Biopsychosocial Predictors of Postmenopausal Dyspareunia: The Role of Steroid Hormones, Vulvovaginal Atrophy, Cognitive‐Emotional Factors, and Dyadic Adjustment

Kao, Alina; Binik, Yitzchak M.; Amsel, Rhonda; Funaro, Deana; Leroux, Nathalie; Khalifé, Samir

doi:10.1111/j.1743-6109.2012.02771.x

Cited by 46 publications

(33 citation statements)

References 34 publications

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“…A recent literature review reports the prevalence of postmenopausal dyspareunia ranging from 2% to 29% 17 and another study found that vulvodynia remains significant at 8% from adulthood until age 70 years. 18 Kao et al 19 reported that 95% of menopausal women with dyspareunia also had localized provoked pain in the vestibule despite the use of hormone supplements in 31% of patients. Because postmenopausal women continue to stay sexually active, dyspareunia, and specifically vestibulodynia, are of clinical and scientific importance.…”

Section: Discussionmentioning

confidence: 98%

“…17,26 In 95% of her postmenopausal cohort with vestibular pain and dyspareunia, women used a variety of estrogen supplements and atrophy varied but vestibular pain persisted. 19 This study describes the histologic profile of vestibulodynia in a menopausal population and includes representative patients in categories of premenopausal primary vestibulodynia, premenopausal secondary vestibulodynia, and now menopausal vestibulodynia. One limitation of this retrospective study is the ability to draw conclusions from these comparisons of small subgroups.…”

Section: Discussionmentioning

confidence: 99%

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Histopathologic Characteristics of Menopausal Vestibulodynia

Leclair

Goetsch

et al. 2013

Obstetrics &Amp; Gynecology

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Histopathologic Characteristics of Menopausal Vestibulodynia

Leclair

Goetsch

et al. 2013

Obstetrics &Amp; Gynecology

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“…Negative attitudes toward menopause were also a factor in greater symptom burden (Yanikkerem et al 2012 ). A second study in 182 women with dyspareunia revealed that rather than estrogen concentrations, pain was associated with cognitive, affective and dyadic variables (Kao et al 2012 ). In research to date, studies generally address one or the other of these types of etiologies, but rarely examine how biologic and psychosocial factors may be additive or synergistic.…”

Section: Challenges Of Managing Menopausal Symptomsmentioning

confidence: 98%

Symptoms: Menopause, Infertility, and Sexual Health

Barton

Ganz

2015

Improving Outcomes for Breast Cancer Survivors

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By 2022, the number of survivors is expected to grow to nearly 18 million. Therefore, addressing acute and chronic negative sequelae of a cancer diagnosis and its treatments becomes a health imperative. For women with a history of breast cancer, one of the common goals of treatment and prevention of recurrence is to reduce circulating concentrations of estradiol, especially in women with hormone receptor positive breast cancer. Hormone deprivation after a diagnosis of breast cancer impacts physiological targets other than in the breast tissue and can result in unwanted side effects, all of which can negatively impact quality of life and function and cause distress. Symptoms that are most strongly linked by evidence to hormone changes after cancer diagnosis and treatment include hot flashes, night sweats, sleep changes, fatigue, mood changes, and diminishing sexual function, including vaginal atrophy (decreased arousal, dryness and dyspareunia), infertility, decreased desire and negative self-image. Weight gain and resulting body image changes are often concomitants of the abrupt onset of treatment-induced menopause. The purpose of this chapter is to briefly review what is known about the advent of premature menopause in women treated for breast cancer, menopausal symptoms that are exacerbated by endocrine treatments for breast cancer, and the associated concerns of hot flashes and related menopausal symptoms, sexual health and fertility issues. We will discuss limitations in the current research and propose strategies that address current limitations in order to move the science forward.

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“…Although vulvar pain symptoms can occur at any time over the life span, it is not uncommon for symptoms to begin for the first time after menopause [1–3]. In fact, the prevalence of chronic vulvar pain in mid-life women has been estimated to be 8.9-38 % percent, making chronic vulvar pain a major health concern for women in this age group [4, 5].…”

Section: Introductionmentioning

confidence: 99%

“…However, evidence indicates that postmenopausal vulvar pain may occur for other reasons as well [6–9]. Additionally, women with atrophy do not all experience pain [7], episodes of postmenopausal vulvar pain are not all successfully treated using estrogen therapy [8, 9], and in a recent study serum estradiol, estrone, and progesterone levels of postmenopausal women were not tightly correlated with vulvar pain [3]. These findings suggest that some vulvar pain reported by postmenopausal women may be a condition other than atrophy, such as vulvodynia, and present independent of estrogen-or atrophyrelated changes.…”

Section: Introductionmentioning

confidence: 99%

Chronic vulvar pain in a cohort of post-menopausal women: Atrophy or Vulvodynia?

Mitro¹,

Harlow²,

Randolph³

et al. 2016

womens midlife health

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BackgroundAlthough postmenopausal vulvar pain is frequently attributed to vaginal atrophy, such symptoms may be due to vulvodynia, a chronic vulvar pain condition. Given the limited research on vulvodynia in postmenopausal women, the objective of this study was to provide preliminary population-based data on the associations of vaginal symptoms, serum hormone levels and hormone use with chronic vulvar pain in a multiethnic sample of post-menopausal women.MethodsWe used data from 371 participants at the Michigan site of the Study of Women’s Health Across the Nation (SWAN) who participated in the 13th follow-up visit. Women completed a validated screening instrument for vulvodynia and provided information on additional vaginal symptoms as well as demographic characteristics, and hormone use by questionnaire. Blood samples were obtained to assess hormone levels. We compared women who screened positive for vulvodynia and women with past or short-duration vulvar pain to women without vulvar pain, using Chi-squared and Fisher’s Exact tests. Relative odds ratios and 95 % confidence intervals were calculated using multinomial logistic regression models adjusting for age, body mass index, and race/ethnicity.ResultsCurrent chronic vulvar pain consistent with vulvodynia was reported by 4.0 % of women, while 13.7 % reported past but not current chronic vulvar pain or short-duration vulvar pain symptoms. One quarter of women who reported current chronic vulvar pain did not report vaginal dryness. Women with current chronic and with past/short duration vulvar pain symptoms were more likely to have used hormones during the preceding year than women without vulvar pain symptoms (13.3 %, 17.6 %, 2.0 %, respectively; p < .01). Increased relative odds of current vulvar pain symptoms were associated with each log unit decrease in serum dehydroepiandrosterone-sulfate, estradiol and testosterone levels at the previous year’s visit.ConclusionSome women who experience chronic vulvar pain symptoms do not report vaginal dryness, and others report continued or first onset of pain while using hormones. Vulvodynia should be considered in the differential diagnosis of postmenopausal women presenting with vulvar pain symptoms.

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Biopsychosocial Predictors of Postmenopausal Dyspareunia: The Role of Steroid Hormones, Vulvovaginal Atrophy, Cognitive‐Emotional Factors, and Dyadic Adjustment

Cited by 46 publications

References 34 publications

Histopathologic Characteristics of Menopausal Vestibulodynia

Histopathologic Characteristics of Menopausal Vestibulodynia

Symptoms: Menopause, Infertility, and Sexual Health

Chronic vulvar pain in a cohort of post-menopausal women: Atrophy or Vulvodynia?

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