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To evaluate the effectiveness of nonpharmacological conservative therapies for women with CPP. A systematic search of electronic databases (Amed, CINAHL, PsycINFO, SportDiscuss, Medline, PubMed, Embase, and Cochrane Central Register of Controlled Trials) was performed in January 2023, and updated in December 2023. Randomized controlled trials comparing a nonpharmacological conservative therapy to inert (eg, placebo, usual care) or nonconservative (eg, surgical, pharmacological) treatment were included. Conservative therapies of interest to this review were: multimodal physical therapy, predominantly psychological approaches, acupuncture, and other tissue-based monotherapies (eg, electrophysical agents, manual stretching). All study data were aggregated, and analyses of the included studies were performed. Effects on pain; sexual measures; psychological and physical function; health-related quality of life; symptom severity/bother; pelvic floor muscle function and morphometry; perceived improvement; and adverse events were analyzed. Meta-analyses (random effects model) were conducted using postintervention scores for data that included similar interventions and outcomes. Standardized mean differences were calculated. A narrative summary of findings that could not be included in the meta-analysis is provided. The quality of the evidence was assessed with the Physiotherapy Evidence Database scale and the certainty of evidence with Grading of Recommendations, Assessment, Development, and Evaluations criteria. Of 5776 retrieved studies, 38 randomized controlled trials including 2168 women (mean age 35.1±8.6) were included. Meta-analyses revealed that multimodal physical therapy resulted in lower pain intensity compared to inert or nonconservative treatments in both the short (standardized mean difference −1.69, 95% confidence interval −2.54, −0.85; high certainty) and intermediate-terms (standardized mean difference −1.82, 95% confidence interval −3.13, −0.52; moderate certainty), while predominantly psychological approaches resulted in no difference in pain intensity (standardized mean difference −0.18, 95% confidence interval −0.56, 0.20; moderate certainty) and a slight difference in sexual function (standardized mean difference −0.28, 95% confidence interval −0.52, −0.04; moderate certainty). The level of evidence regarding the meta-analysis of the effects of acupuncture on pain intensity (standardized mean difference 1.08, 95% confidence interval −1.38, 3.54, nonstatistically significant results in favor of control treatment) precluded any statement of certainty. A limited number of trials investigated individual tissue-based monotherapies, providing a restricted body of evidence. This systematic review with meta-analysis revealed that multimodal physical therapy is effective in women with chronic pelvic pain with a high certainty of evidence. [ABSTRACT FROM AUTHOR]

Hair thread tourniquet syndrome occurs when tissue is strangulated by a hair thread. It occurs most commonly in the digits of infants and young children, but can also occur in the genitalia. A 13-year-old postmenarchal girl with several days of severe vulvar pain and swelling presented to the emergency department. Diagnosis was unclear and she was referred to pediatric and adolescent gynecology. Pelvic examination under anesthesia revealed a hair thread tourniquet involving the bilateral labia minora. The hair tourniquet and portions of bilateral labia minora were excised. Why Should an Emergency Physician Be Aware of This? Genital hair thread tourniquet syndrome is uncommon but must be considered in patients with severe genital pain and swelling. Prompt diagnosis and treatment are important to prevent tissue necrosis and may be facilitated by means of a pelvic examination with sedation. [ABSTRACT FROM AUTHOR]

To assess the presence of anxiety, depression and somatization in women with vulvodynia. The search for articles was performed in the electronic databases MEDLINE, via PubMed, EMBASE, LILACS and the American Psychological Association (PsycINFO). A search strategy was developed using the following terms: "Vulvodynia" and "psychological symptom" and their respective synonyms. The search was limited to human studies and no language restriction. After the screening process, 10 studies met the eligibility criteria and were included in this review. The studies were published between 1993 and 2017, with 2886 participants, of which 912 are cases and 1974 are controls. Meta-analysis of included studies revealed a significant difference between groups in depression outcomes (DMP: 0.75; 95 % CI: 0.41 to 1.10; p < 0.0001; I2: 28 %), anxiety (DMP: 1.22; 95 % CI: 0.84 to 1.59; p < 0.00001; I2:0%) and somatization (DMP: 1.31; 95%CI: 0.80 to 1.82; p < 0.00001; I2: 46 %). Through the meta-analyses, significant associations were observed between vulvodynia and depression, anxiety and somatization. • Women with vulvodynia presented higher depression scores when compared to controls. • Women with vulvodynia have a higher anxiety score when compared with controls. • Women with vulvodynia have higher somatization scores when compared with controls. [ABSTRACT FROM AUTHOR]

• Dyspareunia, vaginismus and chronic pelvic pain are gynecological pathologies that have a strongly negative impact on women's quality of life. • Botulinum toxin shown effectiveness in reducing local inflammation, peripheral and central terminal neurotransmitter release and nociceptive processing. • Botulinum toxin injection was found to be effective in improving vulvar and vaginal dyspareunia, vaginismus, and chronic pelvic pain. Botulinum toxin (BoNT) administration has been proposed in the gynecologic field for pelvic, vulvar and vaginal disorders. On this regard, we aimed assessing the therapeutic effectiveness and safety of BoNT usage in the treatment of vaginal, vulvar and pelvic pain disorders. We searched for all the original articles without date restriction until 31.12.2021. We included all the original articles which administered botulinum toxin in the vulva or vagina of women suffering from vaginismus, dyspareunia, and chronic pelvic pain. Only English language studies and those performed in humans were eligible. We excluded all case reports and pilot study from the qualitative analysis, although we accurately evaluated them. 22 original studies were finally included in the systematic review. Botulinum toxin injection was found to be effective in improving vulvar and vaginal dyspareunia, vaginismus, and chronic pelvic pain. No irreversible side effects were detected. Major side effects reported were transient urinary or fecal incontinence, constipation and rectal pain. The risk of bias assessment proved original articles to be of medium quality. No metanalysis could have been performed since lack of congruency in the definition of pathology and methods of botulinum toxin administration. Data extraction pointed out different endpoints and different methods of analysis. Studies focus on different types of participants and use various techniques and timing. According to the best evidence available, different techniques provide evidence about positive outcomes, with the need for a standardized protocol. [ABSTRACT FROM AUTHOR]

Vulvodynia involves vulvar discomfort that occurs in the absence of an identifiable cause. Because vulvodynia is often accompanied by myofascial pain and pelvic floor tension, transvaginal botulinum toxin (BT) injection into the pelvic floor has been proposed as a possible treatment. Retrospective case series Three adolescents with vulvodynia had a suboptimal response to treatment with several interventions, including neuromodulators (oral and topical), tricyclic antidepressants (oral and topical), and pelvic floor physical therapy. Subsequently, these patients underwent BT injections to the pelvic floor as treatment with varying responses. In select adolescent patients with vulvodynia, transvaginal BT injection into the pelvic floor can be an effective treatment. Further studies are needed to assess the optimal dosing, frequency, and sites of BT injections in the treatment of vulvodynia in pediatric and adolescent patients. [ABSTRACT FROM AUTHOR]

• While often associated with hot flashes, mood swings, and hormonal changes, pain is a frequently overlooked and under-addressed aspect of the menopausal experience. • Pain during menopause may include musculoskeletal discomfort, headaches or migraines, and vulvovaginal pain. • This review article highlights the factors contributing to pain during menopause, evaluates the effects of hormones on menopausal pain, and investigates management strategies for pain during menopause, including both pharmacological and non-pharmacological approaches. Menopause is a biological process marking the end of a woman's reproductive years, typically occurring between the ages of 45 and 55. While often associated with hot flashes, mood swings, and hormonal changes, pain is a frequently overlooked and under-addressed aspect of the menopausal experience. This review article explores the multifaceted nature of pain during menopause, and sheds light on its various manifestations and the factors contributing to its prevalence and severity. Pain during menopause may include musculoskeletal discomfort, headaches or migraines, and vulvovaginal pain. The etiology of these is intricate, involving hormonal fluctuations, psychosocial factors, and genetic predispositions. Fluctuations in estrogen and progesterone levels play a pivotal role in musculoskeletal pain and joint stiffness, and increase susceptibility to conditions such as osteoarthritis. Furthermore, mood disorders, stress, and sleep disturbances may exacerbate the perception of pain. Gender norms, as well as changes in reproductive capacity and societal views on aging, may adversely the impact the self-esteem of individuals undergoing menopause. These symptoms can significantly impact a woman's quality of life, underscoring the need for early identification and appropriate management strategies. This review article highlights the factors contributing to pain during menopause, evaluates the effects of hormones on menopausal pain, and investigates management strategies for pain during menopause, including both pharmacological and non-pharmacological approaches. It also emphasizes the need for further research to better understand the interplay of factors contributing to pain during menopause, in order to allow for more tailored and effective interventions. In understanding and addressing this often-neglected aspect of menopause, healthcare providers can enhance the overall wellbeing and quality of life for women transitioning through this natural life stage. [ABSTRACT FROM AUTHOR]

Objective: Provoked vestibulodynia (PVD) is a challenging and distressing problem for women. The aim of this study was to examine the effect of hyaluronic acid (HA) in the management of this condition.Method: This is a retrospective review of 12 women diagnosed with PVD and treated with HA (19 mg/mL) applied, point-by-point, to the vestibular region at 2 mm intervals and at a depth of 0.5 mm. Women completed a pain VAS and a Female Sexual Function Index (FSFI) before and 45 days after treatment.Results: An improvement was observed both in mean FSFI scores (17.8 to 23.3; p = 0.003) and mean VAS scores (7.2 to 4.1; p = 0.002) after HA application respectively. However, on a telephone interview 3 months post treatment, five women (41.7 %) complained of recurrence of their dyspareunia.Conclusion: HA is a promising management option in provoked vestibulodynia. However, further larger studies with possible alternative regimens and longer follow-up are required. [ABSTRACT FROM AUTHOR]

Vulval pain is a common condition which can cause significant distress to patients. Pain can be from a specific disorder affecting the vulva which presents acutely but becomes a chronic pain if left untreated. If not due to an underlying defined condition, chronic vulval pain is termed Vulvodynia, where pain is classically described as burning in nature. Chronic vulval pain can be challenging for the gynaecologist; correct diagnosis is frequently delayed and treatment is often unsatisfactory. Management relies on a multidisciplinary approach, tailored specifically to the patient. [ABSTRACT FROM AUTHOR]

Provoked, localized, vulvodynia (PVD) is the main subtype of vulvodynia. Although the etiology of PVD is still a topic of debate, inflammation caused by cytokines responding to a dysregulated microbiome is one of the leading proposed theories. Therefore, the purpose of our study is to further explore the cytokine profiles in the study group with PVD using multiplex immunoassays based on electrochemiluminescence. We compared a panel of 26 distinct cytokines levels in the study group with PVD (n = 23) to the control group (n = 18) and cytokine concentrations were measured using MESO QuickPlex SQ 120 instrument with 5 different multiplex assays. Statistical analysis used the Mann-Whitney U test, two-sided p -values, and a significance level of α = 0.05. Differences in cytokine concentrations are described as negligible, small, medium, or large based on Cliff's δ. Concentrations of three cytokines were significantly lower in the PVD group: a large difference in IP-10 (p = 0.029*) and medium differences in IL-1RA 4 4 Cytokine abbreviations: bFGF; Basic Fibroblast Growth Factor, G-CSF; Granulocyte colony stimulating factor, GM-CSF; Granulocyte-Macrophage Colony-Stimulating Factor, IFN; interferon, IL; Interleukin, IP; Interferon-gamma Inducible Protein, MCP; Monocyte Chemoattractant Protein, MIP; Macrophage Inflammatory Protein, PGDF-BB; Platelet Derived Growth Factor Subunit B, RA; Receptor antagonist, TNF; Tumor Necrosis Factor, VEGF; Vascular Endothelial Growth Factor (p = 0.030*) and IL-12 (p = 0.034*). One cytokine level was significantly higher in the PVD group: a medium difference for IL-6 (p = 0.037*). Due to the lack of consistency in elevation of inflammatory profiles, it is not enough to support persistent inflammation as the etiology behind PVD. However, these findings may indicate there is a possible immune response deficiency in some patients who have PVD. The resemblance of cytokine profile in our study to cytokine profile of people with chronic yeast infection further support this proposed mechanism behind PVD. Future studies involving history and testing for yeast infection are necessary to explore this possibility further. • The etiology of provoked vulvodynia is largely a topic of debate • A panel of 26 cytokines were evaluated in patients with provoked vulvodynia • Three cytokines (IP-10, IL-1RA, IL-12) found to be diminished in study group • One cytokine (IL-6) was significantly elevated in the study group • Findings may suggest an immune response deficiency in provoked vulvodynia patients [ABSTRACT FROM AUTHOR]

This Clinical Opinion replaces the NASPAG Clinical Recommendation: Pediatric Lichen Sclerosus published in 2014. The objective of this document is to provide guidance in the diagnosis and management of vulvar lichen sclerosus (LS) in the pediatric and adolescent patient in order to treat patient symptoms and reduce long-term sequelae. LS is a chronic inflammatory condition affecting the anogenital region that may present in the prepubertal or adolescent patient. Clinical presentations include significant pruritus, loss of pigmentation and vulvar adhesions with loss of normal vulvar architecture. Management includes topical agents for induction and maintenance therapy, as well as long-term follow-up for identification and treatment of recurrence and sequelae. This document is intended for use by both primary and specialty pediatric and adolescent gynecology (PAG) providers, including specialists in pediatrics, gynecology, adolescent medicine, and dermatology. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate patient-reported sexual outcomes after chemoradiation therapy and image-guided adaptive brachytherapy for locally advanced cervical cancer in the observational, prospective, multicenter EMBRACE-I study.Methods and Materials: Sexual outcomes were assessed prospectively with the European Organization for Research and Treatment of Cancer Qualify of Life Questionnaire (EORTC-QLQ-CX24) at baseline and follow-up. Crude incidence and prevalence rates of sexual activity, vaginal functioning problems (dryness, shortening, tightening, pain during intercourse), and sexual enjoyment were evaluated. Associations between pain during intercourse and vaginal functioning problems or sexual enjoyment were calculated, pooling observations over all follow-ups (Spearman correlation coefficient). In patients who were frequently sexually active (≥50% of follow-ups), the effects of regular hormonal replacement therapy (HRT) on vaginal functioning problems were evaluated (Pearson χ2).Results: The analysis involved 1045 patients with a median follow-up of 50 months. Sexual activity was reported by 22% of patients at baseline and by 40% to 47% of patients during follow-up (prevalence rates). Vaginal functioning problems in follow-up were dryness (18%-21%), shortening (15%-22%), tightening (16%-22%), pain during intercourse (9%-21%), and compromised enjoyment (37%-47%). Pain during intercourse was significantly associated with vaginal tightening (r = 0.544), shortening (r = 0.532), and dryness (r = 0.408) and negatively correlated with sexual enjoyment (r = -0.407). Regular HRT was associated with significantly less vaginal dryness (P = .015), shortening (P = .024), pain during intercourse (P = .003), and borderline higher sexual enjoyment (P = .062).Conclusions: Vaginal functioning problems are associated with pain and compromised sexual enjoyment. Further effort is required for the primary prevention of vaginal morbidity with dose optimization and adaptation. Secondary prevention strategies, including HRT for vaginal and sexual health after radiation therapy in locally advanced cervical cancer, should be considered and sexual rehabilitation programs should be developed further. [ABSTRACT FROM AUTHOR]

Vulvodynia is a condition characterised by persistent vulval pain and includes particular impacts on sexual and emotional functioning. Acceptance and Commitment Therapy (ACT) has been successfully applied in persistent pain but has not been tested in this population. This single-case experimental design (SCED) study aimed to evaluate whether an online ACT programme improves clinical outcomes in women with Vulvodynia. We also evaluated whether the intervention led to changes in hypothesised processes of therapeutic change. This study applied a nonconcurrent multiple baseline SCED method to assess ACT in women with Vulvodynia. During baseline and treatment phases, participants completed daily self-report outcomes of pain severity and interference, sexual functioning and satisfaction, depression, and hypothesised process-variables: pain-acceptance, present-moment-awareness, committed-action, perceived injustice, and body-exposure anxiety during sexual activities. Full-length assessments of these variables were also completed before and after treatment. The intervention comprised a six-week online ACT programme, combined with a Vulvodynia-specific manual. Visual and statistical analyses were conducted. Seven participants, mostly with mixed Vulvodynia, provided baseline and treatment phase data, and completed the intervention and diaries. Based on the visual inspection, and Tau and Tau-U values as effect sizes from the daily data, all participants showed moderate size improvements in two or more outcomes. However, participants had highly individual treatment effects. Limited improvement was found in depression. Pain-acceptance, committed-action, and perceived injustice also demonstrated change for some participants. The results suggest online ACT may improve pain and sexual outcomes for some women with Vulvodynia. Pain-acceptance, committed-action, and perceived injustice are highlighted as potential processes of change for some participants. In general, responses to treatment appear highly individual. Further application of the SCED approach to ACT for Vulvodynia is recommended. • Vulvodynia involves persistent vulval pain, sexual impacts, and depression. • Acceptance and Commitment therapy (ACT) has not been tested in Vulvodynia. • Online ACT was tested using a single-case experimental design (SCED) in 7 women. • Pain, sexual outcomes, and processes of change improved in most women following ACT. • This SCED study suggests ACT represents a promising avenue in this population. [ABSTRACT FROM AUTHOR]

Provoked vestibulodynia is a vulvar pain condition causing sexual dysfunction, affecting 8% to 10% of women. Our recently published randomized clinical trial (N = 108 couples) found that cognitive behavioral couple therapy (CBCT) and topical lidocaine reduced women's pain and associated sexual symptoms, with CBCT showing more benefits. Little is known about pretreatment predictors of treatment outcomes in couples sex therapy. In the current study, we examined women and their partners' pretreatment demographic (age, relationship length), clinical (pain duration, anxiety) and interpersonal (partner responses to pain, sexual goals) predictors/moderators of women's pain intensity, pain unpleasantness, and sexual function at posttreatment and 6-month follow-up. Longer relationship duration, lower anxiety in women, partner higher solicitousness and partner higher approach sexual goals predicted better pain outcomes for women with PVD irrespective of treatment condition. CBCT was more effective than lidocaine for improving women's sexual function at posttreatment when, at pretreatment, women had partners with higher anxiety and women reported lower approach sexual goals, whereas lidocaine was more effective for improving women's sexual function at follow-up when partners had higher approach sexual goals. Findings can assist clinicians in determining what treatment will be most beneficial for whom. [ABSTRACT FROM AUTHOR]

• This study identified factors altering tDCS response in PVD. • PVD subtype and pain intensity were not associated with tDCS response. • Depressive symptoms were found to be associated with larger pain reduction. There is growing evidence that provoked vestibulodynia (PVD), a frequent and debilitating condition, is characterized by central sensitization. This study aimed to examine predictive factors of transcranial direct current stimulation (tDCS) efficacy in this chronic pain population. Exploratory analysis derived from a randomized controlled trial was performed to assess predictors of pain reduction among 39 women with PVD who received 10 daily sessions of either active or sham tDCS. Clinical characteristics (e.g. pain intensity, duration and pain sensitivity) and psychosexual factors (e.g. pain catastrophizing, pain-related fear, anxiety, depressive symptoms and vaginal penetration cognitions) were assessed at baseline and used to predict tDCS response at 3-month follow-up. Analysis revealed that higher depressive symptoms and lower negative self-image cognitions were significant predictors of pain reduction at follow-up and accounted for 62.3% of the variance in the active tDCS group. Higher genital incompatibility cognitions were related to poorer response, regardless of treatment group. These findings suggest that women with PVD presenting higher depressive symptoms and lower levels of negative self-image cognitions could derive greater benefits from tDCS. These results suggest that tDCS could be effective in a subgroup of women with PVD - a possibility worth exploring with future prospective larger studies. [ABSTRACT FROM AUTHOR]

To compare clinical characteristics, treatment histories, and microbiology of premenarchal girls who presented to a pediatric gynecology specialty clinic with short-duration and chronic vulvar symptoms. Retrospective cohort study. Pediatric and adolescent gynecology clinic at a tertiary care children's hospital. One hundred eighty-two premenarchal patients ages 2-14 years who presented to a pediatric gynecology specialty clinic with vulvar complaints and who were evaluated with a yeast and/or bacterial culture. None. Chronic and short-duration vulvar symptoms, microbiology, and diagnosis. Patients with chronic symptoms were more likely to present with itching (59/102 (57.8%) vs 34/80 (42.5%); P =.04), redness or rash (53/102 (52.0%) vs 22/80 (27.5%); P =.0009), and discomfort (59/102 (57.8%) vs 30/80 (37.5%); P =.006), compared with patients with short-duration symptoms. Overall, 44.5% of patients had a history of antifungal treatment, with a greater proportion of patients with chronic symptoms having received antifungal treatment compared with those with short-duration symptoms (53/102 (52.0%) vs 28/80 (35.0%); P =.02). Despite a history of antifungal treatment in nearly half of the patients, Candida albicans was isolated in only 3/144 (2.1%) yeast cultures. Bacterial vulvar cultures were positive in 75/159 (47.2%), and there was no difference among the symptom duration groups (38/71 (53.5%) vs 37/88 (42.1%); P =.15). Vulvovaginitis is a common gynecological diagnosis among premenarchal girls with short-duration and chronic vulvar symptoms. Regardless of symptom duration, yeast cultures are rarely positive. Antifungal treatment should be avoided in toilet-trained prepubertal girls. [ABSTRACT FROM AUTHOR]

Objective: Vulvar Lichen sclerosus (LS) is a chronic inflammatory disease in which architectural changes and symptoms like itching, soreness, pain and dyspareunia can affect quality of life and sexual activity. Perineoplasty has been shown to be effective as a supportive surgical treatment in women with refractory dyspareunia in addition to the standard topical immunosuppressive treatment. The aim of this study was to evaluate retrospectively general complaints, patient satisfaction concerning sexual activity, reduction of dyspareunia/apareunia, orgasm ability and recurrence of LS after perineoplasty.Study Design: This study is a retrospective monocentric observational study, in which patients with vulvar LS who had undergone perineoplasty were invited to fill out a standardized questionnaire during the follow-up time. The main outcome measure is the overall patient satisfaction after surgical therapy of vulvar LS.Results: Forty-one of the 70 invited patients with a median age at surgery of 58 years (18-74 years) and a median 60 years (19-76 years) at the last follow-up were evaluated. The median follow-up time was 2.3 years (1-5 years). There was a significant (p < 0.001) reduction in general complaints after surgery. Twenty-two patients were very satisfied, 15 were satisfied and 3 were not satisfied with the outcome of the surgery. Only 2 patients would not recommend the surgery. Although, there was a significant (p = 0.02) reduction in dyspareunia after surgery, 10 patients still felt pain during sexual intercourse.Conclusion: This is one of the largest studies reporting on long-term results of perineoplasty. It showed that perineoplasty is a safe surgical treatment option with a high satisfaction rate in patients with dyspareunia due to LS and a desire to regain sexual activity. Perineoplasty can improve sexual activity and achieve overall satisfaction in selected patients even though the recurrence rate of LS in sexually active patients remains high. [ABSTRACT FROM AUTHOR]

"Hair-thread tourniquet syndrome" (HTTS) describes the condition in which fibers of hair or thread wrap around an appendage (ie, toes, fingers, genital structures, tongue, uvula, and neck), eventually causing ischemia and tissue necrosis. To date, few cases of female genitalia HTTS have been described. We report a case of female genitalia HTTS in a 5-year-old girl and report the state of the art by systematically reviewing all existing evidence about female genital HTTS. A total of 29 studies, describing a total of 34 patients, were identified. The presence of a hair-thread wrapping genitalia should be suspected in prepubertal girls complaining of genital pain associated with vulvar/vaginal swelling, wide-based gait, and voiding symptoms. Genital examination disclosing an extremely tender, swollen, and erythematous lesion on the clitoris or labia minora encircled by a hair confirms the diagnosis. The aim of the management is to remove the hair-thread in the shortest time possible, with the use of forceps, scissors, or scalpels, and this is often performed under sedation/anesthesia because of the patient's pain reaction. When the hair-thread is difficult to find or when the lesion is necrotic, excision of the lesion itself can be the only option. Complications include partial or total amputation because of tissue necrosis and recurrence. [ABSTRACT FROM AUTHOR]

This manuscript discusses the case of huge presacral Tarlov cysts (TCs) and the substantial neurologic recovery noted in the patient following spontaneous rupture of the most prominent cyst. Perineural or TCs are nerve root cysts, which are usually incidental findings on magnetic resonance imaging (MRI) and are most frequently observed in the sacral spine. Symptomatic lesions are rarely encountered. In this case, a 44-year-old woman presented with anal and vulva pain on the right side, and bladder and bowel dysfunction. MRI of the lumbosacral spine showed multiple huge bilateral TCs located within the presacral space from S1-3. There was a substantially large right-sided S3 cyst that was presumed to be responsible for her symptoms. Surgical intervention was considered; however, her symptoms improved significantly during the waiting period for surgery because of spontaneous rupture of the right-sided S3 cyst, as confirmed on follow-up MRI. On follow-up over a 1-year period, the patient had been very well with no recurrent symptoms. To our knowledge, this is the first report of spontaneous cyst rupture and resultant neurologic improvement in a case of symptomatic presacral TCs. [ABSTRACT FROM AUTHOR]

Among Australian females, sexual assault affects 1 in 5 Australian women [1], and 1 in 10 girls [2]. While it is well known that females who experience sexual assault have an increased risk of future pelvic pain, there is limited knowledge regarding the occurrence of other gynaecological morbidity. We performed systematic review and meta-analysis for the relationship between sexual assault and gynaecological morbidity. We searched online electronic databases for observational studies on the subject published between 1993 and 2018. Search terms included variants of 'sexual abuse', 'sexual assault' and a range of gynaecological morbidity. Two independent reviewers completed study selection, quality assessment and data extraction. For each gynaecological symptom we calculated common odds ratios and 95 % confidence intervals in relation to sexual abuse history. Our search identified 1846 studies, of which 38 studies were included. A history of sexual assault was significantly associated with overall gynaecological morbidity (RR 1.42; 95%CI, 1.27-1.59), pelvic pain (RR 1.60; 95%CI, 1.36-1.89), 'dyspareunia' (pooled RR 1.74, 95%CI, 1.50-2.02); 'dysmenorrhea' (pooled RR 1.20; 95%CI, 1.11-1.29); 'abnormal menstrual bleeding' (pooled RR 1.29; 95%CI, 1.12-1.49)) and 'urinary incontinence' (pooled RR 1.31; 95%CI, 1.12-1.53)), while association was not statistically significant for 'vaginismus'(pooled RR 1.71; 95%CI, 0.87-3.36) and 'vulvodynia' (pooled RR 1.49; 95%CI, 0.76-2.91). There was no relation with 'prolapse' (pooled RR 1.10; 95%CI, 0.53-2.30). Females with a history of sexual assault have a significantly increased risk of different gynaecological disorders later in life. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to evaluate the clinical effectiveness of complementary treatment using self-applied electrotherapy treatment for pain control over the standard hormonal treatment alone for deep infiltrative endometriosis (DIE).Study Design: Multicentre randomized clinical trial. We included a hundred-one participants with DIE in electrotherapy (n = 53) (hormonal treatment + electrotherapy) or control group (n = 48) (only hormonal treatment) by 8 weeks of follow-up. The primary measurement was chronic pelvic pain (CPP) using a visual analogue scale (VAS) and deep dyspareunia. The secondary outcomes were the quality of life by endometriosis health profile (EHP-30) and sexual function by female sexual function index (FSFI).Results: CPP relief was observed only in the electrotherapy group (pre:7.11 ± 2.40, post:4.55 ± 3.08, p < 0.001). In terms of deep dyspareunia, improvements were observed for both groups (electrotherapy pre:2.02 ± 0.54-1.36 ± 0.96, p < 0.001; control pre:1.95 ± 0.86-1.68 ± 0.82, p = 0.006). Considering the secondary outcomes, a higher total score post-treatment for the EHP-30 was noted in both groups. Regarding sexual function, there was a statistically significant improvement in the FSFI score for the electrotherapy group (p < 0.001), with an increase in the scores for lubrication and pain domains (p = 0.013 and p < 0.001).Conclusions: Electrotherapy treatment using transcutaneous electrical nerve stimulation proved to be a good complementary option for pain control, showing benefits in the reduction of CPP and deep dyspareunia and improving patient's quality of life and sexual function. [ABSTRACT FROM AUTHOR]

Hair-thread tourniquet syndrome is a rare disorder that occurs when a hair or other fiber becomes wrapped around an appendage, resulting in swelling, pain, or even loss of the appendage. Some cases affecting the female genitals have been reported. The case of a 10-year-old girl with a 3-day history of genital pain is presented. During examination, a hair tourniquet was found at the base of a swollen and painful clitoris. The hair was removed under deep sedation, producing immediate relief. The most important concern in genital hair-thread tourniquet syndrome is a high index of suspicion and prompt resolution in order to save the affected tissue. It should be considered on the differential diagnosis for all girls with vulvar swelling and indication of pain. [ABSTRACT FROM AUTHOR]

Objectives: This study set out to investigate the epidemiological characteristics and comorbidities of chronic vulvar pain. Secondary goals were to identify the preferred approaches for managing vulvodynia in Italy.Study Design: A cross-sectional study (the VuNet -Vulvodynia Network project) was performed in consecutive female patients with chronic vulvar pain attending 21 Italian medical centers (public hospitals, university clinics and private outpatient services) in the period December 2016 to November 2018. Study data were entered by healthcare professionals in a special web-based medical record system (PRIDE- Progetto Rete Italiana Dolore vulvarE). These data covered epidemiological aspects, demographic characteristics, obstetric and gynecological history, presence and duration of current and/or past symptoms, associated disorders, details of physical examination and treatment approaches.Results: A total of 1183 subjects with a diagnosis of chronic vulvar pain were included in the study. The main reason for consultation was superficial dyspareunia, present in 64.2 % of the women. 43.4 % of the sample reported comorbid sexual disorders (of desire in 22.1 % and arousal in 21.3 %). 48.3 % of the patients reported prolonged pain lasting between one and five years. Factors associated with vulvar pain included a relatively high family history of diabetes mellitus (father = 8.6 %; mother = 8.4 %), recurrent vulvovaginal candidiasis (32 %), and urinary tract infections (37.4 %: recurrent cystitis in 19.5 % and post-coital cystitis in 17.9 %). Irritable bowel syndrome (28 %), constipation (23.5 %), headache (25.7 %: migraine in 18.0 % and menstrual headache in 7.7 %), allergies (17.5 %: food allergies in 10.1 %, respiratory allergies in 7.4 %), anxiety (15.0 %), dyschezia (11.7 %), invalidating dysmenorrhea/endometriosis (11.1 %), and major depression (7.6 %) were also reported. Vestibulodynia was diagnosed in 837 of the 1183 patients (70.8 %) and generalized vulvodynia in 323 (27.3 %). Notably, 69.1 % of the patients stated that previous therapies had not changed their pain.Conclusions: The diagnoses of vestibulodynia and vulvodynia must be considered in patients with chronic vulvar pain. The VuNet study contributes to a more comprehensive reading of the predisposing, precipitating and maintaining factors that contribute to vulvar pain, and of the key comorbidities. [ABSTRACT FROM AUTHOR]

Dyspareunia is defined as recurrent or persistent genital pain associated with sexual intercourse. It is a symptom that can have a significant impact on women's health, relationships and quality of life. There are multiple different causes for it, including both organic and psychosexual components. Despite the high prevalence of sexual pain, estimated to between 3 and 18% worldwide, few guidelines exist for its evaluation and management. Adequate assessment requires a comprehensive sexual history, a systematic and thorough examination of the lower genital tract to rule out anatomical causes and an exploration of potential psychosexual causes. Further investigations may include swabs and a pelvic ultrasound scan. In some cases, a diagnostic laparoscopy may be required if there is evidence of endometriosis or utero-vaginal pathology that does not respond to conservative management. This article considers the diagnosis and investigation of women complaining of dyspareunia. [ABSTRACT FROM AUTHOR]

Introduction: Previous research has demonstrated an association between military sexual trauma and risk for suicide; however, risk for self-directed violence such as suicide attempt or nonsuicidal self-injury following military sexual trauma is understudied. This study examines the relationship between military sexual trauma and serious self-directed violence resulting in hospitalization, as well as whether this relationship differs by sex.Methods: Participants were 750,176 Operations Enduring Freedom/Iraqi Freedom/New Dawn veterans who were enrolled in Veterans Health Administration care during the period of October 1, 2001-September 30, 2014 and who were screened for military sexual trauma. Data were analyzed in 2019. Bivariate analyses and Cox proportional hazards regression models were employed.Results: Women veterans were more likely to screen positive for military sexual trauma (21.33% vs 1.63%), and women and men were equally likely to experience serious self-directed violence (1.19% women vs 1.18% men). Controlling for demographic variables and psychiatric morbidity, military sexual trauma predicted serious self-directed violence for both men and women. Further, men with military sexual trauma were 15% less likely to experience self-directed violence compared with women with military sexual trauma (hazard ratio=0.85, 95% CI=0.74, 0.98).Conclusions: Military sexual trauma is associated with risk for serious self-directed violence for both men and women veterans, and the relationship may be pronounced among women. Results underscore the importance of incorporating military sexual trauma into treatment and preventative efforts for self-directed violence. [ABSTRACT FROM AUTHOR]

This study characterizes the etiology, clinical features and outcomes of prepubescent vaginal bleeding and summarizes our experience. The data of patients who were hospitalized with vaginal discharge or bleeding treated from January 2012 to December 2018 were retrospectively reviewed. A provincial Grade III Level A Maternity and Children's Hospital. Prepubertal patients with vaginal discharge or bleeding. Patient age, bleeding duration, etiology, treatment and prognosis were recorded. Physical examinations and color Doppler ultrasonography were also performed. There were 158 patients aged from 1 month to 10 years (mean age 5.2 years). Bleeding duration ranged from 1 to 98 days, with an average of 13.3 days. Sixty patients were diagnosed with vaginal foreign bodies, 34 with vulvovaginitis, 34 with vulvar trauma, 13 with ovarian granulosa cell tumors, 8 with urethral mucosa prolapse, 5 with vaginal yolk sac tumors and 1 each with pituitary tumor, hypothyroidism, McCune-Albright syndrome, and short-term intake of a large number of strawberries. All the children were treated according to their different disease etiologies. Prepubertal vaginal bleeding is caused by a variety of different conditions. In our study, the most common causes were vaginal foreign bodies, vulvovaginitis, trauma, vaginal malignant tumors and urethral mucosa prolapse. Careful medical histories and targeted examinations are needed. Vaginoscopy could be considered. Considering the different causes, different treatments should be administered to achieve a good prognosis. [ABSTRACT FROM AUTHOR]

To identify predictors of anticipated pain with intrauterine device (IUD) insertion in adolescents and young women. We performed linear regression to identify demographic, sexual/gynecologic history, and mood covariates associated with anticipated pain using a visual analogue scale pain score collected as part of a single-blind randomized trial of women who received a 13.5-mg levonorgestrel IUD. Three academic family planning clinics in Philadelphia Pennsylvania. Ninety-three adolescents and young adult women aged 14-22 years. Participants received either a 1% lidocaine or sham paracervical block. Anticipated pain measured using a visual analogue scale before and perceived pain at 6 time points during the IUD insertion procedure. Black or African American participants had a median anticipated pain score of 68 (interquartile range [IQR], 52-83), White participants had a median anticipated pain of 51 (IQR, 35-68), whereas participants of other races had a median anticipated pain score of 64 (IQR, 36-73); P =.012. In multivariate analysis, race was the only covariate that significantly predicted anticipated pain at IUD insertion. Women with anticipated pain scores above the median had significantly higher perceived pain during all timepoints of the IUD insertion procedure. Increased anticipated pain is associated with increased perceived pain with IUD insertion. Black adolescent women experience greater anticipated pain with IUD insertion. This population might benefit from counseling and clinical measures to reduce this barrier to IUD use. [ABSTRACT FROM AUTHOR]

Vulvodynia is vulvar pain of at least 3 months duration, without an identifiable cause. In adults, vulvodynia is associated with urogenital symptoms, immunological issues, and other chronic pain conditions. In children and adolescents, only one published case series described an association with urinary symptoms. Associations with other conditions and immunologic issues remain unknown. This study aims to evaluate the association of urogenital symptoms, immunological issues and chronic pain disorders with vulvodynia in children and adolescents using a large research network database (TriNetX). This IRB exempt retrospective cohort study utilized de-identified patient medical records between January 2015 and July 2023 from TriNetX, a HIPAA compliant health research network driven by Children's Mercy Hospital Oracle Cerner Millennium data. Statistical analysis was performed using TriNetX and SPSS Version 28.0 (IBM Corp, Armonk, NY). A single vulvodynia cohort (n=1,410) consisting of females aged 0-18 years-old was identified from TriNetX. Figure 1 shows the development of four further sub cohorts to evaluate associated genitourinary symptoms, chronic pain, immune, and autoimmune disorders with relevant immunological markers. Conditions most commonly associated with vulvodynia included dermatitis and eczema (n=470, 33.3%), pain in joint (n=370,26.2%), pain with micturition (n=310,22%) and migraine (n=160,11.3%). Table 1 shows the comparison of immunological markers between the four sub-cohorts. C-reactive Protein (CRP) was significantly higher in the genitourinary (1198.9 ± 391.3 mg/L) and chronic pain cohorts (145.7 ± 160 mg/L) (p=0.03) compared to the immune disorders and autoimmune cohorts. Eosinophil levels approached statistical significance with levels highest in the autoimmune cohort (4.2 ± 2.5%) (p=0.05) as compared to the genitourinary, immune disorders and chronic pain sub-cohorts. In children and adolescents, vulvodynia is associated not only with genitourinary symptoms but also with chronic pain disorders (migraine headache) and immune disorders (dermatitis and eczema). Elevated CRP in children with vulvodynia, although nonspecific, suggests a possible inflammatory component as etiology. Further research is needed to clarify the etiology of vulvodynia in the pediatric population. [ABSTRACT FROM AUTHOR]

Differentiating pediatric vulvar lichen sclerosis versus vitiligo is a clinical challenge. For both conditions, patients often have a delayed or initial misdiagnosis. Both conditions classically present with hypopigmentation, while LS is more likely to present with symptoms such as pruritus, bleeding, and pain. We aim to add to the existing literature by comparing signs and symptoms in a cohort of patients with either conditions. A retrospective case control study was performed at a single tertiary children's hospital from January 2016 to September 2022. Diagnosis was made by visual inspection by both a pediatric gynecologist and a pediatric dermatologist. Biopsy is not routinely performed for diagnosis. Data collected included demographic information, presenting signs and symptoms, and treatment regimens. Additionally, this interdisciplinary clinic utilizes a standardized collection form for all notes including a detailed dermatologic assessment. This allows us to both monitor patient's disease progression as well as standardize care. For statistical analysis we utilized a test of independence (Pearson's Chi Squared versus Fisher's Exact) Within our study time frame, there was n=80 patients diagnosed with LS and n=18 with vitiligo. Vitiligo and LS had a similar age at presentation (5 and 6 respectively). Ethnicity was similar between the 2 groups, while vitiligo had a higher percentage (55% versus 35%) of African American patients (p< 0.001). Pruritus was a common symptom in both conditions (70% LS and 33.3% vitiligo). Symptoms of vulvar pain (15%), pain with defecation (15%), and bleeding (8.75%) were seen in LS patients, while none of the vitiligo patients had those symptoms. Figure of 8 and clitoral involvement were seen in both conditions as well. Both conditions involved the perianal region and perineum. Vitiligo and LS are challenging to differentiate; however, these data support pain (either vulvar or pain with defecation) and bleeding as more commonly seen in LS compared to vitiligo; however, most patients with LS did not present with these symptoms. These findings also support the importance of interdisciplinary clinics given the overlap of these conditions with varying treatment and long-term implications. Future direction will include evaluating outcomes on management options as well as identifying similarities in patients with LS flares. [ABSTRACT FROM AUTHOR]

Transurethral resection of a bladder tumor (TURBT) is one of the more common procedures performed by urologists in the United States. It is often described as an "incision-free" and "well-tolerated' operation. However, many patients experience significant;distress and discomfort leading up to and after the procedure. As such, substantial opportunity exists to improve the TURBT experience. We have developed an enhanced recovery after surgery (ERAS) protocol to improve perioperative care surrounding ambulatory TURBT. Our ERAS protocol was developed based on feedback from 159 patients participating in a needs assessment survey, input from a convened panel of bladder cancer patients, as well as guidance from clinicians who care for these patients. This is a single-center, randomized-controlled trial;to investigate the effectiveness of an ERAS protocol compared to usual care in patients with bladder cancer undergoing ambulatory TURBT. The ERAS protocol is comprised of pre, intra and postoperative components designed to optimize each phase of perioperative care. 100 patients with suspected or known bladder cancer age greater than or equal to;18 years undergoing initial or repeat ambulatory TURBT will be enrolled. The QoR-15 score, a measure of quality of recovery, will be assessed on the day of surgery and postoperative day 1 and compared between the ERAS and control groups. Secondary outcomes will include the bladder utility symptom;score;and visual analogue scores for dysuria, suprapubic/bladder, urethral, penile and vulvar pain. The number of unexpected outpatient visits, hospital readmissions, patient phone calls, and electronic messages that occur in the first 30 days after surgery will also be assessed. Results: Conclusions: [ABSTRACT FROM AUTHOR]

The etiology of idiopathic pain conditions, such as Provoked vulvodynia (PV), is multifactorial. The efficiency of venlafaxine, serotonin-noradrenaline reuptake inhibitor (SNRIs) in modulating vulvar pain led to the hypothesis that PV might involve central mechanisms. Here, we investigate whether vulvar pain is associated with gene-expression changes in mood, stress and pain systems, including amygdala (Amg), medial prefrontal cortex (mPFC), and periaqueductal gray matter (PAG). Additionally, we examined the analgesic and anxiolytic effects of venlafaxine. We found that the development of chronic vulvar pain in an animal model of PV is associated by overexpression of genes related to neuronal-activity and neuroinflammation in the Amg, mPFC, and PAG. Additionally, changes in the expression of GABA and serotonin synthesis, and reuptake were noted in the Amg and mPFC. Unsurprisingly, anxiety-like behavior and emotional-disorder were observed in rats with chronic vulvar pain. Nevertheless, treatment with venlafaxine (37.5 mg/kg) for one month significantly improves the vulvar hypersensitivity, as well as reduces the anxiety level. More critically, the long-term gene expression adaptation in serotonin receptor and synthesis, GABA synthesis, neuroplasticity, and neuroinflammation in the Amg, mPFC, and PAG, were modulated by venlafaxine in rats with vulvar pain. Our findings suggest that vulvar hypersensitivity induced by inflammation might associated with gene expression changes in brain areas that are involved in mood, stress and pain regulation. These changes probably play a role in central sensitization, and anxiety. Strikingly, enhancing the activity of serotonin and noradrenaline via venlafaxine treatment in rats with vulvar pain induces analgesic and anxiolytic effects. • Provoked vulvodynia is an idiopathic pain condition characterized by vulvar pain. • Chronic vulvar pain (CVP) causes anxiety-like behavior and emotional-disorder in rats. • CVP associate with neuroinflammation in the mPFC, amygdala and PAG. • Venlafaxine (VLX) alleviates vulvar pain and anxiety in rats with CVP. • Gene-expression changes in 5HT, GABA synthesis and neuroinflammation modulated by VLX. [ABSTRACT FROM AUTHOR]

Objective: To study the prevalence and epidemiological characteristics of women with vulvodynia. To assess the risk factors associated to the disease.Study Design: A cross-sectional study was made in which questionnaires were anonymously and confidentially distributed to Spanish women over 18 years of age between April 2016 and September 2017. The questionnaires were distributed by e-mail and through social networks, women's associations and specific websites. This type of questionnaire has been validated and used in many studies of this kind. The women answered questions referred to epidemiological aspects, demographic parameters, medical history, the presence of vulvodynia, associated factors, and comorbidities.Results: A total of 684 questionnaires were completed. The prevalence of vulvodynia was 6.6% (45 women). Thirteen percent (95 women) had experienced vulvodynia at some point in life. The factors associated to vulvodynia were prior vaginal deliveries (p = 0.001), vulvovaginal candidiasis (p < 0.001) and urinary tract infections (p < 0.001). Other pain syndromes such as fibromyalgia (p = 0.012), painful bladder syndrome/ interstitial syndrome (p < 0.001), temporomandibular joint pain (p = 0.021), coxofemoral pain (p = 0.001) or headache (p = 0.001) have also been associated to vulvodynia.Conclusions: The prevalence of vulvodynia in Spain is similar to that found in other countries. Many factors are involved in its development and persistence, particularly the presence of other pain syndromes and recurrent infections that could trigger complex inflammatory reactions. [ABSTRACT FROM AUTHOR]

To describe the experience of a tertiary pediatric and adolescent gynecology service that provides care to children and adolescents who present with vulval pain. Their presentation, associated symptoms, and management is described. A retrospective analysis of all girls younger than 18 years of age who presented to the gynecology clinic of our tertiary referral Children's Hospital between Jan 2010 and July 2016. Electronic medical records were reviewed and parameters recorded using a standardized data sheet. Gynecology clinic of a tertiary referral children's hospital and private rooms of our director of gynecology. Young women younger than 18 years who presented with symptoms suggestive of vulvodynia. Presenting symptoms, characteristics of associated features, treatment options, and treatment outcomes. Forty-seven patients with a mean age of 11 years (range, 3-18 years) were identified. At the time of diagnosis 31/47 (65.9%) were premenarchal. Many presented with a symptom other than pain alone. In particular, 35/47 (74.4%) presented with coexisting or previous urinary symptoms. Of patients examined, most had positive cotton tip examination findings (16/17 (94.1%) and 11/13 (84.6%) for pre- and postmenarchal, respectively) with clinical inspection otherwise unremarkable. Children and adolescents with vulval pain have varied presentations. Many of the pre- and postmenarchal patients had coexisting urinary tract symptomatology at the time of diagnosis. This review of patients seen over 5.5 years at a pediatric tertiary referral center provides information on the presenting symptoms, examination features, and response to clinical management. [ABSTRACT FROM AUTHOR]

Urinary incontinence, fecal incontinence and pelvic organ prolapse are one of the most prevalent gynaecological conditions and constitute a huge global problem affecting approximately 20% of women, increasing with age. Pelvic floor disorders can have negative influence on women's quality of life, decreasing social, psychological, occupational, physical and sexual well-being. Pelvic organ prolapse results in anatomical changes to the urogenital tract and it is perceived to be one of the main factor influencing sexual function. Because treatment of pelvic organ prolapse and complications related to it may cause discomfort, the most important outcome of the therapy, including anatomical restoration, is relief in symptoms and improvement in quality of life. Psychometrical instruments for measuring health-related quality of life are essential during evaluation of women with pelvic floor disorders. Assessing severity of pelvic organ prolapse, its' impact on quality of life, therapy planning and the inclusion of sexuality questionnaires as an outcome measure in urogynecological patients allows to analyze impact of surgical treatment on women's sexual life. For this purpose, condition - specific instruments were developed and published. The aim of this study is to present particular questionnaires and their proper practical application in clinical practice, especially before surgical treatment and follow-up. Furthermore, those questionnaires are essential in order to describe patients' expectations during tailored clinical management. [ABSTRACT FROM AUTHOR]

Introduction: We wanted to evaluate the efficacy of botulinum toxin type A (botulinum toxin) treatment on vulvodynia refractory to conventional treatment.Material and Methods: A follow-up study on botulinum toxin treatment was conducted at Aarhus University Hospital (n = 109). Seventy-nine completed the follow-up. The women included had localized provoked vulvodynia, refractory to first line treatment and were treated with 100*I.E. botulinum toxin electromyography (EMG) guided in the musculus levator ani in the period from March 2012 to May 2015(1). The outcome measures were: Dyspareunia, Negative Interference in Quality of Life (NIQL) and cotton swab test all rated on the numerical rating scale (NRS) and active vitae sexualis. Follow-up was conducted at six months.Results: The women experienced significant improvements on, dyspareunia, which decreased to 5.82 from 7.82 (p < 0.01), NIQL to 6.19 from 7.88 (p < 0.01) and the cotton swab test to 5.50 from 6.81 (p < 0.01). No significant effect on Active Vitae Sexualis was found (p = 0.25).Conclusion: Women injected with 100*I.E. botulinum toxin EMG guided, diagnosed with localized provoked vulvodynia refractory to conventional non invasive treatment, had a reduction in dyspareunia and improved quality of life. Injection of botulinum toxin had no significant effect on vitae sexualis. Randomized controlled trials are, however, much needed. [ABSTRACT FROM AUTHOR]

Vulvar aphthous ulcers have been associated with various prodromal viral illnesses. We describe the case of an adolescent girl who developed vulvar aphthous ulcers during infection with Coronavirus, SARS-CoV-2. A 19-year-old girl presented to the emergency department with cough, sore throat, fevers, and rash, and tested positive for COVID-19. She re-presented 2 days later with vulvar pain and was found to have a vulvar aphthous ulcer. She was admitted for pain control and treated with oral steroids. Improvement in her vulvar pain was noted, along with resolution of fevers, cough, and rash. This case illustrates the novel association of COVID-19 with vulvar aphthous ulcers in adolescents. Use of oral steroids for symptomatic management of COVID-19 led to rapid clinical improvement. [ABSTRACT FROM AUTHOR]

Testosterone use among transgender people likely impacts their experience of sexual function and vulvovaginal pain via several complex pathways. Testosterone use is associated with decreased estrogen in the vagina and atrophic vaginal tissue, which may be associated with decreased vaginal lubrication and/or discomfort during sexual activity. At the same time, increased gender affirmation through testosterone use may be associated with improved sexual function. However, data on pelvic and vulvovaginal pain among transgender men and nonbinary people assigned female at birth are scarce. This study aimed to assess the association between testosterone and sexual function with a focus on symptoms that are commonly associated with vaginal atrophy. We conducted a cross-sectional analysis of 1219 participants aged 18 to 72 years using data collected from 2019 to 2021 from an online, prospective, longitudinal cohort study of sexual and/or gender minority people in the United States (The Population Research in Identity and Disparities for Equality Study). Our analysis included adult transgender men and gender diverse participants assigned female at birth who were categorized as never, current, and former testosterone users. Sexual function was measured across 8 Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction domains. Overall, 516 (42.3%) participants had never used testosterone, and 602 (49.4%) currently used testosterone. The median duration of use was 37.7 months (range, 7 days to >27 years). Most participants (64.6%) reported genital pain or discomfort during sexual activity in the past 30 days, most commonly in the vagina or frontal genital opening (52.2%), followed by around the clitoris (29.1%) and labia (24.5%). Current testosterone use was associated with a greater interest in sexual activity (β=6.32; 95% confidence interval, 4.91–7.74), higher ability to orgasm (β=1.50; 95% confidence interval, 0.19-2.81), and more vaginal pain or discomfort during sexual activity (β=1.80; 95% confidence interval, 0.61–3.00). No associations were observed between current testosterone use and satisfaction with sex life, lubrication, labial pain or discomfort, or orgasm pleasure. Testosterone use among transgender men and gender diverse people was associated with an increased interest in sexual activity and the ability to orgasm, as well as with vaginal pain or discomfort during sexual activity. Notably, the available evidence demonstrates that >60% of transgender men experience vulvovaginal pain during sexual activity. The causes of pelvic and vulvovaginal pain are poorly understood but are likely multifactorial and include physiological (eg, testosterone-associated vaginal atrophy) and psychological factors (eg, gender affirmation). Given this high burden, there is an urgent need to identify effective and acceptable interventions for this population. [ABSTRACT FROM AUTHOR]

The causes of vulvovaginal problems fluctuate from more common and easier to recognize to ones that are rarer like hair-thread tourniquet. Here we report case series of three pediatric patients with vulvar problems caused by pubic hair. The study was approved by the Clinical Research Committee of the Institution (336/22). Our patients were girls one of 8 and two of 9 years old that presented at gynecological clinic with the complaints of the pain in labia minora, that occurred 2-5 days ago. Two patients had no history of trauma and one reported that symptoms appeared after riding a bike. After clinical exam, we revealed similar local signs that included enlarged, edematous and tender clitoral hood. In one patient edematous vulvar area was noticed. Also it was found a strand of hair wrapped around the labia minora and clitoris that was causing accidental strangulation. The problem was solved locally by simple removing of the hair and in one patient strangulated part of skin fell off after haircut. Patients were followed up and on the exam after a week they had normal anatomy findings. Strangulation caused by hair is a rare condition that happens to stay misdiagnosed when it occurs in genital area, so clinicians should always consider this as a differential diagnosis in cases of unclear pain and edema in vulvar area. [ABSTRACT FROM AUTHOR]

We present a rare case of severe vulvar edema secondary to steroid-refractory nephrotic syndrome in a prepubertal girl. The patient is an 8-year-old girl who presented during nephrotic syndrome relapse. She exhibited severe mons pubis and labial edema. She was treated with local symptomatic measures such as sitz baths, barrier ointment, and labial sling, with minimal relief. Improvement ultimately occurred after bilateral nephrectomy. Vulvar edema is rare in prepubertal girls. In this case, the edema was secondary to steroid-refractory nephrotic syndrome and was not responsive to local treatment measures. There is a paucity of data on effective treatment of vulvar edema in young girls. Our goal is to raise awareness of such pathology, which might lead to development of uniform guidelines for treatment of this condition. [ABSTRACT FROM AUTHOR]

Objective: There is uncertainty whether treatment with dehydroepiandrosterone (DHEA) decreases menopausal symptoms for women in the peri- or postmenopausal phase. A previous systematic review considering this subject suggested that DHEA may slightly improve sexual function compared with placebo (CS. Scheffers, S. Armstrong, AEP. Cantineau, C. Farquhar, V. Jordan Dehydroepiandrosterone for women in the peri- or postmenopausal phase. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD011066. DOI: https://doi.org/10.1002/14651858.CD011066.pub2). The purpose of this article is to review recent research investigating whether the use of DHEA, and in particular intravaginal DHEA (Prasterone®), improves sexual function.Methods: We conducted an online search using Medline OVID for recent articles related to DHEA and menopause. We found 48 relevant publications, out of which 14 papers were original research, all related to the development and licensing of intravaginal DHEA. We critically analysed these 14 articles in relation to sexual function.Results: All the randomised controlled trials assessed the efficacy of vaginal DHEA in women with vulvovaginal atrophy and showed that sexual dysfunction improved with treatment regardless of the level of dyspareunia at baseline. Treatment with DHEA was found to be superior to placebo and at least as efficacious as vaginal oestrogens in improving symptoms.Conclusion: Intravaginal DHEA appears to be a safe and effective treatment for menopausal vulvovaginal atrophy and dyspareunia in most women. Further studies are required before it can be recommended for women with a history of thrombosis, cardiovascular disease or hormone-sensitive neoplasms. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of vaginal diazepam in addition to transcutaneous electrical nerve stimulation (TENS) in the treatment of vestibulodynia (VBD).Study Design: This study was a randomized, double-blind, placebo-controlled trial. Forty-two patients with VBD were randomized, 21 underwent diazepam and TENS (diazepam group) and 21 received placebo and TENS (placebo group). Vulvar pain was assessed on a on a 10-cm visual analogue scale (VAS) and dyspareunia according to the Marinoff dyspareunia scale. Vaginal surface electromyography (EMG) and vestibular current perception threshold (CPT) testing were performed at baseline and 60 days after treatment. The primary endpoints included the change in pain and dyspareunia from baseline to 60 days of pain and dyspareunia. The secondary endpoints was the variation in objectivity of pelvic floor muscle (PFM) function and vestibular nerve fiber current perception threshold (CPT).Results: The VAS scores for pain from basal values of 7.5 and 7.2 for the diazepam and placebo, respectively, showed significant (p 0.01) decreases from 4.7 to 4.3, but this difference was not statistically significant. The Marinoff dyspareunia scores in the diazepam group showed a significant difference (p 0.05) from values measured in the placebo group. The ability to relax the PFM after contraction (difference between maximal contraction and rest tone) was significantly greater for the diazepam group versus the placebo group (3.8 μv and 2.4 μv, respectively, p 0.01). The CPT values for all of the nerve fibers increased after the treatment, but this increase was significant in the diazepam group only for the values at a 5-Hz stimulation (C fibers) with a change of 47.8% vs 26.9% (p < 0.05). Only two patients reported a mild drowsiness in the diazepam group.Conclusions: The present study provided indications that vaginal diazepam plus TENS is useful to improve pain and PFM instability in women with VBD. [ABSTRACT FROM AUTHOR]

Objective: The vulvar pain syndrome (VPS) is a multifactorial disease severely influencing the lifestyle of affected women. Among possible etiological factors, local injury, peripheral and/or central sensitization of the nervous system, and a chronic inflammatory status have been positively associated with the development of VPS. The identification of a constitutive altered local inflammatory profile in VPS women may represent an important point in the characterization of patients' phenotype as a useful marker influencing the vulvar micro-environment. The aim of this study was to investigative the possible role of the local cytokines production in women with VPS in comparison to healthy women.Study Design: In this study were collected vaginal swabs from 57 healthy women (HC) who never suffered from VPS and from 30 patients diagnosed with vulvodynia (VPS) by at least 3 years and currently symptomatic. All patients included in this study showed the absence of Sexually Transmitted (STD) diseases and Reproductive Tract Infection. Real-time PCR was performed to assess the genomic sequences of ST pathogens. The Luminex Bio-Plex platform was used for the analysis of a panel of 48 immune factors.Results: Eleven molecules, specifically involved in the pro-inflammatory pathway were significantly modulated in VPS patients in comparison to healthy women, suggesting a persistent inflammatory process.Conclusions: Therefore, these inflammatory factors could be possible biological markers involved in this disease. Nevertheless, other studies are needed to consider this specific immune profile as a valid marker of the vulvodynia. [ABSTRACT FROM AUTHOR]

Chronic pain conditions occurring in the lower abdomen and pelvis are common, often challenging to manage, and can negatively affect health-related quality of life. Methodological challenges in designing randomized clinical trials (RCTs) for these conditions likely contributes to the limited number of available treatments. The goal of this systematic review of RCTs of pharmacologic treatments for irritable bowel syndrome and 3 common chronic pelvic pain conditions are to: 1) summarize the primary end points and entry criteria, and 2) evaluate the clarity of reporting of important methodological details. In total, 127 RCTs were included in the analysis. The most common inclusion criteria were a minimum pain duration (81%), fulfilling an established diagnostic criteria (61%), and reporting a minimum pain intensity (42%). Primary end points were identified for only 57% of trials. These end points, summarized in this article, were highly variable. The results of this systematic review can be used to inform future research to optimize the entry criteria and outcome measures for pain conditions occurring in the lower abdomen and pelvis, to increase transparency in reporting to allow for proper interpretation of RCT results for clinical and policy applications, and to facilitate the aggregation of data in meta-analyses.Perspective: This article summarizes entry criteria and outcome measures and the clarity of reporting of these important design features in RCTs of irritable bowel syndrome and 3 common chronic pelvic pain conditions. These results can be used to improve design of future trials of these largely unaddressed pain conditions. [ABSTRACT FROM AUTHOR]

Student healthcare providers are the type of primary healthcare professionals who usually have first contact with young women who have problems with intimacy, such as vulvar pain – known as vulvodynia. However, a need to increase healthcare professionals' level of knowledge of vulvodynia and its care has been identified. This study aimed to assess the awareness and knowledge of vulvodynia and its care among student healthcare providers, before and after Web-based education. The study design was national, descriptive and quasi-experimental, and was conducted across Finland. A total of 79 participants completed baseline measurements, 58 completed web-based education and 30 took part in a follow-up survey. A survey instrument called ‘Awareness and knowledge of vulvodynia and its care’ was developed for this study, and the data were collected using a web-based questionnaire. Descriptive statistical methods were used to evaluate the participants' awareness and knowledge of vulvodynia and its care before and after web-based education. The primary results indicated that the participants' awareness and knowledge of vulvodynia and its care was statistically significantly improved following web-based education. [ABSTRACT FROM AUTHOR]

Vulvodynia is a idiopathic vulvovaginal pain condition that interferes with the sexual and mental health of affected couples. Research has underscored that psychological factors, such as anxiety and depression, are associated with its development and maintenance and related sexual impairment. However, the daily role of anxiety and depressive symptoms in the pain and sexuality outcomes of couples coping with vulvodynia is not well understood. Using a dyadic daily experience method, 127 women (mean age = 26.21, SD = 6.24 years) diagnosed with vulvodynia and their partners (mean age = 27.44, SD = 7.29 years) reported on anxiety and depressive symptoms, pain, sexual function, and sexual distress over a period of 8 weeks. Multilevel modeling was used to examine how daily deviations in anxiety and depressive symptoms from a participant's own mean were associated with pain, sexual function, and sexual distress. On days of sexual activity, when women reported higher anxiety and depressive symptoms (compared with their average), they reported greater pain and lower sexual function. On days of sexual activity, when women reported higher depressive symptoms, they reported greater levels of sexual distress, and when partners reported higher anxiety and depressive symptoms, women as well as partners reported greater levels of sexual distress. Results suggest that daily anxiety and depressive symptoms play a role in women's experience of vulvodynia-related pain, women's sexual function, and the couple's sexual distress. Targeting daily anxiety and depressive symptoms could enhance the efficacy of psychological interventions for vulvodynia.Perspective: This article examines the daily associations between anxiety and depressive symptoms, women's pain, sexual function, and sexual distress among couples coping with vulvodynia. Findings contribute to refine the biopsychosocial model of pain, showing that daily affective factors are associated with pain and sexual well-being. [ABSTRACT FROM AUTHOR]

Vulvodynia is neuropathic pain of at least 3 months' duration which has recognised associated factors, the underlying cause of the condition is unclear. There are published guidelines for the management of vulvodynia, which recognise that multidisciplinary input is required for its successful treatment. There are also good resources that can be accessed online by women experiencing vulvodynia and clinicians coordinating their care. [ABSTRACT FROM AUTHOR]

Objective: To examine the role of a novel motivational perspective-sexual communal motivation-in women's pain during intercourse and both partners' distress in couples coping with vulvodynia, a prevalent gynecological pain condition. Our goal was to test whether sexual communal strength (i.e., motivation to meet a partner's sexual needs) and unmitigated sexual communion (i.e., prioritization of a partner's sexual needs in neglect of one's own needs) were indirectly associated with pain, depression, and anxiety via sexual distress.Methods: Couples (N=101) completed daily surveys about their sexual communal motivation, sexual distress, anxiety, depression, and women reported on their pain during intercourse. Using multilevel modeling, we examined how daily fluctuations in sexual communal motivation were directly and indirectly (via sexual distress) associated with pain and psychological distress.Results: On days when women with vulvodynia reported higher sexual communal strength, they reported less pain and anxiety, and on days when they reported higher unmitigated sexual communion, they reported more pain, more anxiety, and both partners reported more depressive symptoms. Daily associations between women's unmitigated sexual communion and greater pain, depression and anxiety were mediated by sexual distress.Conclusions: Being motivated to meet a partner's sexual needs was associated with less pain and anxiety for women with vulvodynia, but when this motivation excluded a focus on one's own needs, there were detrimental consequences for women's pain and both partners' depressive symptoms. Interventions for improving women's pain and the psychological well-being of affected couples should target motivational factors and sexual distress. [ABSTRACT FROM AUTHOR]

Vulvodynia is a prevalent chronic pain disorder associated with high medical costs and often ineffective treatments. The major pathological feature is proliferation of vaginal nerve fibers. This study aimed to develop a highly reproducible animal model to study neuroproliferation in the vagina and aid the identification of appropriately targeted treatments for conditions such as vulvodynia. Mild chronic inflammation was induced using microinjection of complete Freund’s adjuvant in the distal vagina of C57Bl/6 mice. Control mice received saline. Inflammation and innervation density were assessed at 7 and 28 days after a single administration or 14 days following repeated administration of complete Freund’s adjuvant or saline. Histochemistry and blinded-analysis of images were used to assess vaginal morphology (H & E) and abundance of macrophages (CD68-labeling), mast cells (toluidine blue staining, mast cell tryptase-immunoreactivity), blood vessels (αSMA-immunoreactivity) and nerve fibers immunoreactive for the pan-neuronal marker PGP9.5. Subpopulations of nerve fibers were identified using immunoreactivity for calcitonin gene-related peptide (CGRP), substance P (SP), vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY). Single administration of complete Freund’s adjuvant resulted in vaginal swelling, macrophage infiltration, vascular proliferation and increased abundance of nerve fibers immunoreactive for CGRP, SP, VIP and/or PGP9.5 but not NPY, evident at seven days. Inflammation further increased following repeated administration of complete Freund’s adjuvant but nerve fiber proliferation did not. Nerve fiber proliferation continued to be evident at 28 days. The inter-individual differences within each treatment group were small, indicating that this model may be useful to study mechanisms underlying vaginal nerve fiber proliferation associated with inflammation. [ABSTRACT FROM AUTHOR]

Vulvodynia, defined as vulvar pain or burning sensation for more than 3 months, without an identifiable cause, can occur at any age. In this paper, the authors address the classification, epidemiology, etiology, diagnosis, and treatment of this condition, focusing on postmenopausal women. In postmenopausal women, vulvar pain and dyspareunia can often be attributed to low levels of estrogen resulting in vulvovaginal atrophy. While correction of vulvovaginal atrophy is an important part of the management of these patients, it will usually be insufficient to manage vulvodynia. The treatment of vulvodynia includes general care measures, topical, oral, or injectable agents, psychological approaches, pelvic floor rehabilitation and, in some cases, surgery. No particular intervention has been shown to be superior, so a "trial and error" strategy is usually used. [ABSTRACT FROM AUTHOR]

Localized provoked vulvodynia (LPV) affects ∼14 million people in the US (9% of women), destroying lives and relationships. LPV is characterized by chronic pain (>3 months) upon touch to the vulvar vestibule, which surrounds the vaginal opening. Many patients go months or years without a diagnosis. Once diagnosed, the treatments available only manage the symptoms of disease and do not correct the underlying problem. We have focused on elucidating the underlying mechanisms of chronic vulvar pain to speed diagnosis and improve intervention and management. We determined the inflammatory response to microorganisms, even members of the resident microflora, sets off a chain of events that culminates in chronic pain. This agrees with findings from several other groups, which show inflammation is altered in the painful vestibule. The vestibule of patients is acutely sensitive to inflammatory stimuli to the point of being deleterious. Rather than protect against vaginal infection, it causes heightened inflammation that does not resolve, which coincides with alterations in lipid metabolism that favor production of proinflammatory lipids and not pro-resolving lipids. Lipid dysbiosis in turn triggers pain signaling through the transient receptor potential vanilloid subtype 4 receptor (TRPV4). Treatment with specialized pro-resolving mediators (SPMs) that foster resolution reduces inflammation in fibroblasts and mice and vulvar sensitivity in mice. SPMs, specifically maresin 1, act on more than one part of the vulvodynia mechanism by limiting inflammation and acutely inhibiting TRPV4 signaling. Therefore, SPMs or other agents that target inflammation and/or TRPV4 signaling could prove effective as new vulvodynia therapies. [ABSTRACT FROM AUTHOR]