pain from baseline to 12 weeks (mean difference [MD] = 42.4 ± 19.4 and MD = 35.7 ± 17.8 at week 24). In the non-TA group (n = 7), women experienced a within-group MD of 28.7 ± 28.5 at 12 weeks and an MD of 36.7 ± 17.7. CONCLUSIONS: In this early-phase research, acupuncture augmentation of lidocaine was acceptable. The study procedures, with modifications, may be feasible for future investigation. Both acupuncture techniques showed a favorable effect; however, the contribution to pain relief is undetermined.


Assuntos
Acupuntura/métodos , Anestésicos Locais/administração & dosagem , Lidocaína/administração & dosagem , Vulvodinia/terapia , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Resultado do Tratamento , Adulto Jovem
6.
Ugeskr Laeger ; 181(39)2019 Sep 23.
Artigo em Dinamarquês | MEDLINE | ID: mdl-31543098

RESUMO

This review discusses female genital mutilation (FGM), which is a culturally founded ritual of unknown origin. The definition is intentional altering or injuring the female genitals for non-medical reasons. The WHO estimates, that more than 200 million women have sequelae from FGM. Acute compli-ca-tions range from haemorrhage and infection to death, while the most common chronic complications are vulvar pain, problems with micturition and childbirth, recurrent infec-tions, dysmenorrhoea, and dyspareunia. Favourable surgical techniques are available. Hitherto, these techniques are limited to certain types of FGM.


Assuntos
Circuncisão Feminina , Procedimentos Cirúrgicos Reconstrutivos , Vulvodinia , Comportamento Ritualístico , Feminino , Humanos
7.
Eur J Contracept Reprod Health Care ; 24(5): 337-346, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31364893

RESUMO

Objective: To quantify the effects of available treatments of vestibulodynia. Methods: Systematic review of randomised controlled trials (RCTs) in six search engines until December 2018, comparing any intervention vs. placebo or sham in women with vestibulodynia. Primary outcome was dyspareunia assessed with visual analogue (VAS) or numeric rating (NRS) scales. Secondary outcomes were daily vestibular symptoms (DVS), McGill Pain Questionnaire (MPQ) and Index of Sexual Satisfaction (ISS). Effects were described as mean differences (MDs) with their 95% confidence intervals (CIs). Traditional and frequentist network meta-analyses (NMA) were performed using random effect models. Results: Four RCTs (n = 275) were included evaluating vaginal cream of conjugated oestrogens, oral desipramine with or without topical lidocaine, topical lidocaine, laser therapy and transcranial direct current. In traditional MA, interventions did not reduce dyspareunia (MD = 0.08; 95%CI = -0.49 to 0.64), DVS (MD = -0.04; 95%CI = -0.31 to 0.24; 4 interventions), or MPQ (MD = -0.17; 95%CI = -2.16 to 1.81; 4 interventions). ISS was significantly improved (MD = -5.14; 95%CI = -9.52 to -0.75). In NMA, oral desipramine with or without lidocaine significantly improved ISS vs. other treatments. Conclusions: Several existing interventions were not associated with improvements in vestibulodynia. There only was improvement of sexual function with oral desipramine with or without lidocaine.


Assuntos
Dispareunia/terapia , Vulvodinia/terapia , Administração Intravaginal , Administração Oral , Adulto , Anestésicos Locais/administração & dosagem , Desipramina/administração & dosagem , Dispareunia/etiologia , Estrogênios/administração & dosagem , Feminino , Humanos , Terapia a Laser/métodos , Lidocaína/administração & dosagem , Metanálise em Rede , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Comportamento Sexual , Estimulação Transcraniana por Corrente Contínua , Resultado do Tratamento , Cremes, Espumas e Géis Vaginais , Vulvodinia/complicações
8.
Int Urogynecol J ; 30(11): 1871-1878, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31375872

RESUMO

INTRODUCTION AND HYPOTHESIS: Vulvodynia is chronic debilitating burning vulvar pain or pain on contact. Although women who suffer from vulvodynia are more likely than others to experience co-morbid interstitial cystitis (IC) and urinary tract infections (UTIs), few studies have explored whether women with vulvodynia experience adverse urinary symptoms (lower urinary tract symptoms [LUTS]) in the absence of urological pain. METHODS: Two hundred and eleven participants with and 226 participants without clinically confirmed vulvodynia completed the Pelvic Pain and Urgency/Frequency (PUF) questionnaire and were scored using all questions, and then a subset of questions relating only to their current frequency and bother of urination during day and night, and the frequency, severity and bother of urgency after voiding. Total, symptom, and bother scores were compared in women with and without vulvodynia, and regression models estimated adjusted odds ratios and 95% confidence intervals for the various LUTS symptoms. RESULTS: As expected, 40% of women with vulvodynia met the criteria for IC (PUF > 12) compared with 2% without vulvodynia. After excluding questions related to bladder or vulvovaginal pain, women with vulvodynia, compared with those without, were skewed toward higher PUF scores, including being 2.4 times more likely to report usually or always bothered by night-time voiding (95% CI 1.22-4.74), and 18 times more likely to report moderate/severe urgency after urination (95% CI 5.48-64.12). CONCLUSIONS: Women with vulvodynia are substantially more likely to report voiding dysfunction and symptoms of urgency than women with no history of vulvar pain. These findings are independent of comorbid interstitial cystitis or history of UTIs.


Assuntos
Sintomas do Trato Urinário Inferior/complicações , Vulvodinia/complicações , Adulto , Estudos de Casos e Controles , Autoavaliação Diagnóstica , Feminino , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Estudos Retrospectivos
9.
Am J Obstet Gynecol ; 221(5): 525.e1-525.e2, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31408632

RESUMO

Provoked vestibulodynia is an often underdiagnosed and mismanaged medical condition that impacts the lives of many women. When symptoms are due to a dramatically increased density of pain fibers in the vestibular endoderm, the condition is referred to as neuroproliferative-associated vestibulodynia. Unfortunately, assessment of pain fiber density can only be performed after surgery during histologic examination. First-line therapies for this condition often include topical or oral medications targeting hyperalgesia and allodynia at the vulvar vestibule. However, in the setting of refractory disease, surgical treatment should be considered. The surgical video (Video 1) highlights anatomical landmarks as well as key surgical steps when performing a vulvar vestibulectomy with a vaginal advancement flap for the treatment of neuroproliferative-associated vestibulodynia. Surgeons should have a thorough understanding of pertinent vulvar anatomical landmarks before performing this procedure (Figure 1). The goal of vulvar vestibulectomy, as described in this video, is to excise the entirety of the vestibule containing the pathologic density of afferent pain fibers. This tutorial serves to identify key anatomical landmarks including Hart's line as well as outline the meticulous dissection required for successful completion of this procedure. We describe our surgical instrumentation as well as provide insight into steps that can be taken to minimize postoperative morbidity.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Vulvodinia/cirurgia , Feminino , Humanos
10.
Praxis (Bern 1994) ; 108(10): 685-691, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31387503

RESUMO

Vulvodynia - Diagnostics and Management Strategies Abstract. Vulvodynia is characterized by chronic, idiopathic vulvar pain lasting for at least three months. After exclusion of other, specific diseases associated with vulvar pain, which can be treated accordingly, realistic therapy goals for this chronic disease should be defined. The therapy concept is multimodal, interdisciplinary as well as individualized and includes the combination of general recommendations with physiotherapeutic and psychotherapeutic measures. Pharmacological therapy, which is indispensable, is carried out off-label and includes the topical and/or systemic use of various substances and substance combinations. Surgical measures may be regarded as a possible option, especially in women with therapy-resistant and provocable vulvodynia. Alternative therapy options such as acupuncture, hypnosis and transcutaneous electrical nerve stimulation are also worth investigating.


Assuntos
Estimulação Elétrica Nervosa Transcutânea , Vulvodinia , Feminino , Humanos , Vulvodinia/diagnóstico , Vulvodinia/etiologia , Vulvodinia/terapia
11.
Eur J Obstet Gynecol Reprod Biol ; 240: 121-124, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31260857

RESUMO

OBJECTIVE: To study the prevalence and epidemiological characteristics of women with vulvodynia. To assess the risk factors associated to the disease. STUDY DESIGN: A cross-sectional study was made in which questionnaires were anonymously and confidentially distributed to Spanish women over 18 years of age between April 2016 and September 2017. The questionnaires were distributed by e-mail and through social networks, women's associations and specific websites. This type of questionnaire has been validated and used in many studies of this kind. The women answered questions referred to epidemiological aspects, demographic parameters, medical history, the presence of vulvodynia, associated factors, and comorbidities. RESULTS: A total of 684 questionnaires were completed. The prevalence of vulvodynia was 6.6% (45 women). Thirteen percent (95 women) had experienced vulvodynia at some point in life. The factors associated to vulvodynia were prior vaginal deliveries (p = 0.001), vulvovaginal candidiasis (p < 0.001) and urinary tract infections (p < 0.001). Other pain syndromes such as fibromyalgia (p = 0.012), painful bladder syndrome/ interstitial syndrome (p < 0.001), temporomandibular joint pain (p = 0.021), coxofemoral pain (p = 0.001) or headache (p = 0.001) have also been associated to vulvodynia. CONCLUSIONS: The prevalence of vulvodynia in Spain is similar to that found in other countries. Many factors are involved in its development and persistence, particularly the presence of other pain syndromes and recurrent infections that could trigger complex inflammatory reactions.


Assuntos
Vulvodinia/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Espanha/epidemiologia , Vulvodinia/etiologia , Adulto Jovem
12.
J Sex Med ; 16(8): 1128-1129, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31277971
14.
BMC Urol ; 19(1): 47, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170952

RESUMO

Interstitial cystitis/bladder pain syndrome (IC/BPS) and female sexual dysfunction (FSD) are common conditions that substantially reduce women's health. In particular, women with IC/BPS show vulvodynia, a kind of FDS that originates from consistent pain around the vulvar area. There have been many studies attempting to find the underlying mechanisms that induce the chronic pain associated with IC/BPS and vulvodynia and explain why these two conditions often coexist. Proposed theories suggest that pain hypersensitivity is being mediated by peripheral and central sensitization. However, there are still many unknown factors, such as etiologies, that can evoke pain hypersensitivity and may be linking the casual relationship between IC/BPS and vulvodynia. At present, knowledge regarding IC/BPS and vulvodynia are insufficient when considering their clinical importance. Therefore, efforts are necessary to elucidate the issues surrounding IC/BPS and vulvodynia.


Assuntos
Cistite Intersticial/complicações , Vulvodinia/etiologia , Feminino , Humanos
16.
Int J Mol Sci ; 20(9)2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31052404

RESUMO

Vulvodynia is a remarkably prevalent chronic pain condition of unknown etiology. An increase in numbers of vulvar mast cells often accompanies a clinical diagnosis of vulvodynia and a history of allergies amplifies the risk of developing this condition. We previously showed that repeated exposures to oxazolone dissolved in ethanol on the labiar skin of mice led to persistent genital sensitivity to pressure and a sustained increase in labiar mast cells. Here we sensitized female mice to the hapten dinitrofluorobenzene (DNFB) dissolved in saline on their flanks, and subsequently challenged them with the same hapten or saline vehicle alone for ten consecutive days either on labiar skin or in the vaginal canal. We evaluated tactile ano-genital sensitivity, and tissue inflammation at serial timepoints. DNFB-challenged mice developed significant, persistent tactile sensitivity. Allergic sites showed mast cell accumulation, infiltration of resident memory CD8+CD103+ T cells, early, localized increases in eosinophils and neutrophils, and sustained elevation of serum Immunoglobulin E (IgE). Therapeutic intra-vaginal administration of Δ9-tetrahydrocannabinol (THC) reduced mast cell accumulation and tactile sensitivity. Mast cell-targeted therapeutic strategies may therefore provide new ways to manage and treat vulvar pain potentially instigated by repeated allergenic exposures.


Assuntos
Analgésicos não Entorpecentes/uso terapêutico , Dronabinol/uso terapêutico , Hipersensibilidade/complicações , Mastócitos/efeitos dos fármacos , Tato , Vulvodinia/tratamento farmacológico , Analgésicos não Entorpecentes/farmacologia , Animais , Dinitrofluorbenzeno/toxicidade , Dronabinol/farmacologia , Feminino , Imunoglobulina E/sangue , Leucócitos/efeitos dos fármacos , Leucócitos/imunologia , Mastócitos/imunologia , Camundongos , Vulvodinia/etiologia , Vulvodinia/fisiopatologia
17.
Ther Umsch ; 73(9): 565-571, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-31113317

RESUMO

Vulvar Pain Abstract. During their lifetime, many women experience vulvar and / or vaginal pain. The reasons of those pains or discomforts can be multiple and sometimes hard to identify and therefore difficult to treat. Besides organic causes such as infections, inflammations, changes after operations and others we can find complex conditions such as vulvodynia and dyspareunia. Vulvodynia is a vulvar pain of at least 3 months duration without clear identifiable cause, which may have potential associated factors. It is important for a successful therapy to identify these factors. It will need an individual access to every woman and there is no single therapy that fits all women. Dyspareunia is also a less common but also complex problem that needs accurate approach and therapy. With this article, we would like to give you insights in these disorders in a practical way in order to make them find their place in our daily practice.


Assuntos
Dispareunia , Doenças da Vulva/diagnóstico , Vulvodinia , Dispareunia/diagnóstico , Feminino , Humanos , Dor/diagnóstico , Dor/etiologia , Disfunções Sexuais Psicogênicas/diagnóstico , Doenças da Vulva/complicações , Vulvodinia/diagnóstico
18.
J Low Genit Tract Dis ; 23(3): 220-225, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30973443

RESUMO

OBJECTIVES: Vulvodynia is common and characterized by vulvar discomfort and pain. However, few studies have assessed hygienic practices in relation to onset. We investigated whether hygienic behaviors were associated with the onset of vulvodynia. MATERIALS AND METHODS: We assessed a self-reported history of personal hygienic behaviors, including wearing tight-fitting clothing, vulva care and genital washing, pubic hair removal, douching, and powdering, a year before first reported onset of vulvar pain among 213 clinically confirmed cases and a similar time period among 221 general population controls. RESULTS: Compared with women who reported never wearing tight-fitting jeans or pants, women wearing tight-fitting jeans or pants 4 or more times per week had twice the odds of vulvodynia (95% CI = 1.14-3.95). Relative to controls, women with vulvodynia were substantially less likely to report use of soaps and gels to cleanse the vulva (95% CI = 0.17-0.63). Among women who chose to remove pubic hair, those who removed pubic hair from the mons pubis compared with bikini-area only hair removal, were 74% more likely to have vulvodynia (95% CI = 1.05-2.89). Finally, compared with women who reported bikini-area only hair removal less than monthly, those who removed hair from the mons pubis weekly or more were nearly 2 times more likely to be vulvodynia cases (95% CI = 0.83-3.49). CONCLUSIONS: Wearing tight-fitting jeans or pants and removing hair from the mons pubis area were associated with increased odds of vulvodynia. Research on how hygienic practices could influence vulvar pain in larger and more temporally addressed populations is warranted.


Assuntos
Comportamento , Higiene , Vulvodinia/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Inquéritos e Questionários , Adulto Jovem
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