Locating Pain in Breast Cancer Survivors Experiencing Dyspareunia

Goetsch, Martha F.; Lim, Jeong Youn; Caughey, Aaron B.

doi:10.1097/aog.0000000000000283

Cited by 45 publications

(31 citation statements)

References 13 publications

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“…Indeed, localized vestibular pain is not unique to LPV. Recently, the chronic pain of atrophic vaginitis has been shown by sensory testing to be localized to the vulvar vestibule rather than the vagina [30]. Based upon our research and that of others[71], we can propose the following mechanism for secondary LPV, and potentially other subtypes.…”

Section: Discussionmentioning

confidence: 52%

Site-specific mesenchymal control of inflammatory pain to yeast challenge in vulvodynia-afflicted and pain-free women

Foster

Falsetta²,

Woeller³

et al. 2015

Pain

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Fibroblast strains were derived from two regions of the lower genital tract of localized provoked vulvodynia (LPV) cases and pain-free controls. Sixteen strains were derived from four cases and four controls, age and race matched, following pre-sampling mechanical pain threshold assessments. Strains were challenged with six separate stimuli: live yeast species (C. albicans, C. glabrata, C. tropicalis, and S. cerevisiae), yeast extract (zymosan), or inactive vehicle. Production of prostaglandin E2 (PGE2) and interleukin-6 (IL-6) were pro-inflammatory response measures. Highest IL-6 and PGE2 occurred with vestibular strains following C. albicans, C. glabrata, and zymosan challenges, resulting in the ability to significantly predict IL-6 and PGE2 production by genital tract location. Following C. albicans and C. glabrata challenge of all sixteen fibroblast strains, adjusting for dual sampling of subjects, PGE2 and IL-6 production significantly predicted the pre-sampling pain threshold from the genital tract site of sampling. At the same location of pain assessment and fibroblast sampling, in situ immunohistochemical (IHC)(+) fibroblasts for IL-6 and Cox-2 were quantified microscopically. The correlation between IL-6 production and IL-6 IHC(+) was statistically significant yet biological significance is unknown because of the small number of IHC(+) IL-6 fibroblasts identified. A low fibroblast IL-6 IHC(+) count may result from most IL-6 produced by fibroblasts existing in a secreted, extracellular state. Enhanced, site-specific, innate immune responsiveness to yeast pathogens by fibroblasts may be an early step in LPV pathogenesis. Fibroblast strain testing may offer an attractive/objective marker of LPV pathology in women with vulvodynia of inflammatory origin.

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Section: Discussionmentioning

confidence: 52%

Site-specific mesenchymal control of inflammatory pain to yeast challenge in vulvodynia-afflicted and pain-free women

Foster

Falsetta²,

Woeller³

et al. 2015

Pain

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“…Hyaluronic acid or lidocaine are additional topical therapies that are options for GSM. 6,7 Although these may provide some symptom relief from vaginal dryness, they do not treat the underlying cause of symptoms or loss of vaginal elasticity. Several small prospective nonrandomized trials have supported that the treatment is effective for relief of symptoms of GSM such as vaginal dryness, vaginal itching, and dyspareunia in postmenopausal and perimenopausal women.…”

Section: Time For Action: Managing Genitourinary Syndrome Of Menopausementioning

confidence: 99%

Time for Action: Managing Genitourinary Syndrome of Menopause

Williams

Lustberg

2019

JOP

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“…This study underlines the importance of the vestibule in the perception of pain with intercourse and suggests a role for a hormonal effect on the development of vestibular pain. 23 …”

Section: Hormonal Influencesmentioning

confidence: 99%

Vulvar Vestibulodynia

Bonham¹

2015

Obstetrical &Amp; Gynecological Survey

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Vulvodynia is a condition that affects approximately 8% to 12% of women during their lifetimes. Vulvar vestibulodynia (VVD), the most common form of this condition, is characterized by pain with touch at the vulvar vestibule and resulting entryway dyspareunia. Studies suggest a multifactorial etiology; hormonal effects, muscle dysfunction, personality, psychosocial factors, and inflammatory mediators may all play some role in the development of this condition. Both peripheral and central sensitization to pain have been implicated in the development of enhanced pain experienced by women with VVD. Recommendations for the treatment of this condition exist; however, treatments of this condition have not been well studied. Few prospective placebo-controlled trials exist, and many of those that do have failed to show clinically relevant efficacy associated with traditional therapies. New studies into the etiology of this condition, as well as potential new therapies, are emerging, but the optimal approach has yet to be defined. Proper vulvar hygiene is recommended, and traditional therapies such as topical medications and centrally acting oral medications may continue to play a role in treatment. Newer studies elucidating the effects of personality and cognitive factors as well as pelvic floor muscle dysfunction in the development of this condition lend support for the inclusion of cognitive behavioral therapy and physical therapy/surface electromyographic biofeedback in the treatment regimen. Surgery for this condition exists, with success rates of 60% to 90%; however, it is recommended only in cases that have failed to respond to traditional therapy.

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Locating Pain in Breast Cancer Survivors Experiencing Dyspareunia

Abstract: I.

Cited by 45 publications

References 13 publications

Site-specific mesenchymal control of inflammatory pain to yeast challenge in vulvodynia-afflicted and pain-free women

Site-specific mesenchymal control of inflammatory pain to yeast challenge in vulvodynia-afflicted and pain-free women

Time for Action: Managing Genitourinary Syndrome of Menopause

Vulvar Vestibulodynia

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