Clinical Characteristics and Psychopathological Profile of Patients with Vulvodynia: An Observational and Descriptive Study

Abstract

Background: Vulvodynia is a fairly common dermatological symptom that often interferes with the personal, social and working activities of affected women and results in a significant loss of their quality of life. It is a persistent and tedious clinical disorder which is often resistant to conventional treatments. Objectives: The aim of this study is to evaluate the main clinical signs, associated psychopathological disorders and outcome after antidepressant treatment of patients with vulvodynia. Methods: Eighty patients were included. Clinical characteristics and psychopathological profiles were determined by appropriate instruments. The improvement of clinical symptoms after combined antidepressant drug therapy was also evaluated. Results: Pain (70%), burning (63.7%), dyspareunia (57.5%) and stinging (56.2%) were the most commonly reported symptoms. Most patients (56.5%) showed anxiety, and 52.2% of them were reported as having a depression disorder. When evaluated by psychometric tools, 81.4% of patients scored >150 on the Life Event Scale, which means a risk >50% of suffering an illness in the near future, and patients’ scores in the Dermatology Life Quality Index showed higher values than the mean of the Spanish validation group. After 6 months of combined treatment with escitalopram (10–20 mg/day), perfenazine (2–4 mg/day) and amytriptiline (10 mg/day), a complete remission of the clinical symptoms was achieved in 41% of patients. In contrast, only 12% of patients who did not follow drug treatment reported a complete resolution of the clinical symptoms. Conclusions: Our results seem to confirm that vulvodynia is associated with psychiatric co-morbidity such as stress and depression. The study highlights that the psychiatric treatment may be a useful option to improve clinical symptoms. Whether these patients should be evaluated for depression or be referred to a psychiatrist, remains to be investigated.

Assessment of Vulvodynia Symptoms in a Sample of U.S. Women: A Follow-up National Incidence Survey

“…Pharmacological or behavioral treatment can also have a substantial impact on reduction of symptoms, [16][17][18] with a recent study demonstrating complete symptom resolution in Ͼ40% of patients treated with combination antidepressent therapy for 6 months. 19 Even if symptoms had resolved, however, original cases still should have answered "yes" to the vulvodynia screening question, as it queried for lifetime history of symptoms. Alternately, these cases may have denied symptoms because of embarrassment or discomfort as a result of the possibility of being overheard by others in close proximity during the time of the survey.…”

Remission, Relapse, and Persistence of Vulvodynia: A Longitudinal Population-Based Study

“…[28][29][30][31] We found that very few women were being treated for their vulvar pain, with the most likely treatment being topical estrogen -progesterone. Treatments were not associated with remission or relapse.…”

Vulvodynia – still a challenging therapeutic problem

“…Podstawą rozpoznania jest szczegółowo zebrany wywiad, brak odchyleń w badaniu przedmiotowym oraz badaniach laboratoryjnych. Choroba znacząco obniża jakość życia, utrudniając codzienne funkcjonowanie w sferze seksualnej oraz psychospołecznej, i nierzadko współwystępuje z depresją, zaburzeniami obsesyjno-kompulsywnymi oraz zaburzeniami lęko-wymi [8,9]. Dotąd nie opublikowano jednoznacznych wytycznych dotyczących postępowania terapeutycznego, popartych badaniami z randomizacją.…”

“…The disease has been shown to significantly decrease the quality of life in affected patients, and have a severe adverse impact on their psychosocial and sexual functioning. It is not uncommon for women with vulvodynia to also suffer from depression, obsessive-compulsive and anxiety disorders [8,9]. There are, as yet, no definitive published guidelines for the therapeutic management of the condition, supported by randomized trials.…”