Vulvodynia: a state-of-the-art consensus on definitions, diagnosis and management.

Department of Obstetrics, Gynecology and Reproductive Sciences, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
The Journal of reproductive medicine (Impact Factor: 0.58). 07/2006; 51(6):447-56.
Source: PubMed

ABSTRACT Vulvodynia is a chronic pain syndrome affecting up to 18% of the female population. Despite its high prevalence and associated distress, the etiology, diagnosis and clinical management of the disorder have not been clearly delineated. This "white paper" describes the findings and recommendations of a consensus conference panel based on a comprehensive review of the published literature on vulvodynia in addition to expert presentations on research findings and clinical management approaches. The consensus panel also identified key topics and issues forfurther research, including the role of inflammatory mechanisms and genetic factors and psychosexual contributors.

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    ABSTRACT: Localized provoked vulvodynia (LPVD) affects approximately 16% of the female population, but biological mechanisms underlying symptoms remain unknown. Like in other, often comorbid chronic pain disorders, altered sensory processing and modulation of pain, including central sensitization, dysregulation of endogenous pain modulatory systems, and attentional enhancement of pain perception have been implicated. The aim of this study was to test whether regions of interest showing differences in LPVD compared to healthy controls (HCs) in structural and evoked-pain neuroimaging studies, also show alterations in during rest compared to HCs and a chronic pain control group (irritable bowel syndrome, IBS). Functional magnetic resonance imaging was performed during resting state in 87 age-matched premenopausal females (29 LPVD, 29 HCs, 29 IBS). Group independent component analysis and general linear models were applied to investigate group differences in the intrinsic connectivity of regions comprising sensorimotor, salience, and default mode resting state networks. LPVD subjects showed substantial alterations in the intrinsic connectivity of these networks compared to HCs and IBS. The intrinsic connectivity of many of the regions showing group differences during rest were moderately associated with clinical symptom reports in LPVD. Findings were robust to controlling for affect and medication usage. The current findings indicate LPVD subjects have alterations in the intrinsic connectivity of regions comprising the sensorimotor, salience, and default mode networks. Although shared brain mechanisms between different chronic pain disorders have been postulated, the current findings suggest some alterations in functional connectivity may show disease specificity.
    Pain 02/2015; 156(5). DOI:10.1097/01.j.pain.0000461289.65571.54 · 5.84 Impact Factor
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    ABSTRACT: Objectives: Compared with non-Hispanic Whites, Hispanic women have significantly higher prevalence of chronic vulvar pain (CVP), which is known to have heterogeneous subtypes. However, it is not known whether subtypes differ by ethnicity, and improved understanding of subtypes may allow for targeted clinical assessment and therapies. We examined subtypes to determine whether they differed by ethnicity. Methods: Data were from 1,551 women who reported chronic vulvar pain consistent with vulvodynia in a population-based, cross-sectional study of women from the Minneapolis/St. Paul metropolitan area, during the years 2010-2013, who returned a validated screener survey about vulvar pain. Results: Among women with CVP, Hispanics reported more primary vulvodynia (adjusted [adj.] risk ratio=1.47; p<0.01), defined as pain with first intercourse or tampon use, and tended to be more likely to describe a burning pain (adj. risk ratio=1.45; p=0.06). Hispanic women with CVP were 17% more likely than non-Hispoanic Whites with CVP to have their pain alleviated with some type of behavior/remedy (p=0.01); for example, among the subgroup of women with CVP who used yeast cream, Hispanics more often reported benefit to their pain (adj. risk ratio=1.51; p<0.01). Discussion: We examined women with CVP and found that in comparison to their non-Hispanic White counterparts, Hispanic women are more likely to report a burning sensation and more likely to have primary vulvodynia, a subtype that is associated with great burden on the lives of affected women.
    Journal of Women's Health 01/2015; 24(2). DOI:10.1089/jwh.2014.4892 · 1.90 Impact Factor
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    ABSTRACT: Context. Vulvar pain level may fluctuate in women with vulvodynia even in the absence of therapy; however, there is little evidence suggesting which factors may be associated with variability. Objective. Determine the feasibility of using smartphones to collect prospective data on vulvar pain and factors that may influence vulvar pain level. Methods. 24 clinically confirmed women were enrolled from a population-based study and asked to answer five questions using their smartphones each week for one month. Questions assessed vulvar pain level (0-10), presence of pain upon wakening, pain elsewhere in their body, treatment use, and intercourse. Results. Women completed 100% of their scheduled surveys, with acceptability measures highly endorsed. Vulvar pain ratings had a standard deviation within women of 1.6, with greater variation on average among those with higher average pain levels (P < 0.001). On the weeks when a woman reported waking with pain, her vulvar pain level was higher by 1.82 on average (P < 0.001). Overall, average vulvar pain level was not significantly associated with the frequency of reporting other body pains (P = 0.64). Conclusion. Our smartphone tracking system promoted excellent compliance with weekly tracking of factors that are otherwise difficult to recall, some of which were highly associated with vulvar pain level.
    06/2014; 2014:659863. DOI:10.1155/2014/659863