Abnormal vaginal microbioma is associated with severity of localized provoked vulvodynia. Role of aerobic vaginitis and Candida in the pathogenesis of vulvodynia

Abstract

Localized provoked vulvodynia (LPV) causes introital dyspareunia in up to 14% of premenopausal women. Vaginal infections like candidosis may play a initiating role. The aim of this study was to test a possible association of vaginal microbiota alternations such as Candida vaginitis (CV), aerobic vaginitis (AV) and bacterial vaginosis (BV) with severity of vulvodynia and painful intercourse. In an observational study, Q-tip touch test (score 1 (no pain) to 10 (worst possible pain)) was performed on seven vestibular locations in 231 LPV patients presenting in the Vulvovaginal Disease Clinics in Tienen, Leuven and Antwerp, Belgium. Severity of pain upon attempting sexual intercourse was recorded in a similar scale. Both scales were compared to results from fresh wet mount phase contrast microscopy on vaginal fluid smears tested for abnormal vaginal flora (AVF), BV, AV and CV according the standardized microscopy method (Femicare). Fisher's exact test was used. Average age was 31.3 ± 11.6 years, and 58.8% (n = 132) had secondary vestibulodynia. There was an inverse relation between the presence of Candida in the vaginal smears and pain score (p = 0.03). There was no relation of pain score, nor Q-tip score with BV. LPV patients with Q-tip score above 7 at 5 and/or 7 o'clock or at 1 and/or 11 o'clock had more often AV than women with lower pain scores (30 vs 14.5%, p = 0.01, and 39 vs 14.7%, p < 0.005, respectively). Detailed study of the vaginal microflora in patients demonstrates that the most severe patients suffer more from AV and less from Candida. These abnormalities need to be actively looked for and corrected before considering surgery or other therapies.

Evaluation of Gut Microbiota in Patients With Vulvovestibular Syndrome

“…Considering the close correlation between inflammation and bacteria, one of the current avenue of research in VVS pathogenesis is focused on the analysis of vaginal microbiome. In our previous study, we have demonstrated that vaginal microbiome is altered in women with VVS [10], and other studies have sug- [11,[25][26][27].…”

Current Practices on Diagnosis and Management of Women With Vulvodynia

“…This nding is consistent with Reed et al [1], who found that more than one-third of women diagnosed with vulvodynia were treated for candidiasis before receiving the nal diagnosis and presented no improvement in vulvar symptoms. A possible explanation for the large number of women treated for candidiasis before reaching the nal diagnosis also relies on the pathogenesis of vulvodynia that associates a high prevalence of yeast infections preceding VVD diagnosis [18]. However, it is important to consider that a large number of women might be diagnosed with candidiasis when complaining of vulvodynia symptoms.…”

Bakteriyel vajinoz ve tedavisinin cinsel fonksiyonlar üzerine etkileri: Bir kesitsel anket çalışması

“…Patients have stated that they feel dirty and bad, were ashamed of their condition and avoided sexual intercourse [17]. In another study carried out Donders and colleagues, it was stated that abnormal vaginal microbiome caused vulvodynia, the most frequent cause was bacterial vaginosis, and this in turn caused sexual dysfunction in patients [18].…”