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Background: Vulvodynia impacts up to 8% of women by age 40, and these women may have a more compromised immune system than women with no vulvar pain history. Aim: Given that psychiatric morbidity is associated with vulvodynia and is known to activate immune inflammatory pathways in the brain and systemically, we sought to determine whether the association between psychiatric morbidity and vulvar pain was independent of or dependent upon the presence of immune-related conditions. Methods: Women born in Sweden between 1973 and 1996 with localized provoked vulvodynia (N76.3) and/or vaginismus (N94.2 or F52.5) diagnosed between 2001 and 2018 were matched to two women from the same birth year with no vulvar pain. International Statistical Classification of Diseases and Related Health Problems (ICD-9 or -10 codes) were used to identify women with a history of depression, anxiety, attempted suicide, neurotic disorders, stress-related disorders, behavioral syndromes, personality disorders, psychotic disorders, or chemical dependencies, as well as a spectrum of immune-related conditions. The Swedish National Prescribed Drug Register was used to identify women with filled prescriptions of antidepressants or anxiolytics. Outcomes: Vulvodynia, vaginismus, or both were outcomes assessed in relation to psychiatric morbidity. Results: Women with vulvodynia, vaginismus, or both, relative to those without vulvar pain, had adjusted odds ratios between 1.4 and 2.3, with CIs highly compatible with harmful effects. When we assessed women with and those without a lifetime history of immune-related conditions separately, we also observed elevated odds ratios in both groups for mood, anxiety, and neurotic and stress disorders. Clinical implications: Documenting psychiatric impairment as a cause or consequence of vulvodynia is critical in clinical practice because psychiatric conditions may impact treatment efficacy. Strengths and Limitations: Strengths of this study include a data source that represents the entire population of women in Sweden that is known to be highly accurate because Sweden provides universal healthcare. Limitations include difficulty in making an accurate assessment of temporality between psychiatric morbidity and the first onset of vulvar pain. In addition, because Swedish registry data have limited information on lifestyle, behavioral, and anthropomorphic factors such as smoking, diet, physical activity, and obesity, these conditions could not be assessed as confounders of psychiatric morbidity and vulvar pain. Conclusions: Immune pathways by which women with psychiatric conditions increase their risk of vulvar pain could be independent from other immune pathways. [ABSTRACT FROM AUTHOR]

Background: Depression and vulvodynia are often comorbid. The onset of depression and vulvodynia may be immune and/or stress/environmentally induced. We explored whether vulvodynia, depression, or both occur in response to a Th1-mediated versus Th2-mediated immune response. Materials and Methods: We analyzed data from a case–control study of clinically confirmed vulvodynia and history of depression determined through structured clinical interviews. Immune dysregulation and inflammation were categorized based on the following self-reported conditions: rheumatoid arthritis, Sjogren's disease, scleroderma, systemic lupus erythematosus, inflammatory bowel disease, fibromyalgia, osteoarthritis, polycystic ovarian syndrome, diabetes mellitus, uterine fibroids, asthma, atopic dermatitis, and allergic rhinitis. Logistic regression analyses were adjusted for marital status, body mass index, age, and pack years. Results: Women with systemic immune dysregulation had higher odds of depression (adjusted odds ratio [aOR] = 1.61, confidence interval [95% CI]: 0.65–3.98), vulvodynia (aOR = 2.45, 95% CI: 1.00–5.96), and comorbid depression and vulvodynia (aOR = 4.93, 95% CI: 2.19–11.10) versus neither condition. Women reporting local immune dysregulation had similar odds of depression (aOR = 1.89, 95% CI: 0.99–3.59), vulvodynia (aOR = 2.12, 95% CI: 1.08–4.18), and comorbid depression and vulvodynia (aOR = 1.96, 95% CI: 0.98–3.90). Women with Th2 inflammation had similar odds of depression (aOR = 2.23, 95% CI: 1.05–4.77) and vulvodynia (aOR = 2.56, 95% CI: 1.20–5.49). Women with Th1 or Th2 inflammation had similar odds of comorbid depression and vulvodynia (aOR = 3.03, 95% CI: 1.48–6.19; aOR = 3.14, 95% CI: 1.49–6.60, respectively). Conclusions: Our results suggest that an imbalance of cytokines, indicated by the presence of one or more immune-related health conditions, is associated with an increased risk of vulvodynia and/or depression. [ABSTRACT FROM AUTHOR]

Introduction: The spectrum of bladder health and the factors that promote bladder health and prevent lower urinary tract symptoms (LUTS) among women are not well understood. This manuscript describes the rationale, aims, study design, sampling strategy, and data collection for the RISE FOR HEALTH (RISE) study, a novel study of bladder health in women conducted by the Prevention of Lower Urinary Tract Symptom (PLUS) Research Consortium. Methods and Results: RISE is a population‐based, multicenter, prospective longitudinal cohort study of community‐dwelling, English‐ and Spanish‐speaking adult women based in the United States. Its goal is to inform the distribution of bladder health and the individual factors (biologic, behavioral, and psychosocial) and multilevel factors (interpersonal, institutional, community, and societal) that promote bladder health and/or prevent LUTS in women across the life course. Key study development activities included the: (1) development of a conceptual framework and philosophy to guide subsequent activities, (2) creation of a study design and sampling strategy, prioritizing diversity, equity, and inclusion, and (3) selection and development of data collection components. Community members and cross‐cultural experts shaped and ensured the appropriateness of all study procedures and materials. RISE participants will be selected by simple random sampling of individuals identified by a marketing database who reside in the 50 counties surrounding nine PLUS clinical research centers. Participants will complete self‐administered surveys at baseline (mailed paper or electronic) to capture bladder health and LUTS, knowledge about bladder health, and factors hypothesized to promote bladder health and prevent LUTS. A subset of participants will complete an in‐person assessment to augment data with objective measures including urogenital microbiome specimens. Initial longitudinal follow‐up is planned at 1 year. Discussion: Findings from RISE will begin to build the necessary evidence base to support much‐needed, new bladder health promotion and LUTS prevention interventions in women. [ABSTRACT FROM AUTHOR]

The study aims to investigate the relationship between diabetes and depression during pregnancy and post-partum among women from lower-income groups. The results indicate that pregnant women and new mothers with diabetes had a higher risk of developing depression during the perinatal period.

Objective: The menstrual cycle may influence vulvodynia through hormonal pathways or vulvar irritation due to menstruation or menstrual hygiene. We assessed menstrual cycle characteristics in those with and without clinically confirmed vulvodynia. Materials and Methods: Participants were recruited from the administrative database of a health care network serving ∼27% of Minneapolis–Saint Paul residents. For 220 clinically confirmed cases and 224 controls, menstrual cycle characteristics were retrospectively assessed at three time points: before age 18, the year before onset of vulvar pain, and 3 months before study participation. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between menstrual characteristics at all three time points and vulvodynia. Models adjusted for prespecified confounders were evaluated against crude effect estimates. Results: Women with heavier menstrual flows had higher odds of vulvodynia compared with women with lighter menstrual flows during their adolescent years (OR 1.62, 95% CI 0.91–2.86), the year before onset of vulvar pain (OR = 2.11, 95% CI 1.10–4.02), and during the 3 months before study participation (OR = 1.67, 95% CI 0.91–3.06). Women with more severe cramps also had higher odds of vulvodynia compared with women with no or mild cramps during their adolescent years (OR = 2.45, 95% CI 1.45–4.15), the year before onset of vulvar pain (OR = 3.30, 95% CI 1.67–6.51), and during the 3 months before study participation (OR = 4.96, 95% CI 1.99–12.36). Women with specific premenstrual symptoms also reported higher odds of vulvodynia. Among those with vulvodynia, half reported a change in vulvar pain across the menstrual cycle, with 60% of these reporting greater pain just before and during menstruation. Furthermore, we observe a trend of decreased tampon use and increased use of sanitary pads as women with vulvodynia moved closer to their date of diagnosis. Conclusions: Menstrual cycle characteristics were associated with vulvodynia, and associations were consistent across different phases of the reproductive life cycle. [ABSTRACT FROM AUTHOR]

In a large, community-based sample of women (N = 750), the authors examined the nature of associations between dysfunctional attitudes and depression. Dysfunctional attitudes were evaluated both as a vulnerability factor for depression and as a consequence of depression. A link was found between past depression and baseline elevations in dysfunctional attitudes that was independent of current subsyndromal symptoms, but intensification of dysfunctional attitudes following prospectively evaluated episodes of depression (depressive 'scarring') was not observed. Although baseline dysfunctional attitudes predicted an episode of major depression over 3 years of prospective study, this prediction, considered alone or in interaction with negative life events, was redundant with that offered by history of past depression. Further, no significant prediction was evident for the Dysfunctional Attitude Scale (A. N. Weissman & A. T. Beck, 1978) when the formerly depressed and never-depressed cohorts were considered separately. Implications for cognitive theories are discussed. Keywords: depression, dysfunctional attitudes, cognitive vulnerability, depressive scarring

The study is carried out to describe risk of relapse in pregnant women who discontinued antidepressant medication proximate to conception compared to those who maintained treatment with these medications. It is observed that women who discontinued medication relapsed significantly more frequently over the course of their pregnancy compared with women who maintained their medication.

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. [ABSTRACT FROM AUTHOR]