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ALIMI YUSUF, IWANAGA JOE, OSKOUIAN RODJ, LOUKAS MARIOS, TUBBS RSHANE. The clinical anatomy of dyspareunia: A review. Clin Anat 2018; 31:1013-1017. [DOI: 10.1002/ca.23250] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/09/2018] [Accepted: 07/13/2018] [Indexed: 12/23/2022]
Affiliation(s)
- YUSUF ALIMI
- Department of Anatomical Sciences; St. George's University; St. George's Grenada West Indies
| | - JOE IWANAGA
- Seattle Science Foundation; Seattle Washington
| | | | - MARIOS LOUKAS
- Department of Anatomical Sciences; St. George's University; St. George's Grenada West Indies
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Is uncertain vulvovaginal candidiasis a marker of vulvodynia? A study in a Dutch general practice research database. BJGP Open 2017; 1:bjgpopen17X100905. [PMID: 30564664 PMCID: PMC6169963 DOI: 10.3399/bjgpopen17x100905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background A recent Dutch study in general practice showed a clear relationship between the diagnosis of vulvovaginal candidiasis (VVC) and symptoms suggestive of provoked vulvodynia (PVD). PVD accounts for the largest group of vulvar pains, but is often not recognised by GPs. Aim To investigate whether diagnostic uncertainty about VVC in general practice could also point to the diagnosis of PVD, and whether and how this diagnostic uncertainty affects management. Design & setting An observational study in 2014 in Dutch general practices of the NIVEL Primary Care Database. Method Women with an uncertain diagnosis of VVC were distinguished from those with certain VVC based on the occurrence of recurrent episodes and persisting complaints, despite treatment. Factors known to be associated with PVD were hypothesised to be more prevalent in women with uncertain VVC. Data on symptom management by GPs were collected. Results In total 7066 women with VVC or uncertain VVC were included. Uncertain VVC was found to account for 28% of these patients. Compared to VVC, the group uncertain VVC included significantly more women with female genital symptoms, tiredness, irritable bowel syndrome (all P<0.001), feeling anxious, reduced sexual desire, depressive disorder, relationship problems, and micturition symptoms (all P<0.05). Compared to VVC, the group uncertain VVC included significantly higher mean numbers of telephone consultations (P<0.001), more referrals to gynaecology (P = 0.009), and higher mean numbers of prescriptions per patient (P<0.001). Conclusion This study's findings indicate that uncertain VVC could be a marker of PVD. GPs might reconsider their diagnostics and management when women present recurrent and persistent vulvovaginal complaints, especially if accompanied by dyspareunia, functional syndromes, micturition symptoms, and psychological conditions.
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Murina F, Graziottin A, Felice R, Gambini D. Alpha Lipoic Acid Plus Omega-3 Fatty Acids for Vestibulodynia Associated With Painful Bladder Syndrome. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:131-137. [DOI: 10.1016/j.jogc.2016.12.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 12/04/2016] [Accepted: 12/23/2016] [Indexed: 11/16/2022]
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Current practice patterns for management of vulvodynia in the United States. Arch Gynecol Obstet 2016; 295:669-674. [DOI: 10.1007/s00404-016-4272-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 12/09/2016] [Indexed: 10/20/2022]
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Ventolini G. A New Line of Attack in Provoked Vulvodynia Management: Pain Neuromodulation? J Gynecol Surg 2016. [DOI: 10.1089/gyn.2016.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gary Ventolini
- School of Medicine, Texas Tech University and Health Sciences Center Permian Basin, Odessa, TX
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LePage K, Selk A. What Do Patients Want? A Needs Assessment of Vulvodynia Patients Attending a Vulvar Diseases Clinic. Sex Med 2016; 4:e242-e248. [PMID: 27484917 PMCID: PMC5121538 DOI: 10.1016/j.esxm.2016.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 06/18/2016] [Accepted: 06/23/2016] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Vulvodynia is a chronic pain disorder that negatively impacts the quality of life of affected women. AIM The goal of this study was to identify unmet needs among localized provoked vulvodynia patients. METHODS A qualitative needs assessment was performed in a subspecialized vulvar clinic in a single academic institution in Canada. Semistructured interviews were conducted, recorded, and analyzed using the constant comparative method of grounded theory to identify common themes. MAIN OUTCOME MEASURES Interviews were conducted until theme saturation was achieved. RESULTS A diverse sample of 8 patients completed all components of the study. The most prominent unmet needs raised by patients in their interviews were categorized into 3 main themes: (1) challenges related to obtaining a diagnosis of vulvodynia and finding practitioners who are knowledgeable about vulvodynia; (2) challenges related to the current impact of the disease physically, emotionally, and in social relationships with patients' intimate partners; and (3) barriers to adherence with recommended therapy. Solutions recommended by patients include better education of physicians regarding vulvodynia and the development of multidisciplinary programs that provide access to physiotherapy, sex therapy, mindfulness and psychology services on-site, information classes for new patients, and the creation of peer support networks for patients and their partners. CONCLUSION A patient-focused needs assessment suggests optimal vulvodynia care requires better education of physicians and a multimodal approach to therapy, ideally with multiple services offered in 1 location.
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Affiliation(s)
- Katherine LePage
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amanda Selk
- Department of Gynecology, Women's College Hospital, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.
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Neonatal vaginal irritation results in long-term visceral and somatic hypersensitivity and increased hypothalamic-pituitary-adrenal axis output in female mice. Pain 2016; 156:2021-2031. [PMID: 26098441 PMCID: PMC4578984 DOI: 10.1097/j.pain.0000000000000264] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Neonatal irritation of the vagina permanently sensitizes the vagina and distant somatic structures in a corticotrophin-releasing factor-dependent manner. Experiencing early life stress or injury increases a woman's likelihood of developing vulvodynia and concomitant dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis. To investigate the outcome of neonatal vaginal irritation (NVI), female mouse pups were administered intravaginal zymosan on postnatal days 8 and 10 and were assessed as adults for vaginal hypersensitivity by measuring the visceromotor response to vaginal balloon distension (VBD). Western blotting and calcium imaging were performed to measure transient receptor potential ankyrin 1 (TRPA1) and vanilloid 1 (TRPV1) in the vagina and innervating primary sensory neurons. Serum corticosterone (CORT), mast cell degranulation, and corticotropin-releasing factor receptor 1 (CRF1) expression were measured as indicators of peripheral HPA axis activation. Colorectal and hind paw sensitivity were measured to determine cross-sensitization resulting from NVI. Adult NVI mice had significantly larger visceromotor response during VBD than naive mice. TRPA1 protein expression was significantly elevated in the vagina, and calcium transients evoked by mustard oil (TRPA1 ligand) or capsaicin (TRPV1 ligand) were significantly decreased in dorsal root ganglion from NVI mice, despite displaying increased depolarization-evoked calcium transients. Serum CORT, vaginal mast cell degranulation, and CRF1 protein expression were all significantly increased in NVI mice, as were colorectal and hind paw mechanical and thermal sensitivity. Neonatal treatment with a CRF1 antagonist, NBI 35965, immediately before zymosan administration largely attenuated many of the effects of NVI. These results suggest that NVI produces chronic hypersensitivity of the vagina, as well as of adjacent visceral and distant somatic structures, driven in part by increased HPA axis activation.
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Schlabritz-Loutsevitch N, Gygax SE, Dick E, Smith WL, Snider C, Hubbard G, Ventolini G. Vaginal Dysbiosis from an Evolutionary Perspective. Sci Rep 2016; 6:26817. [PMID: 27226349 PMCID: PMC4880931 DOI: 10.1038/srep26817] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 05/09/2016] [Indexed: 12/11/2022] Open
Abstract
Evolutionary approaches are powerful tools for understanding human disorders. The composition of vaginal microbiome is important for reproductive success and has not yet been characterized in the contexts of social structure and vaginal pathology in non-human primates (NHPs). We investigated vaginal size, vulvovaginal pathology and the presence of the main human subtypes of Lactobacillus spp./ BV-related species in the vaginal microflora of baboons (Papio spp.). We performed morphometric measurements of external and internal genitalia (group I, n = 47), analyzed pathology records of animals from 1999–2015 (group II, n = 64 from a total of 12,776), and evaluated vaginal swabs using polymerase chain reaction (PCR) (group III, n = 14). A total of 68 lesions were identified in 64 baboons. Lactobacillus iners, Gardnerella vaginalis, Atopobium vaginae, Megasphaera I, and Megasphaera II were not detected. L. jensenii, L. crispatus, and L. gasseri were detected in 2/14 (14.2%), 1/14 (7.1%), and 1/14 (7.1%) samples, respectively. BVAB2 was detected in 5/14 (35.7%) samples. The differences in the vaginal milieu between NHP and humans might be the factor associated with human-specific pattern of placental development and should be taken in consideration in NHP models of human pharmacology and microbiology.
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Affiliation(s)
| | - Scott E Gygax
- Femeris Women's Health Research Center, Genesis Biotechnology Group - Hamilton, New Jersey, USA
| | - Edward Dick
- Southwest National Primate Research Center, San Antonio, Texas, USA
| | - William L Smith
- Femeris Women's Health Research Center, Genesis Biotechnology Group - Hamilton, New Jersey, USA
| | - Cathy Snider
- Southwest National Primate Research Center, San Antonio, Texas, USA
| | - Gene Hubbard
- University of Texas Health Sciences Center, San Antonio, Texas, USA
| | - Gary Ventolini
- Texas Tech University Health Sciences Center at the Permian Basin, Odessa, Texas, USA
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Leusink P, Kaptheijns A, Laan E, van Boven K, Lagro-Janssen A. Comorbidities Among Women With Vulvovaginal Complaints in Family Practice. J Sex Med 2016; 13:220-5. [PMID: 26782608 DOI: 10.1016/j.jsxm.2015.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/07/2015] [Accepted: 12/09/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The lifetime prevalence of women suffering from provoked vestibulodynia (PVD) is estimated to be approximately 15%. The etiology of PVD is not yet clear. Recent studies approach PVD as a chronic multifactorial sexual pain disorder. PVD is associated with pain syndromes, genital infections, and mental disorders, which are common diseases in family practice. PVD, however, is not included in the International Classification of Primary Care. Hence, the vulvovaginal symptoms, which could be suggestive of PVD, are likely to be missed. AIM To explore the relationship between specific vulvovaginal symptoms that could be suggestive of PVD (genital pain, painful intercourse, other symptoms/complaints related to the vagina/vulva), and related diseases such as pain syndromes, psychological symptom diagnoses, and genital infections in family practice. METHODS A retrospective analysis of all episodes from 1995 to 2008 in 784 women between 15 and 49 years were used to determine the posterior probability of a selected diagnosis in the presence of specific vulvovaginal symptoms suggestive of PVD expressed in an odds ratio. Selected comorbidities were pain syndromes (muscle pain, general weakness, irritable bowel syndrome [IBS]), psychological symptom diagnoses (anxiety, depression, insomnia), vulvovaginal candidiasis, and sexual and physical abuse. RESULTS Women with symptoms suggestive of PVD were 4 to 7 times more likely to be diagnosed with vulvovaginal candidiasis and 2 to 4 times more likely to be diagnosed with IBS. Some symptoms suggestive of PVD were 1 to 3 times more likely to be diagnosed with complaints of muscle pain, general weakness, insomnia, depressive disorder, and feeling anxious. CONCLUSION Data from daily family practice showed a clear relationship between symptoms suggestive of PVD and the diagnoses of vulvovaginal candidiasis and IBS in premenopausal women. Possibly, family doctors make a diagnosis of vulvovaginal candidiasis or IBS based only on clinical manifestations in many women in whom a diagnosis of PVD would be more appropriate.
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Affiliation(s)
- Peter Leusink
- Radboud University Medical Centre, Department of Primary and Community Care, Unit Gender & Women's Health, Nijmegen, The Netherlands.
| | - Anne Kaptheijns
- Radboud University Medical Centre, Department of Primary and Community Care, Unit Gender & Women's Health, Nijmegen, The Netherlands
| | - Ellen Laan
- Academic Medical Center, Department of Sexology and Psychosomatic Obstetrics and Gynaecology, University of Amsterdam, Nijmegen, The Netherlands
| | - Kees van Boven
- Radboud University Medical Centre, Department of Primary and Community Care, Unit Gender & Women's Health, Nijmegen, The Netherlands
| | - Antoine Lagro-Janssen
- Radboud University Medical Centre, Department of Primary and Community Care, Unit Gender & Women's Health, Nijmegen, The Netherlands
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Shah N, Ginzburg N, Morrissey D, Whitmore K. Update in Diagnosis and Treatment of Chronic Pelvic Pain Syndromes. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0302-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Identification of novel mechanisms involved in generating localized vulvodynia pain. Am J Obstet Gynecol 2015; 213:38.e1-38.e12. [PMID: 25683963 DOI: 10.1016/j.ajog.2015.02.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/12/2015] [Accepted: 02/09/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Our goal was to gain a better understanding of the inflammatory pathways affected during localized vulvodynia, a poorly understood, common, and debilitating condition characterized by chronic pain of the vulvar vestibule. STUDY DESIGN In a control matched study, primary human fibroblast strains were generated from biopsies collected from localized provoked vulvodynia (LPV) cases and from age- and race-matched controls. We then examined intracellular mechanisms by which these fibroblasts recognize pathogenic Candida albicans; >70% of vulvodynia patients report the occurrence of prior chronic Candida infections, which is accompanied by localized inflammation and elevated production of proinflammatory/pain-associated interleukin (IL)-6 and prostaglandin E2 (PGE2). We focused on examining the signaling pathways involved in recognition of yeast components that are present and abundant during chronic infection. RESULTS Dectin-1, a surface receptor that binds C albicans cell wall glucan, was significantly elevated in vestibular vs external vulvar cells (from areas without pain) in both cases and controls, while its abundance was highest in LPV cases. Blocking Dectin-1 signaling significantly reduced pain-associated IL-6 and PGE2 production during the response to C albicans. Furthermore, LPV patient vestibular cells produced inflammatory mediators in response to low numbers of C albicans cells, while external vulvar fibroblasts were nonresponsive. Inhibition of nuclear factor kappa-light-chain-enhancer of activated B cells (proinflammatory transcription factor) nearly abrogated IL-6 and PGE2 production induced by C albicans, in keeping with observations that Dectin-1 signals through the nuclear factor kappa-light-chain-enhancer of activated B cells pathway. CONCLUSION These findings implicate that a fibroblast-mediated proinflammatory response to C albicans contributes to the induction of pain in LPV cases. Targeting this response may be an ideal strategy for the development of new vulvodynia therapies.
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De Andres J, Sanchis-Lopez N, Asensio-Samper JM, Fabregat-Cid G, Villanueva-Perez VL, Monsalve Dolz V, Minguez A. Vulvodynia-An Evidence-Based Literature Review and Proposed Treatment Algorithm. Pain Pract 2015; 16:204-36. [DOI: 10.1111/papr.12274] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 11/05/2014] [Indexed: 01/23/2023]
Affiliation(s)
- Jose De Andres
- Valencia University Medical School; Valencia Spain
- Department of Anesthesiology Critical Care and Pain Management; General University Hospital; Valencia Spain
- Multidisciplinary Pain Management Department; General University Hospital; Valencia Spain
| | - Nerea Sanchis-Lopez
- Department of Anesthesiology Critical Care and Pain Management; General University Hospital; Valencia Spain
- Multidisciplinary Pain Management Department; General University Hospital; Valencia Spain
| | - Juan Marcos Asensio-Samper
- Department of Anesthesiology Critical Care and Pain Management; General University Hospital; Valencia Spain
- Multidisciplinary Pain Management Department; General University Hospital; Valencia Spain
| | - Gustavo Fabregat-Cid
- Department of Anesthesiology Critical Care and Pain Management; General University Hospital; Valencia Spain
- Multidisciplinary Pain Management Department; General University Hospital; Valencia Spain
| | - Vicente L. Villanueva-Perez
- Department of Anesthesiology Critical Care and Pain Management; General University Hospital; Valencia Spain
- Multidisciplinary Pain Management Department; General University Hospital; Valencia Spain
| | - Vicente Monsalve Dolz
- Department of Anesthesiology Critical Care and Pain Management; General University Hospital; Valencia Spain
- Multidisciplinary Pain Management Department; General University Hospital; Valencia Spain
| | - Ana Minguez
- Department of Anesthesiology Critical Care and Pain Management; General University Hospital; Valencia Spain
- Multidisciplinary Pain Management Department; General University Hospital; Valencia Spain
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Pierce AN, Christianson JA. Stress and Chronic Pelvic Pain. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2015; 131:509-35. [DOI: 10.1016/bs.pmbts.2014.11.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Reme SE, Kirste UM. Female genital pain – A biopsychosocial phenomenon involving fear and avoidance. Scand J Pain 2014; 5:191-192. [DOI: 10.1016/j.sjpain.2014.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Silje Endresen Reme
- Department of Pain Management and Treatment , Oslo University Hospital , Oslo , Norway
| | - Unni Merete Kirste
- Department of Pain Management and Treatment , Oslo University Hospital , Oslo , Norway
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Abstract
Chronic vulvar pain or discomfort for which no obvious etiology can be found, ie, vulvodynia, can affect up to 16% of women. It may affect girls and women across all age groups and ethnicities. Vulvodynia is a significant burden to society, the health care system, the affected woman, and her intimate partner. The etiology is multifactorial and may involve local injury or inflammation, and peripheral and or central sensitization of the nervous system. An approach to the diagnosis and management of a woman presenting with chronic vulvar pain should address the biological, psychological, and social/interpersonal factors that contribute to her illness. The gynecologist has a key role in excluding other causes for vulvar pain, screening for psychosexual and pelvic floor dysfunction, and collaborating with other health care providers to manage a woman's pain. An important component of treatment is patient education regarding the pathogenesis of the pain and the negative impact of experiencing pain on a woman's overall quality of life. An individualized, holistic, and often multidisciplinary approach is needed to effectively manage the woman's pain and pain-related distress.
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Affiliation(s)
- Leslie A Sadownik
- University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, BC, Canada
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Abstract
Vulvar pain syndromes, including vulvodynia, are a common source of morbidity in women and cause much physical and psychological suffering. This brief communication postulates the hypothesis that unexplained vulvar pain may be hitherto undescribed manifestation of painful sensory diabetic neuropathy. It describes the clinical characteristics of vulvodynia and highlights the similarities between this condition and diabetic neuropathy. The hypothesis calls for women presenting with vulvar pain to be screened for diabetes, as well as women with diabetes to be questioned about vulvar symptomatology. The paper hopes to stimulate extensive research in this important, but so far neglected, field of women's endocrine health.
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Affiliation(s)
- Bharti Kalra
- Department of Gynecology, Bharti Hospital and BRIDE, Karnal, Haryana, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
| | - Sarita Bajaj
- Department of Medicine, MLN Medical College, Allahabad, Uttar Pradesh, India
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