Vulvodynia: New Thoughts on a Devastating Condition

Gunter, Jennifer

doi:10.1097/01.ogx.0000290350.14036.d6

Cited by 37 publications

(44 citation statements)

References 90 publications

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“…1 With unexplained vulvar pain now known to be common (lifetime risk and prevalence of 16% and 7%, respectively), 2 the continued lack of information available about antecedent risk factors and treatment has become a source of frustration for many women and their healthcare providers. 3 Diagnosable psychologic disorders, such as depression and anxiety, have not been thoroughly examined in the pathogenesis of vulvodynia, as they have for many medical conditions (e.g., urinary tract or yeast infections). 1,7 One reason for this disparity lies in the complexity of determining if psychologic disorders precede the onset of vulvodynia or occur primarily as a consequence of chronic vulvar pain.…”

Section: Introductionmentioning

confidence: 99%

The Influence of Depression and Anxiety on Risk of Adult Onset Vulvodynia

Khandker

Brady

Vitonis

et al. 2011

Journal of Women's Health

181

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Background: Studies have shown that women with vulvodynia are more psychologically distressed than women without vulvodynia. These studies, however, have not effectively established temporal associations between diagnosed psychiatric disorders and vulvodynia. Methods: The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) was administered to 240 casecontrol pairs of women with and without vulvodynia. Interviews established age at first onset of diagnosed mood and anxiety disorder. Age information was used to determine whether the first episode of mood and/or anxiety was antecedent or subsequent to the first onset of vulvodynia symptoms. Conditional logistic regressions tested whether antecedent depression or anxiety was more likely among women with or without vulvodynia. Cox proportional hazards modeling was then used to estimate risk of subsequent new or recurrent onset of mood or anxiety disorder. Results: After adjusting for education, race, age at menarche, age at first tampon use, and age at first sexual intercourse, odds of vulvodynia were four-times more likely among women with antecedent mood or anxiety compared to women without (95% confidence interval [CI] 2.1-7.5). Vulvodynia was associated with new or recurrent onset of mood or anxiety disorder after adjustment (hazard ratio [HR] 1.7, 95% CI 1.1-2.6) and did not significantly change after including history of mood or anxiety disorder before the onset of vulvodynia or reference age of controls in the models. Conclusions: This is the first community-based epidemiologic study demonstrating that DSM-IV-diagnosed antecedent depression and anxiety disorders influence the risk of vulvodynia and that vulvodynia increases the risk of both new and recurrent onset of psychopathology.

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Section: Introductionmentioning

confidence: 99%

The Influence of Depression and Anxiety on Risk of Adult Onset Vulvodynia

Khandker

Brady

Vitonis

et al. 2011

Journal of Women's Health

181

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“…Niektórzy autorzy wskazują, że ze względu na dużą liczbę potencjalnych czynników etiologicznych może istnieć wiele chorób powodujących podobne objawy, a w efekcie prowadzić do wulwodynii [3,23]. Jednocześnie zwracają uwagę aktualne szacunki co do rozpowszechnienia tego zaburzenia.…”

Section: Dyskusjaunclassified

Vulvodynia: diagnosis and therapy. Part 2

Wachowska¹,

Florkowski²,

Orzechowska³

et al. 2012

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StreszczenieWulwodynia to zaburzenie polegające na chronicznym bólu lub dyskomforcie, charakteryzującym się uczuciem palenia, kłucia czy podrażnienia żeńskich narządów płciowych w przypadkach, kiedy nie występuje żadna infekcja czy choroba skóry sromu lub pochwy powodująca takie objawy. Wulwodynia to syndrom kliniczny, na który wg aktualnych oszacowań może cierpieć 15% kobiet. Obserwacje kliniczne wskazują na istnienie różnych podtypów wulwodynii, wydzielonych na podstawie ich etiologii. Wskazywany jest wielowymiarowy negatywny wpływ tego schorzenia na funkcjonowanie kobiet, a jednocześnie brak jednoznacznych odpowiedzi co do jego etiologii, skutecznych sposobów leczenia, zapobiegania oraz danych dotyczących rozpowszechnienia. Autorzy artykułu dokonują przeglądu najważniejszych informacji dotyczących wulwodynii. W tej części artykułu zostały przedstawione i opisane charakterystyczne objawy stanowiące obraz kliniczny wulwodynii. Podstawą takiego rozpoznania jest wykluczenie w badaniu fizykalnym istniejącej i możliwej do określenia zmiany okolic sromu. Autorzy prezentują także proponowane przez badaczy algorytmy postępowania z pacjentkami, u których moż-liwe jest rozpoznanie wulwodynii. Opisane zostały także proponowane przez różnych badaczy metody terapeutyczne. Przedstawiono proponowane w literaturze metody farmakologiczne. Podkreślono także brak konsensusu w środowisku specjalistów co do możliwości wykorzystywania metod operacyjnych. Zwrócono również uwagę na możliwości stosowania fizjoterapii w leczeniu wulwodynii. Autorzy zauważają także, że wskazane jest otoczenie pacjentek pomocą psychologiczną oraz zastosowanie psychoedukacji. Przedstawiono również opisywane w literaturze metody alternatywne, takie jak hipnoza, akupunktura i biofeedback.

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“…57 Chronic pain can be a disease process itself, irrelevant to verification by physical signs. 63 Although triggering pathology like trauma or infection may be present, the pathological process results from disturbances in the central nervous system (CNS). 63 Support for this theory is found in the fact that local vulvar dysesthesia often occurs in association with other pain syndromes, including pelvic floor dysfunction, 64 68 In addition, women with localized vulvar pain have heightened responses to noxious stimuli in the vulvar area as well as sites distant to the genitalia, including mechanical thermal and chemical stimuli.…”

mentioning

confidence: 99%

“…63 Although triggering pathology like trauma or infection may be present, the pathological process results from disturbances in the central nervous system (CNS). 63 Support for this theory is found in the fact that local vulvar dysesthesia often occurs in association with other pain syndromes, including pelvic floor dysfunction, 64 68 In addition, women with localized vulvar pain have heightened responses to noxious stimuli in the vulvar area as well as sites distant to the genitalia, including mechanical thermal and chemical stimuli. 63 The affected tissue is hyperalgesic to thermal tactile and pressure stimuli, sometimes involving a hyperpathic "after pain" that lasts for minutes after stimulus removal.…”

mentioning

confidence: 99%

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Chronic Pain of the Vulva without Dermatologic Manifestations: Distinguishing among a Spectrum of clinical Disorders

Farage

Miller

Summers

et al. 2010

Clin Med�Insights�Womens�Health

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Abstract:The causes of chronic vulvar pain are many and when not accompanied by obvious physical signs they are difficult to unravel. Many common vulvar dermatoses can manifest without obvious erythema or mucocutaneous lesions, as can some less common disorders of both infectious and allergic origin. In addition localized and generalized vulvar dysesthesia, recently defined chronic pain syndromes of neurogenic origin, can also occur in the vulvar area. Chronic vulvovaginal symptoms in early stages are often presumptuously labeled as vulvovaginal candidiasis (VVC) by patients and clinicians alike, which can delay accurate diagnosis. When presented with chronic vulvar pain unaccompanied by verifiable signs, the clinician must effect a sensitive integration of a detailed medical history, including temporal associations of all potential exposures, with more definitive diagnostic tools. Effective use of those available tools can improve initial diagnosis, thus allowing prompt initiation of effective therapy. Optimal therapy will recognize the significant psychological distress that accompanies any chronic pain syndrome.

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Vulvodynia: New Thoughts on a Devastating Condition

Abstract: After completion of this article, the reader should be able to state that vulvodynia is a complex disorder, explain that no one treatment is superior, relate that pathophysiology is important, and recall that psychological aspects of chronic pain must be appreciated.

Cited by 37 publications

References 90 publications

The Influence of Depression and Anxiety on Risk of Adult Onset Vulvodynia

The Influence of Depression and Anxiety on Risk of Adult Onset Vulvodynia

Vulvodynia: diagnosis and therapy. Part 2

Chronic Pain of the Vulva without Dermatologic Manifestations: Distinguishing among a Spectrum of clinical Disorders

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