Vulvovaginal Disorders Research Articles

(081) ACCESSIBILITY AND PRESCRIBING PATTERNS OF HORMONE THERAPIES AMONGST ISSWSH PROVIDERS

Abstract Introduction Vaginal estrogen is a common topical therapy used to treat vulvovaginal disorders and genitourinary syndrome of menopause (GSM). Systemic hormone replacement therapy (HRT) is an evidence based treatment for menopause and female sexual dysfunction. Insurance coverage for topical estrogen and HRT is highly variable and may be inaccessible for many patients. Compounded medications are an alternative that some prescribers turn to despite inconsistency in quality, safety, and prices. Objective To examine prescribing patterns of ISSWSH providers of various hormonal and non-hormonal topical therapies, HRT, and strategies of increasing patient access to these medications. Methods A fourteen-item survey was distributed to ISSWSH providers via online platforms including social media. Participants were asked about medical education background and specialty, practice location, topical hormone replacement therapy (i.e., estrogen, estrogen and testosterone) and non-hormonal therapy (i.e., capsaicin, gabapentin) prescription practices, the most common diagnoses for which they prescribe these medications, systemic hormone therapy prescription practices, and counseling on cost-saving programs. All data was de-identified prior to analysis. Descriptive statistics were performed in SPSS. Results Fifty-five responses were collected. Of these, a majority of participants (51%) are ob-gyn providers and 22% are urology providers. The remaining participants are providers of internal medicine, family medicine, midwifery, urogynecology, and functional medicine. A majority are designated MD, DO, or equivalent (49%) and 45.5% are advanced practice providers (NP or PA). Interestingly, 100% of participating family medicine providers (n=8) report prescribing estrogen-containing systemic therapies, compared to ob-gyns (89%) and urologists (58%). Systemic testosterone was prescribed most often by urologists. Numerous providers report prescribing topical estrogen and testosterone: 50% being family medicine, 67% urologists, 67% midwives, 71% ob-gyns, and 100% of urogynecologists. Prescribing patterns for non-hormonal topicals vary. Gabapentin and valium appear to be most common in ob-gyn practices (43% each). Valium is also commonly prescribed by urologists, family medicine providers, and urogynecologists. According to the results, internal medicine providers rarely prescribe non-hormonal options. Additionally, our data reveals that 91% of participants report counseling patients on cost-saving programs like GoodRx, Mark Cuban Cost Plus Drugs, and others. Conclusions In conclusion, topical and systemic hormone therapies are prescribed at high rates by family medicine, ob-gyn, urogynecology, and urology providers within the ISSWSH community. However, the types of therapies prescribed vary greatly. Counseling regarding cost-saving methods shows to be promising, suggesting that patients are receiving these therapies at the most affordable rate. Further examination of pharmacy-level practices, patient refill trends, and direct medication costs will help to better describe and address patients’ barriers in acquiring treatment options. Disclosure No.

Short-Term Telehealth Follow-up in Complex Gynecologic Conditions [ID 2683660

INTRODUCTION: Studies show up to 50% of patients leave health care appointments not understanding or remembering important information, instructions, or correct use of medications. The Rutgers Center for Vulvovaginal Health treats women referred for complex vulvovaginal or pain disorders and sexual dysfunctions. Despite receiving written instructions and diagrams at initial visit, many returned without having started or having discontinued treatment. We initiated a nurse practitioner telehealth visit 2–3 weeks after initial encounter to evaluate acceptance and benefit in this population. METHODS: This was a retrospective chart review of 50 telehealth visits for new patients seen at the center. Outcome measures were determined from questions presented to all women regarding understanding of condition, and adherence to medication and treatment plan. RESULTS: Overall, 98% of women found the telehealth visit helpful, and 46% had questions related to their first visit. Of the 43 prescribed medications, 37 initiated treatment (86%) and only 2 (4.7%) had not attempted to fill the prescription. Medication was changed in 10%, mostly because of side effects. Pelvic floor physical therapy and imaging studies were initiated in 75% and 67%, respectively. CONCLUSION: Women with complicated gynecologic problems viewed a short-term follow-up telehealth visit positively. This communication presents an opportunity for another point of contact that can be incorporated into a busy practitioner schedule without the requirement of an in-person visit, and allow convenience and reinforcement for women, as well as necessary treatment alterations. Further studies are needed to see if this short-term follow-up enhances long-term compliance or outcomes.

Diagnostic performance of an automated microscopy and pH test for diagnosis of vaginitis

Vaginitis is a common gynecological problem, nevertheless, its clinical evaluation is often insufficient. This study evaluated the performance of an automated microscope for the diagnosis of vaginitis, by comparison of the investigated test results to a composite reference standard (CRS) of wet mount microscopy performed by a specialist in vulvovaginal disorders, and related laboratory tests. During this single-site cross-sectional prospective study, 226 women reporting vaginitis symptoms were recruited, of which 192 samples were found interpretable and were assessed by the automated microscopy system. Results showed sensitivity between 84.1% (95%CI: 73.67–90.86%) for Candida albicans and 90.9% (95%CI: 76.43–96.86%) for bacterial vaginosis and specificity between 65.9% (95%CI: 57.11–73.64%) for Candida albicans and 99.4% (95%CI: 96.89–99.90%) for cytolytic vaginosis. These findings demonstrate the marked potential of machine learning-based automated microscopy and an automated pH test of vaginal swabs as a basis for a computer-aided suggested diagnosis, for improving the first-line evaluation of five different types of infectious and non-infectious vaginal disorders (vaginal atrophy, bacterial vaginosis, Candida albicans vaginitis, cytolytic vaginosis, and aerobic vaginitis/desquamative inflammatory vaginitis). Using such a tool will hopefully lead to better treatment, decrease healthcare costs, and improve patients’ quality of life.

Pediatric and Adolescent Obstetric and Gynecologic Encounters in US Emergency Departments: A Cross-Sectional Study.

To describe pediatric and adolescent obstetric and gynecologic diagnoses presenting at emergency departments (EDs) in the United States. This was a retrospective, cross-sectional study design that utilized the Nationwide Emergency Department Sample (NEDS), which comprised hospital-owned EDs throughout the United States in 2018. The participants included a sample set of female patients from birth to 18 years old. All obstetric and gynecologic (OB/GYN) International Classification of Disease (ICD-10) codes were categorized. Descriptive, bivariate, and multivariate analyses were used to assess diagnoses by age group, hospital type, ED disposition (eg, admission and transfer), payer, and median household income. In 2018, there were 518,244 OB/GYN ED visits by female patients aged less than or equal to 18 years. Vulvovaginal disorders and abnormal uterine bleeding were among the top 5 presentations in all age groups. The top diagnoses varied by age group. Diagnoses with higher morbidity and mortality (ovarian torsion and ectopic pregnancy) had higher admission and transfer rates compared with diagnoses that can be commonly managed in the outpatient setting (vulvar or vaginal disorders). This is the first study that evaluated OB/GYN diagnoses in pediatric and adolescent patients presenting to the ED. Educational and referral efforts should focus on not only emergency diagnoses, such as ovarian torsion, adnexal masses, and ectopic pregnancy, but also common presentations that can often be managed in the outpatient setting, such as vulvovaginal disorders and abnormal uterine bleeding.

Measurement of the vaginal wall thickness by transabdominal and transvaginal ultrasound of women with vaginal laxity: a cross-sectional study.

An objective diagnostic method to understand vaginal laxity (VL) is still missing. The aim of our study is to determine whether vaginal wall thickness (VWT) measured by ultrasound may differ according to the abdominal or vaginal techniques and to assess whether clinical variables are associated with vaginal measurements of women with VL. A cross-sectional study conducted at a tertiary hospital included 82 women aged ≥ 18 years with VL complaints assessed by the Vaginal Laxity Questionnaire. Women who reported severe comorbidities or vulvovaginal disorders, previous treatment for VL, and use of vaginal estrogen in the last 6 months were excluded. Participants reporting VL underwent transabdominal (TAUS) and transvaginal ultrasound (TVUS) and physical examination and answered validated questionnaires. Descriptive data were given as mean and standard deviation, median (range), and absolute and relative frequency. The significance level adopted for this study was 5%. Sample size calculation was not performed for the present study. Mean age was 41.20 ± 8.64 years, and most participants were multiparous, with previous vaginal delivery and having vaginal intercourse. A statistically significant difference (up to 3 mm) between TAUS and TVUS measurements of the VWT was found in the proximal, middle-third, and distal compartments. A significant correlation was found between VWT and TAUS or TVUS in the mid-third and distal compartments. A significant correlation was found between the VWT measurements in TVUS and TAUS. Our findings might give the health professional more possibilities for investigating VWT according to patient characteristics.

Lactobacilli and Cytokine Modifications during Menopause and Their Relation to Vulvar and Vulvovaginal Disorders.

ObjectivesFemale sexual and reproductive health is heavily influenced by the levels and ratios of Lactobacilli species and vaginal cytokines. Menopause marks a profound body change as it shifts to a natural and permanent non-reproductive state. Vulvovaginal diseases encompass a broad variety of sexual health conditions. Furthermore, both menopause and vulvovaginal diseases affect vaginal Lactobacilli and cytokine levels. Thus, this study aimed to investigate the correlation between menopause, vulvovaginal diseases, and vaginal Lactobacilli and cytokine levels.MethodsVaginal swab samples were collected as part of a prospective data bank creation to study vaginal conditions as approved by the Institutional Review Board of Texas Tech University Health Sciences Center, Lubbock, USA. This study utilized 38 samples in this database, which were assigned to the pre-menopausal with no vulvovaginal conditions (n = 20) and post-menopausal with vulvovaginal conditions (n = 18) groups. A real-time polymerase chain reaction was conducted to determine the relative concentration of Lactobacilli species, while cytokine analysis was performed using multiplex enzyme-linked immunosorbent assay immunoassay. The standardized mean difference, multivariate analysis of variance, and permutational unequal variance t test were used for the statistical analysis.ResultsCytokines, interleukin (IL)-6, macrophage inflammatory protein-1α, IL-8, and Lactobacillus iners expression were significantly elevated in the control group compared to the study group (P = 0.03 for the cytokines, P = 0.0194 for Lactobacilli).ConclusionsThe levels of vaginal cytokine and Lactobacillus profile were significantly different between the pre-menopausal and post-menopausal groups.

Effects of Fractional CO2 Laser Treatment on Patients Affected by Vulvar Lichen Sclerosus: A Prospective Study.

Background: Fractional carbon dioxide (CO2) lasers are today considered the most effective and efficient treatment for many vulvovaginal disorders, providing mini-invasive procedures without side effects. Previous studies demonstrated the efficacy of fractional CO2 lasers in vulvar lichen sclerosus (VLS), a chronic skin disorder characterized by itching and painful lesions. Complications include pain, sexual and/or urinary dysfunction, with a negative quality of life, and an increased risk of squamous cell carcinoma. A definitive VLS treatment is still lacking. Objectives: This is a prospective, single-center study aimed at evaluating the effect of fractional microablative CO2 laser treatment on women affected by VLS. Materials and methods: Patients with histologically confirmed VLS underwent three fractional microablative CO2 laser treatments, 4 weeks apart, on the genital affected areas. Clinical and VLS-related symptoms, side effects, and patient satisfaction index were assessed and recorded for all the patients using the visual analog scale (VAS). Results: Data from a total of 70 patients were included, paired at different time points and analyzed. VLS-related symptoms and other relevant parameters (pH, vaginal introitus discomfort, dyspareunia, vaginal dryness, itching, and burning) showed a statistically significant improvement (p < 0.001) after the first laser treatment and kept improving after second and third sessions. According to VAS, the two most common symptoms, vaginal introitus discomfort and dyspareunia, went from (mean ± standard deviation) 8.2 ± 2.3 and 8.3 ± 2.2, respectively, at baseline, to 3.6 ± 2.6 and 3.8 ± 2.6, respectively, 1 month after the last treatment. Vaginal dryness, itching, and burning were significantly improved as well. Most patients declared to be very satisfied with the results of the treatment. A total of 62.8% of the women expressed a satisfaction score ≥8 on a scale from 0 to 10. Conclusions: Fractional microablative CO2 laser treatment seems to be safe and effective to treat VLS and improve VLS-related symptoms.

Interactions between vulvovaginal disorders and urinary disorders: The case for an integrated view of the pelvis.

Lower urinary tract symptomatology is often difficult to categorize if history and investigation focus only on the urinary tract. Disease and dysfunction in organs more posteriorly can often cause or influence such bladder and urethral symptoms. Vulvovaginal skin diseases are an important but often missed influence on lower urinary tract symptomatology.

Itraconazole Improves Vulvodynia in Fungus Culture-Negative Patients Post Fluconazole Failure.

IntroductionVulvodynia is a difficult condition to treat due to both the uncertain etiology of the disorder and poorly available therapies. This difficulty leads to a disproportionately high prevalence and cost of treatment for this condition. Candida vulvovaginitis is a frequent co-present diagnosis in vulvodynia patients. Whether through treatment of co-present, candida vulvovaginitis or by systemic interaction, itraconazole has been proposed as a treatment for vulvodynia.AimTo describe objective change in vulvodynia pain in a cohort of patients treated with itraconazole.MethodsThis study was a retrospective cohort study comprised of women diagnosed with vulvodynia who were treated with itraconazole between January 1, 2011 and October 17, 2017. Patients had failed fluconazole treatment and had negative fungus cultures for >2 months before itraconazole treatment. All other vulvovaginal disorders were excluded.Main outcome measureThe main outcome measure was the change in pain before and after treatment as measured by cotton swab testing.Results106 patients met inclusion criteria. Average pain reduction for the entire cohort was 60.7%. Patients who continued itraconazole for 5 to 8 weeks demonstrated a 69.6% reduction in cotton swab test pain. Pain reduction as a percentage of total patients showed complete resolution of pain in 37.7% of patients and >50% reduction in 66.0% of patients. Two-sample paired T-tests for means analysis of pain scores disproved the null hypothesis (P < .01, α = 0.01) and showed a 50% reduction in pain to be significant (P = 0.043, α = 0.05). Two-tailed Wilcoxon signed rank test also demonstrated rejection of the null hypothesis (α = 0.05).ConclusionsItraconazole therapy is associated with a significant reduction in vulvovaginal pain in patients with negative fungus cultures and no other identifiable disease in this pilot study. A randomized placebo-controlled trial is warranted.Rothenberger R, Jones W, MacNeill C. Itraconazole Improves Vulvodynia in Fungus Culture-Negative Patients Post Fluconazole Failure. J Sex Med 2021;9:100383

Vaginitis 101: An online, self-directed vulvovaginal disorders curriculum for the obstetrics and gynecology resident

Vaginitis 101: An online, self-directed vulvovaginal disorders curriculum for the obstetrics and gynecology resident

Diagnosis and Management of Vulvar Skin Disorders: ACOG Practice Bulletin Summary, Number 224.

Vulvar skin disorders include a variety of inflammatory conditions of the vulva that also may affect the extragenital area. Pruritus and pain are two of the most common presenting symptoms in vulvar clinics (). Vulvovaginal symptoms often are chronic and can adversely affect sexual function and sense of well-being. The purpose of this Practice Bulletin is to provide updated diagnostic and management recommendations for the most common vulvar skin conditions associated with inflammation: contact dermatitis, lichen simplex chronicus, lichen sclerosus, and lichen planus. Other vulvovaginal disorders such as vaginitis, vulvar low-grade squamous intraepithelial lesions and vulvar high-grade squamous intraepithelial lesions (previously termed vulvar intraepithelial neoplasia), genitourinary syndrome of menopause (vulvovaginal atrophy), and vulvar pain (vulvodynia) are addressed in other documents from the American College of Obstetricians and Gynecologists ().

Diagnosis and Management of Vulvar Skin Disorders: ACOG Practice Bulletin, Number 224.

Vulvar skin disorders include a variety of inflammatory conditions of the vulva that also may affect the extragenital area. Pruritus and pain are two of the most common presenting symptoms in vulvar clinics (). Vulvovaginal symptoms often are chronic and can adversely affect sexual function and sense of well-being. The purpose of this Practice Bulletin is to provide updated diagnostic and management recommendations for the most common vulvar skin conditions associated with inflammation: contact dermatitis, lichen simplex chronicus, lichen sclerosus, and lichen planus. Other vulvovaginal disorders such as vaginitis, vulvar low-grade squamous intraepithelial lesions and vulvar high-grade squamous intraepithelial lesions (previously termed vulvar intraepithelial neoplasia), genitourinary syndrome of menopause (vulvovaginal atrophy), and vulvar pain (vulvodynia) are addressed in other documents from the American College of Obstetricians and Gynecologists ().

Bioapigyn® Ointment of Pelvic Muscle Tonus Versus Pelvic Floor Muscle Training for the Treatment of Urinary Incontinence

Objective/Purpose: The purpose of this work was the assessment of the clinical efficacy and safety of Bioapigyn® vaginal ointment for pelvic muscle tonus compared to pelvic floor muscle training in alleviating the symptoms of stress, urge and mixed urinary incontinence and vulvo-vaginal disorders in child-bearing and menopausal & postmenopausal women. Materials and Methods: The experimental group consisted of 66 women was treated 28 days with Bioapigyn® ointment for pelvic muscle tonus (2.5 mL/day). The control group also consisted of 66 participants was subjected to pelvic floor muscle training during 28 days (five times a day). ICIQ-UI SF score, the residual urine volume, perineometry, the total score of vulvo-vaginal symptoms and vaginal pH were determined before and after the treatment or training. Results: Following the treatment with Bioapigyn® ointment ICIQ-UI-SF score decreased 54.9%, perineometry parameters increased between 31.5 and 34.3%, residual urine decreased for 76.9% and vaginal pH for 14.2%. All the symptoms of vulvo-vaginal disorders disappeared completely in all participants. The control group showed no changes in vaginal pH or the improvement concerning the vulvo-vaginal complaints. ICIQ- UI-SF score decreased for 4.3%, residual urine volume for 9.1% while perineometry parameters increased between 4.3 and 8.3%. Conclusion/Discussion: Bioapigyn® vaginal ointment for pelvic muscle tonus alleviate the symptoms of incontinence by tightening and firming of the smooth muscles of the pelvic floor thanks to the ingredients with smooth muscles contraction/relaxation and astringent properties. Low pH, high osmolarity, viscosity, greasiness and coating effect of the ointment eradicated vulvo-vaginal complaints.

Penicillin V four times daily for five days versus three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci: randomised controlled, open label, non-inferiority study

ObjectiveTo determine whether total exposure to penicillin V can be reduced while maintaining adequate clinical efficacy when treating pharyngotonsillitis caused by group A streptococci.DesignOpen label, randomised controlled non-inferiority study.Setting17 primary...

BIOAPYGIN HERBAL OINTMENT AND PESSARIES COMPARED TO ACIDOSALUS PESSARIES AND VAGINAL PROBIOTIC IN THE TREATMENT OF VULVO-VAGINAL DISORDERS

Objective / Purpose : The objective of the study was assessment of the clinical efficacy and safety of Bioapigyn O vaginal ointment and pessaries compared to Acidosalus O pessaries and vaginal probiotic in alleviating vulvo-vaginal disorders. Materials and methods : 124 females were randomly selected into four groups (each of 31 participants) and treated once a day for ten days with: A) Bioapigyn O vaginal pessaries (one pessary per day); B) 2.5 mL of Bioapygin O vaginal ointment; C) Acidosalus O vaginal pessaries (one pessary per day); D) 2.5 mL of Acidosalus O vaginal probiotic. All the patients were subjected to gynecological examination, measurement of vaginal pH, Pap test, native and KOH test, self-assessment and clinical assessment of the symptoms at baseline and following the therapy. Results : Following the treatment with Bioapigin O vaginal ointment, Bioapigyn O pessaries, Acidosalus O pessaries, Acidosalus O vaginal probiotic the total score of vulvo-vaginal disorders decreased for 85.2%, 88.9%, 82.7% and 78%, respectively and vaginal pH decreased between 9.1% and 14.3%. Native test showed normalization of the vaginal flora following the treatment with all four products with no significant difference among the products. Conclusion/Discussion : Both Bioapigyn O and Acidosalus O products were highly efficient in alleviation of vulvo-vaginal disorders. The products created unfavorable conditions for pathogenic growth through the lowering of vaginal pH value, promoting the growth of lactobacilli, creating the environment with low water activity and creating a protective layer on the damaged mucosa that creates a physical barrier to the entrance of the pathogens into the cells and enables the recovery of the vaginal mucosa.

Vulvovaginal Disease Education in Canadian and American Gynecology Residency Programs: A Survey of Program Directors.

The aims of the study were to assess and describe the current vulvovaginal curriculum in gynecology residency training programs in Canada and the United States and to compare this with national training objectives. A 22-question electronic survey was sent to 252 gynecology program directors in Canada and the United States between September 2015 and July 2016 using the platform SurveyMonkey.com. Survey responses were entered into SPSS Version 23, and analysis was performed using descriptive statistics. Overall, 58 (23%) of 252 programs directors responded. Nearly all of the sites provided formal teaching on pain disorders (54/58, 93%), vulvar dermatoses (54/58, 93%), and vulvovaginal infections (57/58, 98%). Exposure to vulvovaginal clinics varied widely. On average, program directors estimated that residents spend a median of 10 hours (0-200) in vulvar pain clinics, 9 hours (0-200) in dermatology clinics, and 50 hours (0-480) in colposcopy clinics during residency training. Most program directors (53/57, 93%) believed that all general gynecologists should be able to manage vulvar disorders in practice. Reported obstacles to treating vulvar disorders included lack of training (41/58, 71%) and lack of interest (35/58, 60%). While most residency programs provided formal education on vulvovaginal diseases, clinical exposure is extremely variable between sites. When it is not possible to increase clinical exposure to vulvovaginal disorders, traditional training methods (lectures, textbooks) should be supplemented with online modules and other means of learning to improve resident knowledge of vulvovaginal diseases.

Role of female intimate hygiene in vulvovaginal health: Global hygiene practices and product usage.

Women use various feminine hygiene products, often as part of their daily cleansing routine; however, there is a paucity of published medical literature related to the external vulva and how personal hygiene practices can affect it. This review article provides background information on the physiological changes that occur during women’s lives and reviews the relevance of transient and resident microbiota as they relate to common vaginal and vulvar disorders. It also discusses the need for female intimate hygiene, common practices of feminine hygiene from a global perspective, and the potential benefits of using suitable external, topical feminine vulvar washes to minimize the risk of vulvovaginal disorders and to improve overall intimate health in women around the world. Supported by international guidelines, daily gentle cleansing of the vulva is an important aspect of feminine hygiene and overall intimate health. Women should be encouraged to choose a carefully formulated and clinically tested external wash that provides targeted antimicrobial and other health benefits without negatively impacting on the natural vulvovaginal microbiota.

Efficacy and tolerability of a plant-based, multi-component cream (Ginetrox®) in vulvovaginal disorders of the genitourinary syndrome during menopause

Genitourinary syndrome of menopause (GSM) is a symptomatic condition including vaginal dryness, irritation, dyspareunia and recurrent urinary tract infections which affects 40-54% of post-menopausal women. Although several estrogen-based therapies are available, it is generally preferable to avoid hormonal therapy, particularly in women with mild symptoms or at risk for estrogen-responsive neoplasia. Therefore, the most common treatment options are over-the-counter vaginal creams for symptomatic relief. Thirty-three postmenopausal women suffering from GSM were enrolled in this observational study. A multi-component cream (Ginetrox®, Indena, Milan, Italy) was applied on the vestibular area of the vagina for three months. The primary endpoints were: vaginal burning and/or pain, assessed by Visual Analog Scale and dyspareunia, assessed using the Marinoff Score. As a secondary endpoint, vestibular health was evaluated through a four-point scale. Side effects and adherence to treatment were also recorded. Statistically significant improvement was observed in pain scores and dyspareunia at the end of the treatment compared to baseline values. The vestibular health index significantly decreased after 3 months. Tolerability was acceptable. This preliminary study suggests that the plant-based, multi-component cream Ginetrox® could be effective and safe in counteracting menopause-related vaginal discomfort symptoms.

Study of Vulvo-Vaginal Disorders in Southern Rajasthan Women of Different Ages

Study of Vulvo-Vaginal Disorders in Southern Rajasthan Women of Different Ages

Vulvovestibulitis syndrome: the role of temperament and mood in women

Background: Recent literature highlights how some psychological factors could play a key role in the development and course of gynaecological illnesses by influencing health-related outcomes. Nevertheless, little is known about the influence of the temperament and character traits and depressive symptoms in women’s health. Objective: The aim of this study was to evaluate psychological patterns in terms of personality and mood, among women with vulvovaginal disorders and women with other general gynaecological conditions. Methods: Thirty-two women suffering from vulvar vestibulitis (VVS) and 34 suffering from other gynaecological disorders (Mean age = 49±17) have been evaluated with the Temperament and Character Inventory (TCI) and the Montgomery-Asberg Depression Rating Scale (MADRS). Results: With reference to personality, women with VVS obtained a higher score on the temperamental trait of Harm Avoidance showing a disposition to face problems with pessimistic thoughts and a vulnerability for anxiety and fatigue. With reference to mood, women with VVS reported a higher number of depressive symptoms. Furthermore, the dimensions of temperament are significantly related to the mood in the whole sample. Conclusions: Women with VVS present specific psychological patterns (temperament, character and mood) that could have an impact in the development and/or duration of the disease. For this reason, in addition to traditional medical treatments, a psychological support focused on anxiety and depression management would be useful for a broader and person-centered approach to attending gynecological patients.