Mental health among college students a year after COVID-19 outbreak in Israel: The association between wellbeing and anxiety.

Objective: To evaluate anxiety and well-being among college students. Participants: The sample comprised 366 college students who responded to an online survey In January 2021. Methods: An online survey included demographics, a 7-item Generalized Anxiety Disorder Scale (GAD-7), and a 14-item Mental Health Continuum-Short Form (MHC-SF) measuring well-being. Results: Findings revealed low self-rated well-being compared to the general population. The mean anxiety level was 8.89, and 39% of respondents showed moderate to severe anxiety. Negative correlations were found between well-being and anxiety. A regression model showed that students who live with their parents, had been diagnosed with COVID-19, and have low emotional well-being scores, are at risk of suffering from anxiety (R2=0.32, F = 53, p < 0.001). Conclusions: Student mental health is significantly affected by the pandemic and should be carefully monitored. It is crucial to provide timely psychological support to prevent negative long-term implications of the crisis on student mental health.

How Does Myofascial Physical Therapy Attenuate Pain in Chronic Pelvic Pain Syndrome?

Background: Chronic pelvic pain syndrome (CPPS) is a multifactorial disorder comprising structural and functional muscular abnormalities, a dysfunctional pain system, and psychological distress. Myofascial physical Therapy (MPT) that is targeted at improving pelvic muscle functioning is considered a first line nonpharmacological treatment for CPPS, although the precise mechanisms that lead to symptoms alleviation have not yet been elucidated. Purpose: This longitudinal study aimed to examine the local and systemic effects of MPT intervention, including biopsychophysiological processes, among CPPS patients. Methods: The study included 50 CPPS women. Morphologic assessment of the levator ani and quantitative sensory testing of the pain system were applied alongside with evaluation of pain-related psychological factors using designated questionnaires. All measures were evaluated both before and after MPT in 39 patients. The long-term effects of MPT were evaluated by clinical pain reports obtained at 3 and 9 months following MPT that were compared with a nontreated group of 11 untreated CPPS women. Results: Along with an improvement in the clinical pain intensity (p = 0.001) and sensitivity to experimental pain tests (p = 0.001) following MPT, the results also indicate that MPT has anatomical, psychological, and social therapeutic effects (p = 0.04; p = 0.001; p = 0.01, respectively). Furthermore, clinical pain evaluation at 3 and 9 months after MPT revealed a significant improvement in women who received treatment (p = 0.001). Conclusions: The findings of this pilot study suggest multisystemic (direct and indirect anatomical, neurophysiological, and psychological) effects of MPT on the multifactorial pain disorder of CPPS and therefore place MPT as a mechanism-based intervention.

Localized Provoked Vulvodynia: Association With Nerve Growth Factor and Transient Receptor Potential Vanilloid Type 1 Genes Polymorphisms.

OBJECTIVE: The aim of the study was to study the associations between localized provoked vulvodynia (LPV) and several single-nucleotide polymorphisms (SNPs) in the transient receptor potential vanilloid type 1 (TRPV1), nerve growth factor (NGF), and the heparanase (HPSE) genes. MATERIALS AND METHODS: Prevalence of SNPs among 65 women with moderate or severe primary LPV (initial symptoms occur with first provoking physical contact) and 126 healthy, ethnically matched controls was analyzed in an observational case-control study. Each participant answered a questionnaire addressing familial LPV occurrence and comorbid pain conditions. RESULTS: Familial occurrences of LPV, temporomandibular joint (TMJ) symptoms, recurrent vaginitis, and irritable bowel syndrome were significantly higher among LPV women than healthy controls. Genotyping analyses revealed a novel, statistically significant high prevalence of polymorphism c.945G>C (rs222747) of TRPV1 and a SNP in the promoter region of NGF (rs11102930) in LPV women compared with controls. A logistic regression model for rs222747 and rs11102930 frequent alleles indicates significant LPV association within the entire study group and Ashkenazi Jewish women, respectively. Comparison of pain conditions with frequent alleles showed the rs222747 "CC" genotype of TRPV1 associated with women with TMJ, recurrent vaginitis, and LPV. CONCLUSIONS: Our results suggest novel genetic susceptibility to primary LPV associated with specific alleles in genes TRPV1 and NGF and propose the rs222747 "C" allele of TRPV1 as a common genetic predisposition for other pain syndromes.

Negative Illness Perceptions are Associated With a Pronociceptive Modulation Profile and Augmented Pelvic Pain.

OBJECTIVES: A patient's personal interpretations of a health threat or "illness perceptions" (IPs) are associated with their clinical outcomes. This study explored whether IPs are associated with pain severity and ability to modulate pain in women with chronic pelvic pain syndrome (CPPS), as well as the predictive value of IPs on myofascial manual therapy (MMT) success. MATERIALS AND METHODS: Illness Perceptions Questionnaire-Revised (IPQ-R), mechanical and heat pain thresholds, mechanical temporal summation, and conditioned pain modulation (CPM) were evaluated in CPPS patients (n=39) before, and 3 months after MMT. CPPS severity was obtained by the Brief Pain Inventory (BPI). RESULTS: Stronger perceptions of illness chronicity were correlated with less efficient CPM (r=0.488, P=0.002) and increased mechanical pain intensity (r=0.405, P=0.02). Lower perceptions of control over illness were associated with enhanced mechanical temporal summation (r=0.399, P=0.01). Higher BPI scores were correlated with emotional representations (negative emotional representations) and severe consequences due to CPPS. Regression analyses revealed that negative IPs predict less efficient MMT. DISCUSSION: Cognitive representations play a unique role in CPPS expression and MMT outcomes. The interplay between negative IPs and a pronociceptive modulation profile, mediated by enhanced facilitatory and reduced inhibitory processes, may be involved in the manifestation of CPPS.

A common pronociceptive pain modulation profile typifying subgroups of chronic pelvic pain syndromes is interrelated with enhanced clinical pain.

Provoked vestibulodynia (PVD) and painful bladder syndrome (PBS), subgroups of chronic pelvic pain syndromes (CPPS), are considered to share common biophysiological peripheral mechanisms. In addition, indications of a pronociceptive pain profile coexisting with psychological vulnerability suggest common dysfunctional pain processing and pain modulation in these 2 subgroups of CPPS. We therefore aimed at comparing the pain profile and psychological traits of patients with PVD and PBS to see whether the pain profile contributes to intersubject variability of clinical pain symptoms. Patients with PVD (n = 18) and PBS (n = 21) were compared with healthy controls (n = 20) in their responses to (1) pain psychophysical tests applied to both referred (suprapubis) and remote (hand) body areas and (2) pain-related psychological factors (pain catastrophizing, depression, anxiety, and somatization). We found a similar pronociceptive pain profile in the 2 subgroups of CPPS-enhanced facilitation (ie, hyperalgesia in the referred body area [P < 0.001]) and inefficient inhibition (ie, reduced conditioned pain modulation [P < 0.001] that were associated with both enhanced pain ratings evoked during trigger point examination [P < 0.037]) and higher Brief Pain Inventory ratings (P = 0.002). The latter was also correlated with pain catastrophizing (r = 0.504, P = 0.001) and depression symptoms (r = 0.361, P = 0.024). The findings suggest common mechanisms underlying a dysfunctional nociceptive system in both PVD and PBS. The intersubject variability in the level of dysfunction and its association with disease severity recommends a personalized pain treatment that may alleviate daily pain and dysfunction in patients with CPPS.

The use of dehydroepiandrosterone in the treatment of hypoactive sexual desire disorder: a report of gender differences.

Data regarding the efficacy of dehydroepiandrosterone (DHEA) in the treatment of hypoactive sexual desire disorder (HSDD) are scarce and inconsistent. We aimed to determine possible gender differences in the efficacy of DHEA as a treatment for HDSS. Postmenopausal women (n=27), and men (n=21) with HSDD, were randomized to receive either DHEA 100 mg daily or placebo for 6 weeks in a controlled, double blind study. Primary outcome measures were sexual function questionnaires. Hormone serum levels of DHEAS, total and bioavailable testosterone, estradiol, and urine levels of DHEA and androsterone were also measured. Participants on active treatment showed a significant increase in circulating serum levels of DHEAS, while bioavailable testosterone levels increased in women only. In women only, significant interaction effects were observed for sexual arousal (p<0.05), satisfaction (p<0.05), and cognition (trend; p=0.06). For arousal, a significant improvement was observed for the DHEA treated group at 6 weeks (p=0.001). Significant correlations were observed between bioavailable T and sexual cognitions, arousal and orgasm, while DHEAS was correlated with satisfaction. In the men, significant correlations were observed between testosterone and arousal (r=.45), sexual drive (r=.50) and orgasm (r=.55). In women with HSDD, DHEA treatment had a significant beneficial effect on arousal, whereas no efficacy was demonstrated in men, indicating a possible gender difference. This improvement seems to be mediated via DHEA's metabolism to testosterone. Our positive results suggest that the neurosteroid DHEA may be effective as a treatment for women with HSDD if administered at a dose of at least 100 mg per day.

Enoxaparin treatment for vulvodynia: a randomized controlled trial.

OBJECTIVE: To estimate the effectiveness of enoxaparin-a low-molecular-weight heparin with antiheparanase properties-in treating localized provoked vulvodynia. METHODS: Forty women with severe localized provoked vulvodynia were randomly and blindly assigned to self-administer either 40 mg enoxaparin or saline subcutaneously for 90 days. Dyspareunia and local sensitivity were evaluated before, at the end, and 90 days after treatment. The most painful focus was biopsied at the beginning of the study and a parallel site at the end of study for mast cells, PGP 9.5 nerve fiber staining, and heparanase quantification. RESULTS: The enoxaparin-treated women showed a greater reduction in vestibular sensitivity at the end of treatment and 3 months later (29.6% compared with 11.2%, P=.004). Seventy-five percent (15 of 20) of them reported more than 20% pain reduction compared with 27.8% (five of 18) in the placebo group (P=.004). Seven enoxaparin-treated women compared with three in the placebo group had almost painless intercourse at the end of the study. In women who had improvement of sensitivity at the site parallel to the original biopsy site, there was a histologically documented reduction in the number of intraepithelial-free nerve fibers in the enoxaparin group. CONCLUSION: Enoxaparin reduced the vestibular sensitivity and dyspareunia, concomitant with a reduction in intraepithelial free nerve fibers, in women with localized provoked vulvodynia.

Genito-sensory analysis in women with arousal and orgasmic dysfunction.

INTRODUCTION: Diagnosis and treatment of female sexual dysfunction (FSD) are currently based on subjective female reports and physical examination. The GenitoSensory Analyzer (GSA) is a quantitative sensory testing tool designed to quantify vibratory and thermal sensation in the vagina and clitoris in a reproducible manner, and may therefore contribute to the diagnosis and management of FSD. AIM: To address the question of whether women with arousal and/or orgasmic sexual disorders have genital sensory abnormalities as measured by the GSA. MAIN OUTCOME MEASURES: Thresholds for warm, cold, and vibratory sensation at predetermined points in the vaginal wall and clitoris. METHODS: Female subjects complaining of arousal and/or orgasmic sexual disorders for more than 6 months were evaluated using a questionnaire based on the female sexual function index (FSFI). Women with a desire disorder, pain disorder, vulvar vestibulitis syndrome, or acute vaginal or/and introital infection were excluded. The GSA device measured thresholds for warm, cold, and vibratory sensation at predetermined points in the vaginal wall and clitoris. Eight measurements were obtained, and deviations from previously published normative values were identified. RESULTS: Twenty-eight women (age 40.4 +/- 13 years) complaining of arousal and/or orgasmic FSD comprised the study cohort. Twenty-five of them (89%) had at least one pathologic genitor-sensory threshold on GSA testing and 19 (68%) had >3 pathologic thresholds. Pathologic GSA results were associated with lower arousal scores on the FSFI questionnaire, older age, and menopausal status. CONCLUSIONS: Most of the study women had at least one genitor-sensory pathology on GSA testing, indicating a possible organic component in their disorder. Our findings support the incorporation of the GSA as a quantitative tool in the assessment and diagnosis of patients with FSD.

Vulvar vestibulitis syndrome and estrogen dose of oral contraceptive pills.

INTRODUCTION: Vulvar vestibulitis syndrome (VVS) is a diverse, multifactorial phenomenon. Its precise etiology is unknown. AIM: To define the association between oral contraceptive (OC) estrogen dosage and VVS. Methods. Women diagnosed as having VVS participated in the study. MAIN OUTCOME MEASURES: Data on type and usage of oral contraceptive pills (OC) were obtained by a questionnaire, and they were compared for the data on OC usage in the general population. RESULTS: Available commercial data on Israeli women taking OC showed that 51% of them use low-dose estrogen (

Hyperoxaluria in women with vulvar vestibulitis syndrome.

OBJECTIVE: To determine whether evaluation and treatment of hyperoxaluria in vulvar vestibulitis syndrome (VVS) is justified. STUDY DESIGN: Forty women (mean age, 24.5 years; range, 18-35) diagnosed with VVS at a sex therapy clinic participated. Diagnosis of VVS relied upon Friedrich's criteria: (1) severe vulvar vestibular pain upon touch or attempted vaginal entry, (2) tenderness to pressure localized within the vulvar vestibule, and (3) physical findings confined to vulvar erythema of various degrees. Oxalate was measured in 24-hour urine samples. Women with hyperoxaluria (urine oxalate >50 mg/24 h) were placed on a low-oxalate diet and oral calcium citrate as single therapy and reevaluated 3 months later. RESULTS: Hyperoxaluria was diagnosed in 7 women (17.5%), of whom 1 demonstrated an objective improvement and could have pain-free vaginal intercourse following treatment, yielding a 2.5% benefit from the evaluation and treatment of hyperoxaluria. CONCLUSION: There is no justification for evaluation and treatment of hyperoxaluria in women with VVS due to its low yield and economic burden.

Childhood nocturnal enuresis in vulvar vestibulitis syndrome.

OBJECTIVE: To define correlations between vulvar vestibulitis syndrome (VVS) and childhood nocturnal enuresis and the effect of biofeedback therapy. STUDY DESIGN: Of 104 women diagnosed with VVS, 54 (30 with primary vulvar vestibulitis syndrome [PVVS] and 24 with secondary vulvar vestibulitis syndrome [SVVS], mean age 24.5 years) chose Glazer biofeedback therapy. Information on lower urinary tract symptoms was recorded at the initial and final visits. RESULTS: Eight of the 30 women with PVVS (26.6%) had a history of childhood enuresis as compared to none of the women with SVVS (p < 0.01). The 8 women developed lower urinary tract symptoms following biofeedback treatment. None of the women with SVVS had urinary symptoms before or following biofeedback therapy. The high, unstable baseline muscle tone revealed by the Glazer technique to be present in all VVS patients underwent substantial reduction and stabilization at the end of biofeedback therapy. CONCLUSION: Childhood nocturnal enuresis is apparently common among women with PVVS. New urinary symptoms may develop following biofeedback therapy for PVVS.