Vulvodynia - an evolving disease.

Vulvodynia is a common vulval pain syndrome that occurs most commonly in reproductive women of all ages. It can, in some cases, present for the first time after menopause. Up to about 15% of adult women have had symptoms of vulvodynia, with 4-5% currently symptomatic. Since there are no specific tests for diagnosis, vulvodynia is a diagnosis of exclusion. The condition is commonly associated with other chronic pain disorders and can be exceedingly debilitating, resulting in sexual dysfunction, severe depression and/or anxiety. It can significantly impair quality of life. Goals for long-term team approach management should be discussed with the patient at the commencement of each intervention as effectiveness of therapy is not assured. Currently, there is no intervention that effects cure in all individuals and a combination of pharmacological therapy, psychotherapy and physiotherapy, reserving surgery as a last-line option, is the best option for treatment. There are no long-term data on how long women will have symptoms and, if resolved, what provokes symptoms again in the future, whilst correlation between the etiology of vulvodynia and efficacy of treatment is not known.

God, spirituality and religion in women dying from gynecological cancer.

Thoughts of death and dying will prevail constantly in the minds of women with gynecologic cancer. Invariably, there is the hope that, when the end comes, there will be 'a good death'. End-of-life decisions, with particular emphasis on what the patient and her family constitute 'a good death' to be, will be influenced by emotional, psychological, mental, physical, spiritual and religious backgrounds. It is important to allow patients to resolve their despair by communicating their innermost thoughts. Spirituality and religious belief are important components that may play major roles in enabling patients to obtain peace and require the participation of all members of the health-care team managing the cases. Clinicians should appreciate the patient's concerns, beliefs, fears, spiritual and religious needs and be sensitive to comments that may indicate spiritual distress. Active listening and supportive dialogue may help patients work through existential issues and find peace. Patients who are in spiritual distress should be referred to certified and trained spiritual care professionals, chaplains, counselors and clergy.