Vulvar vestibular effects of ospemifene: a pilot study.

The study aimed to assess the effects of ospemifene on vulvar vestibule in postmenopausal women with vulvar pain and dyspareunia. Fifty-five postmenopausal women used oral ospemifene 60 mg/d for 60 d. Symptoms of dryness, burning, and dyspareunia were evaluated on a 10 cm visual analog scale. Visual examination of the vulvar vestibule was also conducted. Patients also underwent current perception threshold (CPT) testing obtained from the vulvar vestibule. Fifty-five patients (94.6%) completed the treatment. Hot flashes were the most frequent adverse effects, but this led to a discontinuation of therapy in three patients (5.4%). After therapy, there was a statistically significant decrease from the baseline in the mean scores for dryness, burning, and dyspareunia and reduction of vestibular trophic score (baseline value of 11.2-4.2 after the therapy, p ≤ 002) and cotton swab test scores (2.81 compared with 1.25, p = .001). There was a difference in CPT values for all nerve fibers and more consistent for C fibers (-38% of sensitivity). These results confirm the efficacy of ospemifene on postmenopausal vestibular symptoms and signs; moreover, the drug was effective in normalizing vestibular innervation sensitivity.

The relationship of interstitial cystitis/painful bladder syndrome to vulvodynia.

INTRODUCTION: Many patients have interstitial cystitis/painful bladder syndrome (IC/PBS), a condition of frequency, urgency, and pain affecting more than 1 million women in the United States. The vulva, not the urethra or bladder, may actually be the site of some of the reported pain in women with IC/PBS. PURPOSE: The purpose of this study was to identify the presence of vulvodynia in women diagnosed with IC/PBS. METHOD: A mailed survey was used to identify women with IC/PBS who also reported vulvar pain. The survey also identified related factors, such as menstrual/hormonal status, sexual function, abuse, and sequence of vulvar and bladder pain from adolescence to adulthood. RESULTS: Four-hundred-sixteen women with a documented diagnosis of IC/PBS were mailed a survey. The response rate was 49.6%, with 197 completed surveys returned. Results include vulvar pain in adolescence reported by 10.9% of the respondents, while vulvar pain in adulthood was reported by 48.4% of the women. During the last year, 62.7% of the respondents reported vulvar pain. Ninety-five percent (95%) of the women reported having been sexually active in adulthood, but one-third were not currently sexually active; 27% reported fear of pain as the reason. An abuse history was reported by 28.5% of the women. Of the women who were postmenopausal (two-thirds of the group), 38% used hormone replacement therapy. Birth history showed no correlation to vulvar pain. CONCLUSIONS: The chronic pain that IC/PBS patients feel may not be totally related to their bladder, but instead, may be vulvar pain. The incidence of abuse, past pelvic surgeries, pelvic floor dysfunction, and the chronologic sequence of co-morbid symptoms should be further assessed.

Current views on etiology, diagnosis and the treatment of pain connected with sexual intercourse at women.

Painful intercourse at women is a diagnostically and therapeutically difficult issue, but most of all there is no accordance to the etiology of this health problem. At present there are six classification systems by menas of which one tries to describe this issue. The layout of presented work is based on International Classification on Female Sexual Disorders, which in point four, includes Sexual Pain Disorders--dyspareunia, vaginismus and pain disorders not connected with sexual intercourse, but caused by other type of sexual stimulation. In context of current views on painful intercourse seen as the pain unit not as the sexual dysfunction, the crucial role of a gynaecologist in the diagnosis of this affliction has been underlined.

Pain, psychosocial, sexual, and psychophysical characteristics of women with primary vs. secondary provoked vestibulodynia.

INTRODUCTION: Women with provoked vestibulodynia (PVD), a common cause of dyspareunia, are typically considered a homogeneous group. However, research suggests that differences on some factors (e.g., medical history, pain characteristics, psychological functioning, treatment response) exist based upon whether the pain was present at first intercourse (primary PVD: PVD1) or developed at some later point (secondary PVD: PVD2). AIMS: The purpose of this study was to examine differences in demographic variables, pain characteristics, psychosocial and psychosexual adjustment, and pain sensitivity between women with PVD1 and PVD2. METHODS: Twenty-six women suffering from PVD (13 with PVD1 and 13 with PVD2) completed a screening assessment, a standardized gynecological examination, an interview, questionnaires, and a quantitative sensory testing session. MAIN OUTCOME MEASURES: These included pain ratings during the gynecological examination and interview, scores on measures of psychosocial/sexual functioning (e.g., Short Form-36 [SF-36] Health Survey, Female Sexual Function Index), and thresholds and pain ratings during thermal sensory testing over the dominant forearm and vulvar vestibule. RESULTS: The women with PVD1 were more likely to be nulliparous, but they were not significantly different from the women with PVD2 on other demographic variables or in their pain ratings during the gynecological examination. The women with PVD1 reported lower levels of social and emotional functioning and heightened anxiety surrounding body exposure during sexual activity, and they also displayed lower heat pain tolerance over the forearm and lower heat detection and pain thresholds at the vulvar vestibule than the women with PVD2. CONCLUSIONS: The findings from this study support previous research indicating that women with PVD1 and PVD2 differ in a number of domains. Further research is needed to confirm and elaborate on these findings.

Overlap between orofacial pain and vulvar vestibulitis syndrome.

OBJECTIVES: To explore the prevalence of orofacial pain (OFP) among patients with vulvar vestibulitis syndrome (VVS) and to examine the relationship between signs and symptoms of OFP and clinical characteristics of women with VVS, we investigated differences in psychologic characteristics and severity of painful intercourse. METHODS: In this cross-sectional exploratory study, 137 women with VVS completed questionnaires that assessed levels of pain, anxiety, somatization, and presence of signs and symptoms suggestive of clinical and subclinical OFP. Demographic data were gathered from medical records. RESULTS: OFP was found to be a highly prevalent (78%) condition among women with VVS. Compared with women who had no OFP symptoms (n=30), those with symptoms (n=64) reported higher levels of anxiety (45.0 vs. 37.8, Bonferroni adjusted P=0.017), somatization (125.2 vs. 96.0, Bonferroni adjusted P<0.001), and psychologic distress (62.8 vs. 56.0, Bonferroni adjusted P=0.002). Although we observed a similar trend among women with subclinical OFP (n=43), this trend only reached statistical significance with respect to somatization. Differences were not detected for demographics, duration of pain, and severity of pain during intercourse across the 3 groups. DISCUSSION: OFP is a common condition among women with VVS. Because severity and duration of painful intercourse did not differ by OFP classification but psychologic characteristics did, we must begin to question a unidimensional focus on vestibular mucosa as a reason for pain and persistent distress.

[Assessment of painful sexual intercourse occurrence among women in gynaecological practice]. / Ocena wystepowania bolesnego wspólzycia u kobiet w praktyce ginekologicznej.

OBJECTIVES: Analysis of painful sexual intercourse occurrence among women who are patients of a gynaecological practice. MATERIAL AND METHODS: 104 women have been examined by means of self-constructed questionnaire consisting of parts A and B. All interviewees had had sexual intercourses. Part A of the questionnaire included questions concerning painful sexual intercourse and was completed by the interviewees, whereas part B included questions concerning the presence of symptoms of vulvar vestibulitis and was completed by the gynaecologist after the examination. Statistical analysis was performed by means of chi-quadrat test. RESULTS: Out of 104 examined women, 20 patients (19.2%) complained of painful intercourse occurrence. CONCLUSION: 1. Women at all ages experience painful intercourse, although there are different reasons for its occurrence. 2. Women may experience pain connected with sexual intercourse although they never experienced intercourse with vaginal penetration. 3. In case of 1/4 of women, coital pain occurs at the attempt of intercourse or "at the very thought of it". 4. Pain during sexual intercourse occurs in case of almost 50% of post menopausal women, experiencing vaginal dryness. 5. Since 30% women with visible features of vulvar vestibulitis, detected during gynaecological examination, experience painful sexual intercourse, gynaecological examination should constitute a constant element of diagnosis of painful sexual intercourse among women.

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 (