Artículo Americano sobre vulvodinia

17.12.2012 08:44

In This Issue
Feature Article
Vulvodynia/Vulvovaginal Pain
Chronic Pain
Vulvovaginal Disorders
Feature Article
Urogenital symptoms and pain history as precursors of vulvodynia: a longitudinal study.
Reed BD, Payne CM, Harlow SD, Legocki LJ, Haefner HK, Sen A
J Womens Health (Larchmt). 2012 Nov;21(11):1139-43. doi: 10.1089/jwh.2012.3566.
BACKGROUND: We sought to assess vulvodynia incidence and risk factors among those with and without premorbid urogenital symptoms. METHODS: Women's Health Registry members who completed a baseline assessment in 2004 were sent a 2-year and 4-year follow-up survey containing a validated screen for vulvodynia. Subgroup analysis of vulvodynia incidence rates was performed, and risk factors associated with incidence were assessed. RESULTS: Of 1037 original enrollees, 723 (69.7%) completed consecutive surveys (initial and 2-year or initial, 2-year, and 4-year), 660 of whom did not have current or past vulvodynia at baseline. Of these 660, 71 (10.8%) first met criteria for vulvodynia within the 4-year period, for an annual incidence rate of 3.1% (95% confidence interval [CI] 2.5-4.0). Baseline strict controls were less likely to develop criteria for vulvodynia diagnosis (annual incidence rate of 1.4%) compared to those with an intermediate phenotype (presence of dyspareunia or history of short-term vulvar pain), for whom the incidence rate was 5.6% (p<0.001). Risk factors for incident vulvodynia differed between these two groups. Among the strict controls, an increased risk was noted among younger women (incidence rate ratio) [IRR] 3.6). For those with an intermediate phenotype, risk was increased among nonwhite women and those reporting pain with or after intercourse (IRR 2.2, 3.4, and 3.1, respectively). In both control groups, incident vulvodynia risk increased among those reporting urinary burning at enrollment (IRR 4.2 and 2.8 for strict and intermediate phenotype controls, respectively). CONCLUSIONS: The annual incidence of vulvodynia is substantial (3.1%) and is greater among women reporting a history of dyspareunia or vulvar pain that did not meet criteria for vulvodynia compared to those without this history, suggesting that generalized urogenital sensitivity may be a common underlying mechanism predating the clinical presentation of vulvodynia.
Vulvodynia/Vulvovaginal Pain
With the identification of a high-risk group for the development of vulvodynia comes an eye on prevention.
Nguyen RH
J Womens Health (Larchmt). 2012 Nov;21(11):1130-1. doi: 10.1089/jwh.2012.3967. 
An article in this issue [Reed et. al. above] of the Journal brings the field one important step closer to improved description of the natural progression, specifically from a nondisease state to vulvodynia. A high-risk group of women for the development of diagnosable vulvodynia is women showing some component of vulvodynia, such as pain with first tampon insertion or intercourse and vulvar burning. Even within this high-risk group, however, additional factors may increase the risk of vulvodynia diagnosis, and these factors include nonwhite race, pain after intercourse, and burning with urination. Priorities for vulvodynia research can now evolve into theories for primary or secondary prevention of this consuming condition.
Effect of lubricating gel on patient comfort during vaginal speculum examination: a randomized controlled trial.
Hill DA, Lamvu G
Obstet Gynecol. 2012 Feb;119(2 Pt 1):227-31.
OBJECTIVE: To estimate the efficacy of lubricating gel compared with using water for pain during vaginal speculum insertion. METHODS: This study was a randomized trial of nonpregnant women aged 18-50 years who required a vaginal speculum examination between February and July 2011. Patients blinded to study assignment underwent vaginal speculum examination using a standardized technique with a medium-sized plastic speculum prepared with either 0.3 mL lubricating gel or 3 mL of water used to cover both speculum blades. Patients recorded pain using a 10-cm visual analog scale immediately after speculum insertion. A pre hoc power analysis determined that 55 patients in each arm would be required to detect a difference of 0.9 cm on a 10-cm visual analog scale. RESULTS: A total of 299 consecutive women requiring vaginal speculum examination were screened for enrollment and 120 women were randomized with 60 per group. There were no marked differences in the demographic characteristics of the gel (n=59) and water (n=60) participants available for final analysis. The gel group showed significantly lower pain scores for speculum insertion (mean ± standard deviation: 1.41±1.55 compared with water 2.15±1.93, P<.01). Of patients undergoing examination with gel, 20 of 59 (33.9%) marked zero on the pain scale compared with six of 60 (10%) patients receiving water (P=.002). All 73 patients who underwent Pap screening had adequate cytology. CONCLUSION: Applying a small amount of lubricating gel significantly decreases patient pain during vaginal speculum insertion.
Clinical and therapeutic aspects of vulvodynia: the importance of physical therapy.
Polpeta NC, Giraldo PC, Teatin Juliato CR, Gomes Do Amaral RL, Moreno Linhares I, Romero Leal Passos M
Minerva Ginecol. 2012 Oct;64(5):437-45.
Vulvodynia affects a large number of women worldwide. It is estimated that the prevalence rate of vulvodynia is 16% in women aged 18 to 64 years, resulting in constant demand for specialized medical care, although little therapeutic success is achieved. Furthermore, the cause of this disorder remains unknown and involves different symptoms that are implicated in important chronic vulvar pain with disastrous consequences for the afflicted women. In view of these data, the authors have proposed a bibliographic review of the pathophysiology and treatment of vulvodynia. The aim of this review was to assist in clinical diagnosis and elucidate the multidisciplinary treatment that appears to be associated with a higher success rate in these women. Physical therapy using diverse techniques has an important role in multidisciplinary care, obtaining satisfactory results in the treatment of pelvic floor muscle dysfunction and thus improving the symptoms and quality of life in women with vulvodynia.
Health-related quality of life in patients with interstitial cystitis/bladder pain syndrome and frequently associated comorbidities.
Suskind AM, Berry SH, Suttorp MJ, Elliott MN, Hays RD, Ewing BA, Clemens JQ
Qual Life Res. 2012 Oct 7. [Epub ahead of print]
PURPOSE: To estimate the association of chronic non-urologic conditions [i.e., fibromyalgia (FM), chronic fatigue syndrome (CFS), and irritable bowel syndrome (IBS)] with health-related quality of life (HRQOL) in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). METHODS: A total of 276 women with established diagnoses of IC/BPS completed a telephone interview which included demographics, self-reported medical conditions, the SF-36 health survey, and the interstitial cystitis symptom index (ICSI). Of the 276 study participants, 82 (30%) had IC/BPS plus another pelvic pain condition (overactive bladder, endometriosis, or vulvodynia). Multivariate linear regression analysis was used to identify correlates of SF-36 physical and mental component summary scores. RESULTS: Mean patient age was 45.1 (SD 15.9) years, and 83 % of the subjects were white. Mean values for the SF-36 Physical Component Score (PCS) and Mental Component Score (MCS) means were 39 (SD 14) and 45 (SD 12), respectively, indicating significant HRQOL reductions. Mean ICSI score was 11.27 (SD = 4.86). FM and IBS were significantly associated with worse SF-36 scores: -8 points on the PCS (p < 0.001) and -6 points on the MCS (p < 0.001).



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