Comorbidities Among Women with Vulvovaginal Complaints in Family Practice

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.

Loneliness Mediates the Relationship Between Pain During Intercourse and Depressive Symptoms Among Young Women

“…In a study of 63 women with chronic pelvic pain, increased pelvic pain and decreased sexual function were significantly related to increased depressive symptoms, which in turn was related to decreased support, defined by relationship quality with their partners (Randolph & Reddy, 2006). A large retrospective analysis of clinical data from the Netherlands found that women with genital pain, painful intercourse, and/or other vaginal/vulvar complaints were over twice as likely to experience clinically significant depressive symptoms (Leusink, Kaptheijns, Laan, van Boven, & Lagro-Janssen, 2016). Similarly, Khandker et al (2011) found that a DSM-IV diagnosed depressive disorder was an independent risk factor for subsequent vulvodynia, and vulvodynia increases the risk of new and recurrent onset of a mood disorder, highlighting the bidirectional temporal relationship between pain during intercourse and depressive symptoms.…”

A prospective study to compare the efficacy and safety of tioconazole and clotrimazole vaginal gel in patients suffering from vulvovaginal candidiasis

“…Provoked vestibulodynia is 4-7 times more common with vulvovaginal candidiasis and treatment of the cause would result in relief of the symptoms. 12 About 8.2% of the total cases among tioconazole gel group experience an adverse event which was slightly more as compared to 4.5% in clotrimazole gel group wherein the difference was insignificant. Out of this most common was pruritis followed by burning and irritation among both the groups.…”

Sensory processing of women diagnosed with genito-pelvic pain/penetration disorder: a research proposal

“…Anxiety has been confirmed to accompany diagnoses of both sensory processing [20,22,23,36] and sexual pain disorders [37][38][39][40][41][42]. The presence of SPD is not only a risk factor for the development of mental health conditions, e.g.…”