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Objectives: Explore associations between eating disorders (EDs) and sleep duration and the impact of depression symptoms (DSs) in American college students. Participants: College students from 2018 to 2019 Healthy Minds Study. Methods: Multivariate logistic regression evaluated associations between EDs (bulimia, anorexia, binge eating [BED]) and sleep duration. Stratified analyses assessed effect modification by DSs and gender. Results: Students reporting any eating disorder had no greater risk of not recommended sleep duration during weekdays compared to those with no eating disorder history (Adjusted OR = 0.99, 95% CI: 0.89-1.13). However, subjects reporting BED were at greater risk of deficient sleep during weekends compared to those with no EDs (Adjusted OR = 1.26, 95% CI: 1.01-1.58). This association was not impacted by DSs. However, all EDs were associated with not-recommended sleep duration among those who identified as other gender identity in comparison to those with no EDs. Conclusion: Health educators should monitor academic performance in students with EDs for adequate sleep duration. [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]

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]

Background: Hormonal contraceptive use is common among reproductive-aged women, but research evaluating its etiological relationship to vulvodynia remains mixed. We sought to evaluate this association and examine the potential for bias due to care-seeking behavior. Materials and Methods: We conducted a case–control study of women recruited from a large health care network database from 2008 to 2011. Of 26,455 eligible respondents, 1168 met the case definition for chronic vulvar pain (CVP). We matched each case to three controls by age and used conditional logistic regression to calculate odds ratios (ORs) for prior hormonal contraception (HC) use and CVP, stratifying cases by whether or not they sought care for their vulvar pain. We also simulated the influence of potential biases due to care seeking, using parameters based on this dataset. Results: HC users had higher odds of CVP (adjusted OR = 2.6, 95% confidence interval [CI]: 2.2–3.2). Effect estimates were stronger when cases were restricted to care seekers (adjusted OR = 2.9, 95% CI: 2.2–3.7). Effect estimates decreased slightly as time increased between HC initiation and pain onset. Our simulations suggested that effect estimates may be spuriously strengthened when cases are restricted to care-seeking women, but controls are recruited from the general population. Conclusions: Our results suggest an association between antecedent HC use and CVP that is potentially spuriously strengthened in case–control studies when cases are restricted to care seekers but controls are not. [ABSTRACT FROM AUTHOR]

Background: The lifetime prevalence of prolonged vulvar pain ranges from 3% to 28% among premenopausal women. Provoked vestibulodynia (PVD), often accompanied with various degrees of vaginismus, is the predominant cause. We explored the association between birth-related events and the risk of developing PVD/vaginismus during adulthood. Materials and Methods: We identified all women born in Sweden between 1973 and 2001 and categorized those with and without a diagnosis of PVD/vaginismus between 2001 and 2016 (during ages 15–43 years). Nationwide registry data were used to estimate the association between health during infancy (preterm birth, low birth weight, small for gestational age [SGA], Appearance, Pulse, Grimace, Activity and Respiration [APGAR] scores <7, and pain exposure during infancy) and the onset of PVD/vaginismus later in life using an event probability model. Results: Of the 1,359,315 women born in Sweden during 1973–2001, 9,247 were diagnosed with PVD (n = 6,648), vaginismus (n = 3,567), or both (n = 969). Preterm delivery <37 weeks (adjusted odds ratios [aOR]: 1.15, 95% confidence interval [CI]: 1.05–1.26), low birth weight <2,500 g (aOR: 1.24, 95% CI: 1.12–1.36), extremely low birth weight <1,500 g (aOR 1.41, 95% CI: 1.10–1.82), and SGA (aOR 1.20, 95% CI: 1.08–1.34) were factors associated with developing PVD/vaginismus. APGAR scores <7 or pain exposure during birth or infancy was not associated with PVD/vaginismus. Advanced maternal age, higher educational attainment, and being born in Sweden were associated with having a female offspring diagnosed with PVD/vaginismus. Conclusions: In a population of Swedish women 15–43 years of age, adverse health at birth was associated with developing PVD/vaginismus later on in life. [ABSTRACT FROM AUTHOR]

Objective: We determined whether self-reported new or recurrent yeast infections were a risk factor for and/or consequence of vulvodynia and then determined the extent to which various levels of misclassification of self-reported yeast infections influenced these results. Materials and Methods: In this case-control study we retrospectively assessed self-reported new and recurrent yeast infections prior and subsequent to first vulvar pain onset among 216 clinically confirmed cases and during a similar time period for 224 general population controls. Results: A history of >10 yeast infections before vulvodynia onset was strongly but imprecisely associated with currently diagnosed vulvodynia after adjustment for age, age at first intercourse, and history of urinary tract infections [adjusted odds ratio = 5.5, 95% confidence interval (CI) 1.7-17.8]. Likewise, a history of vulvodynia was associated with a twofold risk of subsequent new or recurrent onset of yeast infections after adjustment for age, age at first intercourse, and history of yeast infections before vulvodynia onset (comparable time period among controls, 95% CI 1.5-2.9). Bias analyses showed that our observed associations were an underestimation of the true association when nondifferential misclassification of self-reported yeast infections and certain differential misclassification scenarios were present. However, if women with vulvodynia more frequently misreported having them when they truly did not, our observed associations were an overestimate of the truth. Conclusions: There appears to be a positive relationship between yeast infections preceding and following the diagnosis of vulvodynia, but this relationship varies from strong to nonexistent depending on the relative accuracy of the recalled diagnosis of yeast infections among cases and controls. To better understand the bidirectional associations between yeast infections and vulvodynia, future validation studies are needed to determine the extent to which misclassification of self-reported yeast infections differs between women with and without vulvodynia. [ABSTRACT FROM AUTHOR]

Objectives: Compared with non-Hispanic Whites, Hispanic women have significantly higher prevalence of chronic vulvar pain (CVP), which is known to have heterogeneous subtypes. However, it is not known whether subtypes differ by ethnicity, and improved understanding of subtypes may allow for targeted clinical assessment and therapies. We examined subtypes to determine whether they differed by ethnicity. Methods: Data were from 1,551 women who reported chronic vulvar pain consistent with vulvodynia in a population-based, cross-sectional study of women from the Minneapolis/St. Paul metropolitan area, during the years 2010-2013, who returned a validated screener survey about vulvar pain. Results: Among women with CVP, Hispanics reported more primary vulvodynia (adjusted [adj.] risk ratio=1.47; p<0.01), defined as pain with first intercourse or tampon use, and tended to be more likely to describe a burning pain (adj. risk ratio=1.45; p=0.06). Hispanic women with CVP were 17% more likely than non-Hispoanic Whites with CVP to have their pain alleviated with some type of behavior/remedy ( p=0.01); for example, among the subgroup of women with CVP who used yeast cream, Hispanics more often reported benefit to their pain (adj. risk ratio=1.51; p<0.01). Discussion: We examined women with CVP and found that in comparison to their non-Hispanic White counterparts, Hispanic women are more likely to report a burning sensation and more likely to have primary vulvodynia, a subtype that is associated with great burden on the lives of affected women. [ABSTRACT FROM AUTHOR]

Background: Vulvodynia is an unexplained chronic vulvar pain condition. Case-control studies provide opportunities to examine potential mechanisms by which vulvodynia may develop. Findings inform etiological models that can be tested in subsequent prospective studies. Methods: A survey of interpersonal relationships and the Structured Clinical Interview for DSM-IV Axis I Disorders was administered to 215 case-control pairs of women with and without vulvodynia. Conditional logistic regression was used to examine associations between affect-based chronic stressors (i.e., living in fear of abuse, perceived abuse, and antecedent mood disorders) with vulvodynia. These associations were then examined among women with and without a history of childhood abuse. Results: Among women with a history of severe childhood abuse, those with vulvodynia had three times the odds of living in fear of any abuse compared to women without vulvodynia (95% confidence interval: 1.0, 11.0), after adjustment for childhood poverty. Among women with no history of childhood abuse, those with vulvodynia had over six times the odds of antecedent mood disorder compared to women without vulvodynia (95% confidence interval: 1.9,19.6). Conclusion: Our findings suggest that affect-based chronic stressors may be important to the psychobiological mechanisms of vulvodynia. Prospective studies are recommended to test biopsychosocial models of the etiology of vulvodynia. [ABSTRACT FROM AUTHOR]

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

Background: Studies have shown that women with vulvodynia are more psychologically distressed than women without vulvodynia. These studies, however, have not effectively established temporal associations between diagnosed psychiatric disorders and vulvodynia. Methods: The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) was administered to 240 case-control pairs of women with and without vulvodynia. Interviews established age at first onset of diagnosed mood and anxiety disorder. Age information was used to determine whether the first episode of mood and/or anxiety was antecedent or subsequent to the first onset of vulvodynia symptoms. Conditional logistic regressions tested whether antecedent depression or anxiety was more likely among women with or without vulvodynia. Cox proportional hazards modeling was then used to estimate risk of subsequent new or recurrent onset of mood or anxiety disorder. Results: After adjusting for education, race, age at menarche, age at first tampon use, and age at first sexual intercourse, odds of vulvodynia were four-times more likely among women with antecedent mood or anxiety compared to women without (95% confidence interval [CI] 2.1-7.5). Vulvodynia was associated with new or recurrent onset of mood or anxiety disorder after adjustment (hazard ratio [HR] 1.7, 95% CI 1.1-2.6) and did not significantly change after including history of mood or anxiety disorder before the onset of vulvodynia or reference age of controls in the models. Conclusions: This is the first community-based epidemiologic study demonstrating that DSM-IV-diagnosed antecedent depression and anxiety disorders influence the risk of vulvodynia and that vulvodynia increases the risk of both new and recurrent onset of psychopathology. [ABSTRACT FROM AUTHOR]

Purpose: A recent histological study of vestibular tissue from women with localized vulvodynia found universal presence of mast cells compared to no presence in vestibular tissue among controls. Since histamine is generated by mast cells, and mast cells contribute to the production of cytokines during chronic inflammation, we assessed the association between conditions that elicit a clinically relevant histamine response and vulvodynia. Methods: We studied 239 women with and 239 women without vulvodynia to assess the influence of self-reported allergic reactions antecedent to first development of vulvar pain symptoms among cases, and a matched reference age among controls. Results: Women with self-reported hives prior to first report of vulvar pain or reference age among controls were 2.5 times more likely to develop vulvodynia (95% confidence interval [CI], 1.7–4.4). Those reporting a history of allergic reactions to insect bites were 2.1 times more likely (95%CI, 1.1–4.0), and those reporting a history of seasonal allergies were 2.0 times (95%CI, 1.3–3.2) more likely to develop vulvodynia. Findings were similar in a restricted subset of clinically confirmed cases and matched controls. Conclusions: An altered immuno-inflammatory response to environmentally induced allergic reactions may predispose women to the development of vulvodynia or may be markers of an already heightened immuno-inflammatory response. [Copyright &y& Elsevier]