Vulvar Burning Research Articles

The LADY study: epidemiological characteristics of prevalent and new genitourinary syndrome of menopause cases in Greece

Objective The genitourinary syndrome of menopause (GSM) is often underdiagnosed and undertreated despite its significant impact on postmenopausal quality of life. We assessed the prevalence of GSM and associated symptoms in Greek perimenopausal/postmenopausal women attending gynecology clinics. Methods Four hundred and fifty women, aged 40–70 years (93.1% postmenopausal), attending three gynecology clinics at university hospitals completed a validated questionnaire and underwent pelvic examination. Results GSM was diagnosed in 87.6% of the women at the study visit, whereas only 16% of the overall sample had been previously diagnosed with the condition. Vaginal dryness (72.7%), vulvar burning sensation or itching (58.0%) and dyspareunia (52.7%) were the most prevalent symptoms. Pelvic signs consisted of vaginal dryness (89.1%), loss of vaginal rugae (80.6%) and vulvovaginal pallor (86.9%). However, only 31.3% of the participants had discussed genitourinary symptoms with their health-care professionals (HCPs). Regarding management, only 11.1% of women had prior experience with any form of therapy, and currently only 8.7% were receiving treatment. Conclusion GSM is highly prevalent in this Greek perimenopausal/postmenopausal population. Nevertheless, the majority of women remain undiagnosed and untreated. Education for both women and HCPs regarding GSM will lead to improved diagnosis and better management of this syndrome.

(032) A Large Retroperitoneal Schwannoma Masquerading as Genito-Urinary Syndrome of Menopause

Abstract Introduction Retroperitoneal schwannomas are extremely rare, slow growing, benign, neurogenic tumors. Their diagnosis is challenging and often incidentally found upon evaluation of vague symptoms. Extrinsic compression to nearby organs or nerves may cause pain and paresthesia. Vulvar pain as a presenting symptom of a retroperitoneal schwannoma is reported in the literature in a case with pudendal nerve involvement. Here we present a case report of a patient who presented with vulvar burning and lower urinary tract irritative symptoms which was found to have a large infra-hepatic retroperitoneal schwannoma. Objectives In this report we show case how performing a detailed neurological evaluation and having a good understanding of the vulvar, perineal, and lower extremity dermatomal innervation have assisted in early diagnosis and treatment of a large retroperitoneal schwannoma. Methods A 65-year-old menopausal woman presented to her primary provider for a 3-month-history of worsening vulvar burning sensation associated with urinary burning, frequency, and nocturia. The pain is worse at night and when sitting for more than an hour. The patient endorsed low back pain that radiated like pins down her anterior thighs. The patient underwent evaluation by her referring provider to rule out a urinary tract infections and vaginitis. She was treated with vaginal estrogen tablets with partial relief for a working diagnosis of Urogenital Syndrome of Menopause. Patient was then referred to Gynecology due to inadequate relief. A detailed pelvic examination revealed normal labia majora and minora with no erythema or swelling. The Vestibule, Bartholin and Skene glands were non tender. Q-tip testing provoked burning sensation in the left and right labia minora on the medial and lateral aspect as well as the labia majora. Pelvic Floor evaluation elicited left pelvic floor tenderness and bilateral ischial spine pain concerning for Pudendal neuralgia. Also, noted paresthesia overlying the left lower extremity at the L3 and L4 distribution at the medial thigh (Figure-1) The patient underwent a bilateral pudendal block with total resolution of her vulvar pain for 24 hours and hence, lumbar and pelvic nerve entrapment was suspected. Magnetic Resonance Imaging was requested. Evaluation revealed a 3.3x4.4cm left ovarian mass and uterine fibroids that could potentially explain L2-L5 radiculopathy. The Lumbar MRI noted a cystic mass in the right mid abdomen for which further evaluation with CT scan was recommended. (Image-1). Referral to Surgical Oncology and Gyn oncology was sought. Epithelial ovarian cancer tumor markers were normal. Catecholamine studies were nonrevealing except for unexplained increase in dopamine levels. Results Surgical excision of the retroperitoneal and ovarian tumor revealed a left ovarian Fibroma and Schwannoma with Cystic Degeneration, confirmed with Immuno-peroxidase studies for S100 and SOX10. The patient had an uncomplicated post-operative course and remains asymptomatic with total resolution of her urinary and vulvar burning symptoms. Conclusions This a case report of vulvar and urethral paresthesia caused by an exceedingly rare tumor located high in the retroperitoneum. Diagnosis was aided by detailed history, comprehensive gynecological, and neurodermatomal evaluation. Appropriate imaging and timely referral led to early diagnosis and treatment, resulting in symptom resolution. Disclosure No.

(070) Treatment of Genitourinary Syndrome of Menopause is Beneficial for Lichen Sclerosus Patients

Abstract Introduction Postmenopausal women with Lichen Sclerosus frequently report vulvar symptoms consistent with genitourinary syndrome of menopause (GSM) including pruritus, dyspareunia, or non-provoked pain. Our data revealed not surprising vulvar itching as the most frequently reported symptom of LS, second most frequent was general irritation, followed by vaginal dryness, and vulvar burning. Distinguishing these symptoms from GSM which occurs in 27-84% of postmenopausal women can be problematic. Objective The purpose of this study was to understand the symptoms of postmenopausal women with LS. We specifically surveyed them regarding their symptoms and treatments they had tried including both prescription and over the counter. Methods We interviewed 25 women with biopsy proven LS. This was part of a larger study on the microbiome and genetics of postmenopausal women with LS. Results Our data revealed that while the majority of the women in our study were using standard treatments such as high or medium potency steroid ointments or calcineurin inhibitor, less than 25% reported using hormonal medicines in their vulva (4 of 17), a common treatment for postmenopausal symptoms of vulvar burning, general irritation and dryness; Our data revealed that 50% of the women reported they had used at least more than one prescription or over the counter product to manage symptoms, none of which were hormone related. Conclusions Our data suggests that while these women were treated for their LS, their menopausal symptoms were not addressed. These findings lead us to believe perhaps their menopausal symptoms had been undertreated and that LS symptoms may be difficult to manage exclusively with standard treatments such as steroids and/or calcineurin inhibitors in postmenopausal women. Treatment of GSM with standard recommended treatments is beneficial for LS patients. Disclosure No

(282) Impact of Lichen Sclerosus on Menopausal Women's Sexual Health

Abstract Introduction Lichen sclerosus (LS) is a vulvar dermatosis of unknown origin that affects 1 in 70 women. There is a higher incidence in menopausal women, which may be due to detection bias. LS presents with skin texture changes, hypopigmentation, and scarring. Common symptoms include vulvar burning, pruritus, and dyspareunia. Objective This study was to understand the sexual health experience for menopausal women with LS and was part of a larger study on the microbiome and genetics of menopausal women with LS. Methods We interviewed 25 women with biopsy proven LS and 5 post-menopausal women who do not have LS or any other vulvar symptoms. This was part of a larger study on the microbiome and genetics of postmenopausal women with LS. We specifically surveyed them regarding the impact their diagnosis had on their sexual health. Results The majority (n=10) of the women reported a satisfactory sex life prior to being diagnosed with LS. However, the majority (n=11) of respondents reported that it negatively changed since being diagnosed and most reported their sex life as not being satisfactory (n=8). When asked how their sex life changed women responded with “too uncomfortable at times so hesitant to cause irritation,” “pain, avoidance for intercourse,” “no sex life,” or “no desire no sex.” Unfortunately, the majority (n=10) of the women were not told when they were diagnosed with LS about the possible changes to their sex life. Furthermore, the majority (n=28) were not prescribed medications or had procedures done to improve their sexual health. Conclusions Our study revealed that LS had a negative impact on our participants' sexual health and yet the women were not informed of this or given treatment options. We hope this study will call attention to providers to the need for patient education regarding LS' potential negative effects on women's sexual health. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Scynexis

Research and Development of a Vulvar Moisturizer to Target Unmet Gynecological and Aesthetic Needs

ABSTRACT Introduction There is a limited number of peer-reviewed medical publications concerning non-invasive topically genital cosmetic products that could act as a frontline treatment for aesthetic concerns. The vulvar area has received limited research and attention in both the cosmetic and skincare industry. Many topical creams exist primarily as medical interventions; however, topical cosmetic products are an unmet consumer need in that they have less risk than surgical intervention when seeking enhancement or improvement of the female genital appearance. The unmet consumer need can be realized with a non-invasive vulvar moisturizer developed to improve vulvar aesthetics. Objective A novel vulvar moisturizer product (VMP) was formulated and tested in a prospective study that was conducted to assess consumer acceptance and tolerability of the VMP when used by healthy women twice-daily for the duration of four weeks. Methods A VMP was formulated by a multi-disciplinary team including an Obstetrician / Gynecologist, Cosmetic Chemist, and Chemical Engineer. The formulation delivery system includes a reverse emulsion containing emollients (jojoba esters), antioxidants (vitamin C and vitamin E), skin protectants (dimethicone), and moisturizing ingredients, including but not limited to Hyaluronic acid. This novel cream contains technology to allow for immediate and prolonged skin soothing and moisturization. Clinical testing was performed. An institutional review board (IRB)-approved single-center consumer in-use study that was performed at a USA based sexual medicine center by a trained sexual medicine physician. Twenty-five female subjects, 18-85 years old, and in good medical and gynecological health with no active untreated medical conditions were recruited for this study. Subjects applied the VMP on both the left and right sides of the external vulvar tissue twice daily for four weeks. At the completion of the study, subjective tolerability measurements and self-assessment were completed. A binomial exact test was performed on responses to each question. The null hypothesis was that the responses (positive, negative, neutral) were evenly distributed (33%, 33%, 33%) among the 25 subjects. The goal was to disprove the null hypothesis at a statistical significance of *p <0.05. Results The novel VMP successfully completed 12-weeks of accelerated stability in final packaging testing and meet shelf-life criteria during research and development. After termination of formal stability testing, the product was submitted for clinical testing. Twenty-five, female subjects, with an average age of 39 +/- 10 years completed the consumer in-use study. Female subjects were primarily Caucasian (48%) and 44% Hispanic or Latino completed the study. Self-assessment results indicated highly statistically (***p < 0.001) favorable responses for each category: vulva perception, product characteristics, product package, and overall satisfaction. Specifically, after 4 weeks: - 100% of subjects responded favorably to “After product use, my vulva feels soft.” - 100% of subjects responded favorably to “This product nourishes vulvar skin.” - 96% of subjects responded favorably to “After product use, my vulva feels overall healthy and beautiful.” - 96% of subjects responded favorably to “This product maintained and improved my natural healthy vulvar skin.” Overall, the subjects felt confident and valued that the VMP was formulated with high-quality ingredients and reported appreciation for a non-hormonal product. Results from subjective tolerability evaluation showed the VMP yielded no vulvar burning, itching, or stinging, or any other adverse events for any subject by the end of the study. Conclusion This single-center consumer in-use study supports the hypothesis that the VMP when used twice daily for four weeks achieved consumer acceptance and was tolerable. Consumer acceptance was demonstrated in all self-assessment categories, vulva perception, product characteristics, packaging, and overall satisfaction. Further research is currently being conducted with the VMP for a post shave utilization use. Commercialization of this vulvar moisturizer and availability is anticipated in 2023. Disclosure Yes, this is sponsored by industry/sponsor: Revision Skincare®

Chronic vulvar pain in gynecological outpatients.

Chronic vulvar pain (CVP) is pain in the vulvar area exceeding threemonths of duration. Previous studies have reported a prevalence of 7-8% in the general population and observed an association between CVP and other chronic pain, affective disorders and early life stressors. The aim of this study was to estimate the prevalence of CVP among gynecological outpatients and to explore its association with child sexual abuse, comorbid fibromyalgia and mental health. We conducted a questionnaire-based cross-sectional study among consecutive women attending an unselected general gynecological outpatient clinic at St Olav's University Hospital, Trondheim, Norway, during the period August 1st, 2017, to June 30th, 2018. CVP was defined as having experienced either vulvar burning, sharp pain or allodynia for threemonths or more within the previous year. Fibromyalgia was defined as widespread pain in the past six months in conjunction with a symptom severity score≥5 on the fibromyalgia symptom severity score inventory, an ordinal scale from zero to 12. We collected information on sexual coercion experience and assessed mental health with the mental health inventory (MHI-5) of the SF-36 health survey, which yields a zero to five scale. Of 1,125 questionnaires distributed, 810 (72%) were returned, and 762 (68%) included in final analyses. Among these, 130 (17.1%) reported CVP within the previous year and 92 (16.7%) were classified as suffering from fibromyalgia. Fibromyalgia was associated with CVP (adjusted OR of 1.8, 95% CI 1.1-3.1). Child sexual abuse was reported by 96 (13.1%) and was associated with CVP (adjusted OR 2.0, 95% CI 1.2-3.3). CVP and fibromyalgia were both associated with lower mental health scores; 0.51 and 0.58 points on the MHI-5 scale, respectively. Chronic vulvar pain is common among women in a gynecological outpatient clinic and associated with child sexual abuse, comorbid fibromyalgia and worse mental health. Ethical committee number: REK Midt No. 2016/2150.

Consumer acceptance and in-use study evaluating a vulvar moisturizer

ABSTRACT Introduction There is a limited number of peer-reviewed medical publications concerning non-invasive topically genital cosmetic products that could act as a frontline treatment for aesthetic concerns. The vulvar area has received limited research and attention in the cosmetic and skincare industry. Many topical creams exist primarily for medical conditions; however, topical cosmetic products are an unmet consumer need in that they have less risk than surgical intervention when seeking enhancement or improvement of the female genital appearance. The unmet consumer need can be realized with a non-invasive vulvar moisturizer developed to improve vulvar aesthetics. Objective This prospective study was conducted to assess consumer acceptance and tolerability of a vulvar moisturizer product (VMP) when used by healthy women twice-daily over the course of four weeks. Methods This was an institutional review board (IRB)-approved single-center consumer in-use study that was performed at a sexual medicine center by a trained sexual medicine physician. Twenty-five female subjects, 18-85 years old, and in good medical and gynecological health with no active untreated medical conditions were recruited in the study. Subjects applied the VMP on both the left and right sides of the external vulvar tissue twice daily for four weeks. At the end of the study, subjective tolerability measurements and self-assessment were completed. A binomial exact test was performed on responses to each question. The null hypothesis was that the responses (positive, negative, neutral) were evenly distributed (33%, 33%, 33%) among the 25 subjects. The goal was to disprove the null hypothesis at a statistical significance of *p <0.05. Results Twenty-five, female subjects, with an average age of 39 +/- 10 years completed the consumer in-use study. Female subjects were primarily Caucasian (48%) and 44% Hispanic or Latino completed the study. Self-assessment results indicated highly statistically (***p < 0.001) favorable responses for each category: vulva perception, product characteristics, product package, and overall satisfaction. Specifically, after 4 weeks: • 100% of subjects responded favorably to “After product use, my vulva feels soft.” • 100% of subjects responded favorably to “This product nourishes vulvar skin.” • 96% of subjects responded favorably to “After product use, my vulva feels overall healthy and beautiful.” • 96% of subjects responded favorably to “This product maintained and improved my natural healthy vulvar skin.” Overall, subjects felt confident and valued that the VMP was formulated with high-quality ingredients and appreciated that it did not contain hormones. Results from subjective tolerability evaluation showed the VMP yielded no vulvar burning, itching, or stinging, or other adverse events for any subject by the end of the study. Conclusion This single-center consumer in-use study supports the hypothesis that the VMP when used twice daily for four weeks achieved consumer acceptance and was tolerable. Consumer acceptance was demonstrated in all self-assessment categories, vulva perception, product characteristics, packaging, and overall satisfaction. Further research is currently being conducted with the VMP for a post shave utilization use. Disclosure Work supported by industry: yes, by Revision SkinCare . A consultant, employee (part time or full time) or shareholder is among the authors (Consultant of Revision Skincare ).

Molecular characterization of Trichomonas infections in women of Ilam City, southwestern Iran.

Trichomoniasis is a sexually transmitted infection (STI) caused by the flagellated protozoan Trichomonas vaginalis. Little information is available on the epidemiology and genetic diversity of T. vaginalis in Ilam City, southwestern Iran. A descriptive cross-sectional investigation was carried out between July 2017 and December 2018 on the suspected women patients referred to eight gynecology clinics of Ilam City for probable Trichomonas infection. They were undergone a set of clinical, parasitological, and molecular examinations. During clinical consultation, posterior vaginal fornix secretions and urine samples were gathered from the participants. For the reasons such as physical conditions and cultural and religious constraints, most of participating women, especially young girls due to their virginity, preferred to give urine samples instead of vaginal discharge. The presence of Trichomonas was diagnosed by microscopic examination and molecular detection using conventional PCR targeting ITS1-rDNA. A total of 1765 suspected individuals were examined clinically via vaginal secretions (495 specimens) and urine samples (1270 specimens). Of them, 21 (1.18%) cases, including 13 vaginal secretions and 8 urine samples, were positive for Trichomonas infection by microscopy. Slightly more than half of the patients (11/21, 52.4%) complained of vulvar itching, burning, and frequent urination. Cervical lesions, patchy erythema, and vaginal discharge were recorded in 28.6%, 23.8%, and 19% of the patients respectively. All patients with positive microscopic identification were confirmed by amplification of 450-bp fragment of ITS1-rDNA. Phylogenetic analysis revealed a high rate of genetic homogeneity in which all our isolates together with homologous sequences from China, Philippines, Austria, and USA were clustered within the same clade. A statistically significant relationship was recorded between the patients positive for trichomoniasis and the presence of chronic disease (e.g., diabetes, immune system deficiency).

Care Seeking for Chronic Vulvar Pain Among a Large, Population-Based Sample of Reproductive-Aged Women.

Background: Chronic vulvar pain is a prevalent but often misdiagnosed and undertreated condition that adversely impacts quality of life. A large proportion of women report not seeking care for chronic vulvar pain, but little is known about the factors that underlie care-seeking decisions. Materials and Methods: We used a large, population-based survey of women aged 18-40 years to assess a history of chronic vulvar burning, pain on contact, or itching that had lasted ≥3 months. The survey also captured demographic characteristics and comorbidities. Women were asked if they had ever sought care for their chronic vulvar condition. Demographic characteristics and comorbidities were evaluated across pain categories and by care-seeking behaviors. Results: A higher proportion of women who described their pain as burning only and both burning and pain on contact had sought care for their pain (69.2% and 85.2%, respectively) compared with pain on contact only (41.8%). Women who described their pain as pain on contact only were also less likely to see multiple providers and to have ever received treatment for their pain. Care seekers were more likely to be married, have a college education, have a normal body mass index, and have multiple gynecologic comorbidities. Conclusions: Our study suggests that care-seeking behavior varies by pain type. Less than half of women who characterized their pain as pain on contact had sought medical care. Those who did seek care reported seeing fewer providers than those who experienced burning. Providers may wish to proactively ask patients about pain on contact.

Chikungunya associated vulvitis: case report and literature review

Introduction: Chikungunya virus is spreading worldwide due to migration and globalization and could be presented with systemic and with unusual symptoms. Objective: To report a case of virus-transmitted infection detected in a woman during the gynecological examination at a vulvar clinic. Case report: A 73-year-old Caucasian woman attended a vulvar clinic because of dyspareunia and vulvar burning. Ulcers were observed on labia minora and perineum. A Chikungunya was diagnosed by seroconversion in paired specimens. She was prescribed prednisolone 40 mg once a day for 10 days. After oral steroid treatment, the woman had no body rashes or lesions on her genitals. Conclusion: This study emphasized that rare signs of unusual vulvitis with ulcers could be associated with Chikungunya infection.

Alleviation of vulvovaginitis symptoms: can probiotics lead the treatment plan?

Disruption of vaginal microbiota equilibrium promotes infectious clinical syndromes with annoying symptoms, such as vaginal discharge, odour, irritation, pruritus, and vulvar burning. Although identifying and eradicating the pathogen involved has been the standard of care, regional microbiota restoration with probiotics has been gaining ground in recent years. This study aimed to assess the effectiveness of topical Bacillus coagulans treatment for patients exhibiting vaginal discomfort symptoms. A clinical trial was conducted on the use of a topical B. coagulans regimen among reproductive-age women (n=70) with vaginal discomfort symptoms. We assessed their symptoms using a questionnaire, measured vaginal pH, and performed vaginal swabs for microscopy and cultivation. Over the next 4 days, patients received B. coagulans vaginal douches and suppositories with appropriate antibiotic treatment being added on the fourth day based on vaginal swab results. Patients returned 16 days later to fill out in the questionnaire again. The Wilcoxon signed-ranked test was then used to assess differences in symptomatology and pH between appointments. A reduction in vaginal pH was reported between the first and second visit (P<0.001). The probiotic regimen exerted a beneficial effect in all vaginal manifestations: vulvovaginal itching, burning sensation, vaginal irritation, and vaginal discharge (P<0.001 for all symptoms). Additionally, three out of the four symptoms were alleviated to a greater extent during the first four days of exclusive probiotic use than during the second phase (P=0.007, P=0.004, and P=0.033). Our sample provided significant results regarding the benefits of B. coagulans for vaginal discomfort. We postulate that the greatest symptom improvement was achieved within the first 4 days of exclusive probiotic use, before the addition of antibiotics. This study agrees with the increasing literature on the contribution of probiotics toward vaginitis treatment.

Efficacy of nystatin vaginal effervescent tablets and nifuratel tablet combined with recombinant human interferon alpha 2b suppository in the treatment of candida vaginitis

Objective To explore the efficacy of nystatin vaginal effervescent tablets, nifuratel tablet combined with recombinant human interferon alpha 2b suppository in the treatment of candida vaginitis. Methods 124 patients with candida vaginitis were selected as the research subjects.The patients were randomly divided into two groups according to different treatment.The control group was treated with nystatin vaginal effervescent tablets + nifuratel tablet, the study group was given recombinant human interferon alpha 2b suppository on the basis of the control group.The symptoms, clinical curative effect, quality of life score, adverse reaction rate were observed and compared in the two groups. Results There were no statistically significant differences between the two groups in symptom and physical signs before treatment(all P>0.05). After treatment, the vulvar itching, burning pain, abnormal leucorrhea, redness symptoms and signs of the study group were (0.95±0.44)points, (1.02±0.51)points, (1.13±0.62)points, (1.09±0.56)points, which were significantly lower than those of the control group[(1.42±0.98)points, (1.28±1.02)points, (1.38±1.17)points, (1.37±1.12)points, t=2.529, 2.512, 2.505, 2.618, all P<0.05]. The total effective rate of the study group was 95.2%, which was significantly higher than 74.2% of the control group (Z=-2.839, P<0.05). After treatment, the quality of life scores of physiological function, bodily pain, mental health, emotional function and social function in the study group were (80.16±9.23)points, (84.22±9.95)points, (87.49±10.46)points, (89.27±12.35)points, (88.21±11.74)points, which were significantly higher than those in the control group[(67.58±5.34)points, (71.49±7.28)points, (73.52±7.61)points, (76.83±8.32)points, (75.51±8.16) points, t=9.728, 8.577, 9.036, 7.039, 7.537, all P<0.05]. The incidence rate of adverse reactions of the study group was significantly lower than that of the control group(χ2=10.978, P<0.05). Conclusion Nystatin vaginal effervescent tablets, nifuratel tablet combined with recombinant human interferon alpha 2b suppository in the treatment of candida vaginitis can significantly improve clinical symptoms, improve the therapeutic effect, and improve the quality of life of patients with significant clinical value, it is worthy of reference. Key words: Candidiasis, vulvovaginal; Nystatin; Nifuratel; Interferon alpha 2b

Vulvar Vestibulectomy for Neuroproliferative-Associated Provoked Vestibulodynia: A Retrospective Analysis

Objective: This study was conducted to determine if women with neuroproliferative-associated vestibulodynia who had vulvar vestibulectomy had less vulvar pain and sexual distress than women with neuroproliferative-associated vestibulodynia who chose not to have this surgery. Materials and Methods: This was a retrospective analysis study of a vulvar disorders clinic database. A database review was used to identify 227 women diagnosed with neuroproliferative-associated vestibulodynia for whom conservative treatment failed and who were advised to have vulvar vestibulectomy. Of the 227 women, 101 elected to undergo vestibulectomy and 126 declined the procedure. Ninety-eight of the 101 women who had surgery and 40 of the 126 who declined surgery answered an online questionnaire. Results: Compared to women who had vestibulectomy, women who declined this surgery were more likely to report significant persistent vulvar burning (29.58% versus 80%; p < 0.001), vulvar rawness (23.450% versus 67.5%; p < 0.0001), vulvar cutting (9.18% versus 30%; p < 0.002), and sexual distress, as measured by the Female Sexual Distress Scale (18.88 versus 25.925; p = 0.005). In addition, 97% of surgical pathology specimens met the histopathologic criteria for neuroproliferative-associated vestibulodynia. Conclusions: This study demonstrated the importance of the 2015 International Society for the Study of Vulvovaginal Disease/International Society for the Study of Women's Sexual Health/International Pelvic Pain Society vulvodynia nomenclature emphasizing that treatment should be chosen according to possible associated factors rather than using a “shotgun” approach. The correlation between the presumptive preoperative diagnoses and the confirmatory postoperative histology validates the vulvar-pain diagnostic algorithm previously published by King and colleagues. Finally, this study provides further evidence that vulvar vestibulectomy can be an appropriate first-line treatment for women with neuroproliferative-associated vestibulodynia. (J GYNECOL SURG 34:58)

Association of Vulvar Symptoms With Pelvic Organ Prolapse and Urinary Incontinence.

The aim of this study was to compare vulvar symptoms between urogynecology patients diagnosed with urinary incontinence (UI) and/or pelvic organ prolapse to women presenting for annual gynecological care. This is a retrospective cross-sectional study. Vulvar symptoms (burning, pain, itching, dyspareunia, and discharge) were measured by asking respondents to rate the severity of each symptom from 0 (none) to 10 (most severe). Patient history, diagnoses, and the Urogenital Distress Inventory-6 (UDI-6) score were abstracted from records. Vulvar symptom results were categorized (0, none; 1-3), mild; ≥4, moderate to severe). Logistic regression models explored whether UI symptoms (UDI-6) and urogynecology diagnoses were associated with each vulvar symptom (moderate to severe vs none). A total of 606 urogynecology patients grouped by the following urogynecology clinical diagnoses: UI (n = 230), prolapse (n = 193), UI + prolapse (n = 183), and 258 controls (general gynecology patients) were included. The mean (± SD) age (years) was 57.5 ± 16.1, 62.4 ± 13.9, 59.0 ± 14.9, and 41.3 ± 13.8 in the UI, prolapse, UI + prolapse, and control groups, respectively (p < .01). Increasing urinary symptoms were associated with all vulvar symptoms (odds ratio [OR], 1.1-1.2 for each 1 point increase in UDI-6; p < 0.05 for all). Prolapse and UI + prolapse diagnoses (compared with controls) were associated with vulvar burning (OR [95% confidence interval {CI}], 2.5 [1.2-5.0] and 2.9 [1.3-6.1] and pain (OR (95% CI), 3.6 [1.5-8.5] and 3.3 [1.4-8.2], respectively). Prolapse diagnoses were also associated with dyspareunia (OR [95% CI], 5.4 [2.2-13.3]). Patients with pelvic organ prolapse are more likely to report vulvar burning, pain, and dyspareunia than gynecologic control patients. Urinary symptoms were associated with all vulvar symptoms.

Perceived Stereotyping and Seeking Care for Chronic Vulvar Pain

We examined stereotyping of chronic pain sufferers among women aged 18-40 years and determined whether perceived stereotyping affects seeking care for women with chronic vulvar pain. Cross-sectional study using a community-based survey of vulvodynia asking if "Doctors think that people with chronic pain exaggerate their pain," and if "People believe that vulvar pain is used as an excuse to avoid having sex". Twelve thousand eight hundred thirty-four women aged 18-40 years in metropolitan Minneapolis/St. Paul, Minnesota. Women were considered to have a history of chronic vulvar pain if they reported vulvar burning lasting more than 3 months or vulvar pain on contact. Four thousand nine hundred eighty-seven (38.9%) women reported a chronic pain condition; 1,651 had chronic vulvar pain. Women experiencing chronic pain were more likely than those without to perceive stereotyping from both doctors and others; a dose-response with the number of pain conditions existed. Women with chronic vulvar pain were more likely to believe that people think vulvar pain is an excuse to avoid intercourse. Half of the women with chronic vulvar pain did not seek medical care for it; of these, 40.4% perceived stereotyping from doctors. However, it was women who actually sought care (45.1%) who were more likely to feel stigmatized by doctors (adjusted relative risk = 1.11, 95% confidence interval: 1.01-1.23). Perceived negative stereotyping among chronic pain sufferers is common, particularly negative perceptions about physicians. In fact, chronic vulvar pain sufferers who felt stigmatized were more likely to have sought care than those who did not feel stigmatized.

Prevalence of symptoms consistent with a diagnosis of vulvodynia: population-based estimates from 2 geographic regions

We used validated sensitive and specific questions associated with clinically confirmed diagnoses of unexplained vulvar pain (vulvodynia) to compare the cumulative incidence of vulvar pain and prevalence of care-seeking behavior in Boston metropolitan area (BMA) and in Minneapolis/Saint Paul metropolitan area (MSP) from 2001 through 2005 using census-based data, and 2010 through 2012, using outpatient community-clinic data, respectively. We received self-administered questionnaires from 5440 women in BMA and 13,681 in MSP, 18-40 years of age, describing their history of vulvar burning or pain on contact that persisted >3 months that limited/prevented intercourse. By age 40 years, 7-8% in BMA and MSP reported vulvar pain consistent with vulvodynia. Women of Hispanic origin compared to whites were 1.4 times more likely to develop vulvar pain symptoms (95% confidence interval, 1.1-1.8). Many women in MSP (48%) and BMA (30%) never sought treatment, and >50% who sought care with known health care access received no diagnosis. Using identical screening methods, we report high prevalence of vulvar pain in 2 geographic regions, and that access to health care does not increase the likelihood of seeking care for chronic vulvar pain.

Telephone Triage

The study aimed to determine which self-reported vulvovaginal symptoms are most consistent with candidiasis confirmed by yeast culture and to establish guidelines to determine who can be appropriately treated by telephone triage versus office examination for women with vulvovaginal symptoms. A retrospective chart review of 105 patients seen in the Saint Louis University Vulvar and Vaginal Disorders Specialty Center during a 14-month period was performed after institutional review board approval. Patient's age, medication use, symptom scores on a Likert rating scale for vaginal/vulvar pain, burning, itching, dyspareunia, wet-mount results, and yeast culture results were recorded. Differences in the occurrence of vaginal/vulvar symptoms of any severity between women with positive and with negative yeast culture results were calculated using χ2 and Fisher exact tests. Differences in symptom scores of any severity were compared between women with positive and with negative yeast culture results using nonparametric Kolmogorov-Smirnov test, owing to a lack of normality of the distributions. Sensitivity of 75% or greater and specificity of 67% or greater were sought for all 9 recorded symptoms. Multiple logistic regression analysis was used to determine which symptoms and their cutoff values were significant independent predictors of a positive yeast culture result. Receiver operating characteristic curve analysis was used to determine the efficacy of individual symptoms and combinations of symptoms for predicting a positive yeast culture result. A value of p < 0.05 was used to denote statistical significance. Four vulvovaginal symptoms met cutoff criteria for analysis to predict a positive yeast culture result: vaginal burning, vulvar burning, vulvar itching, and clitoral pain. Vaginal burning with a score of 6 or greater (p < 0.001) and vulvar itching with a score of 5 or greater (p < 0.05) were significant independent predictors of a positive yeast culture result. Women with both a vaginal burning score of 6 or greater and a vulvar itching score 5 or greater had a positive predictive value of 91.7% (22/24). Vaginal discharge was not shown to be predictive of candidiasis. Diagnosis of candidiasis using self-reported vulvovaginal symptoms by telephone triage is difficult. Self-reported scores for vaginal burning of 6 or greater and for vulvar itching of 5 or greater are significant indicators of a positive yeast culture result. Vaginal discharge was not predictive of a diagnosis of candidiasis. A symptom chart can aid office staff in telephone triage of symptomatic women.

Role of Vulvar Care Guidelines in the Initial Management of Vulvar Complaints

This study aimed to determine the effectiveness of vulvar care guidelines as the initial treatment of vulvar complaints. A chart review was conducted at the Saint Louis University Vulvar and Vaginal Disease Center. Women with vulvar symptoms in the absence of specific identifiable causes were evaluated and given guidelines for vulvar care. An 11-point Likert scale was used to rate symptoms at the initial and follow-up visits. Compliance level was determined. A decrease in mean scores was shown for dyspareunia (7.5 ± 2.0 to 4.6 ± 3.1, p < .001), burning after intercourse (6.8 ± 2.7 to 3.4 ± 2.4, p = .10), vulvar burning (5.7 ± 2.6 to 2.1 ± 1.9, p < .001), vulvar itching (4.9 ± 2.8 to 2.5 ± 2.6, p < .001), and vulvar pain (5.8 ± 2.8 to 2.2 ± 3.0, p < .01). The mean dyspareunia difference scores were significant between the low- and high-compliance groups. Vulvar care guidelines are successful for the management of vulvar complaints.

Management of Lichen Sclerosus With Triamcinolone Ointment

To determine whether topical triamcinolone ointment effectively reduces patient's symptoms for the management of lichen sclerosus (LS). A retrospective chart review of LS patients seen during 2004 to 2008 in the Saint Louis University Vulvar Clinic was conducted. Inclusion criteria were biopsy-confirmed LS and age 18 years and older. Data were collected at the initial visit and at 6 to 10 weeks, 3 months, and 6 months of follow-up. Effectiveness was assessed using symptom scores on a Likert scale. Data were analyzed using either paired t tests or nonparametric Wilcoxon signed rank tests using a p value less than.05 to denote statistical significance. Of 41 women, 34 met inclusion criteria. Vulvar pruritus was the most frequently reported vulvar symptom, occurring in 32 (94.1%) of 34 women. Dyspareunia, vulvar burning, and vulvar pain were reported in 17 (54.8%) of 31, 22 (64.7%) of 34, and in 13 (38.2%) of 34 women, respectively. Statistically significant reductions in mean symptom scores between the initial and the 6- to 10-week follow-up visits were found for dyspareunia, vulvar burning, vulvar pruritus, and pain (p values < .05 to < .001) and at 3-month follow-up visits for dyspareunia, vulvar burning, and vulvar pruritus (p < .05). Complete symptom relief was reported for 8 (47.1%) of 17 women with dyspareunia, 19 (86.4%) of 22 women with vulvar burning, 23 (71.9%) of 32 women with vulvar pruritus, and 12 (92.3%) of 13 women with vulvar pain. Topical triamcinolone ointment is an effective treatment for the management of LS based on the significant reduction of patient symptom scores. Inherent risks with long-term use of high-potency corticosteroids should prompt all practitioners to consider triamcinolone ointment as a safer long-term treatment for patients with LS.

Onset of Vulvodynia in a Woman Ultimately Diagnosed With Creutzfeldt-Jakob Disease

Vulvodynia, defined as vulvar pain or burning in the presence of normal vulvar appearance, is common and is associated with chronic pain syndromes and psychiatric disorders. A postmenopausal woman complained of vulvar burning. Causes for vulvar burning including yeast infection, estrogen deficiency, and contact dermatitis were excluded. Vulvovaginal examination was normal. Subsequently, she complained of headaches, insomnia, and depression. She developed ataxic gait with rapidly progressive dementia. Brain biopsy confirmed the diagnosis of Creutzfeldt-Jakob disease, and 3 weeks later she lapsed into coma and died. This report is unique in that a rare disease, known to result in neuronal damage, mimicked symptoms of vulvodynia in its initial phase. This supports the hypothesis that vulvodynia is a neuropathic syndrome originating in the nervous system.