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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The subject of vulvar vestibulitis was reviewed in regard to clinical variables that may be associated with this problem as well as the success of available treatment modalities. Questionnaires were returned by 71 patients diagnosed as having vulvar vestibulitis. Identical information was obtained from a comparison group of individuals with no clinical or physical findings suggesting this diagnosis. A history of recurrent candidiasis and previous condyloma acuminatum were the only variables noted more frequently in patients with vestibulitis. Among the patients treated by perineoplasty, 66% reported complete or significant alleviation of vulvar pain; 78% of the women noted a significant decrease in dyspareunia. Of the patients treated with intralesional interferon, six (50%) reported significant improvement in dyspareunia. Vulvar vestibulitis is a puzzling clinical entity whose etiology is not well understood. Perineoplasty still appears to be the treatment of choice in properly selected individuals.
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PMID:Vulvar vestibulitis: significant clinical variables and treatment outcome. 137 Jan 23

The results of a randomized prospective trial investigating the morbidity from intranasal splints in 105 patients, were analysed. Intranasal splints are associated with considerable morbidity (significantly greater post-operative pain and a higher incidence of septal perforation and vestibulitis) and although they significantly reduce the likelihood of developing intranasal adhesions, a similar benefit can be obtained by careful nasal toilet at one week.
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PMID:The morbidity from nasal splints in 105 patients. 149 31

VVS is currently recognized as one of the leading causes of vulvodynia or chronic vulvar pain. Its cause is unknown, and it is defined by a constellation of signs and symptoms confined to the vulvar vestibule. Hence, there is introital or entry dyspareunia, vestibular erythema of varying degrees, and localized tenderness confined to the vulvar vestibule. It has been found to be associated with subclinical HPV infection; chronic, recurrent candidiasis; and persistent alteration of vaginal pH secretion, and therapy for some of these conditions sometimes leads to amelioration of the symptoms associated with vulvar vestibulitis. The majority of cases, however, are still idiopathic. The more chronic and severe cases are frequently helped by a surgical procedure that results in excision of most of the vestibule and advancement of the vaginal epithelium. Some of the milder cases are known to remit spontaneously, so conservative, supportive management is of the utmost importance.
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PMID:Vulvar vestibulitis syndrome. 160 69

All gynecologic patients seen by the author during a 6-month period were questioned and examined by means of a swab test to determine the prevalence of vulvar vestibulitis and the normal variation in sensitivity of vestibular skin. Of 210 patients, 78 (37%) had some degree of positive testing. A total of 31 patients (15%) were found to fulfill the definition of vulvar vestibulitis. A questionnaire was administered to these patients as well as to seven patients in whom vestibulitis had been previously diagnosed. A total of 50% had always had pain, most since their teenage years. Their history was not suggestive of a cyclic or remittent pattern of symptoms. Those with secondary dyspareunia or resolution of pain were usually either in a post partum phase or had group B streptococcus or human papillomavirus. The two most severe cases of vestibulitis occurred after use of fluoroucil cream. A total of 32% had some female relative with dyspareunia or tampon intolerance, raising the issue of a genetic predisposition.
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PMID:Vulvar vestibulitis: prevalence and historic features in a general gynecologic practice population. 164 69

Topical capsaicin has been introduced in the U.S. and Canada as a cream indicated for temporary relief of neuralgia following episodes of herpes zoster infections and in the treatment of diabetic neuropathy. Although capsaicin is clinically used as an external analgesic for temporary relief of neuralgia, it has also been widely used as a research tool to study peripheral pain. Capsaicin apparently works to release substance P from sensory nerve fibers and after repeated applications, depletes neurons of substance P. Clinical investigations of topical capsaicin include trials in chronic pain syndromes such as postherpetic neuralgia, postmastectomy neuroma, reflex sympathetic dystrophy syndrome, diabetic neuropathy, rheumatoid arthritis, psoriasis, hemodialysis-associated itching, and vulvar vestibulitis. In addition, therapeutic benefits of capsaicin cream on apocrine chromhidrosis have been described. Further clinical studies are warranted in several of these conditions to establish the efficacy of topical capsaicin. Serious or unexpected adverse reactions from clinical use have not been reported to date. Considering the paucity of safe and effective treatments for the conditions mentioned above, capsaicin cream appears to warrant further clinical investigations to establish its efficacy in a variety of chronic pain syndromes.
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PMID:Topical capsaicin in dermatologic and peripheral pain disorders. 165 16

A woman had suffered from vulvar vestibulitis (vulvodynia) for four years. Pain from the disorder had disrupted her ability to function at work and home as well as sexually. An initial full range of treatments, including multiple operations, had produced no relief. Examination of the urine for evidence of excess oxalate, which has been shown to cause epithelial reactions similar to those found in vulvodynia, showed periodic hyperoxaluria and pH elevations related to the symptoms. Calcium citrate was given to modify the oxalate crystalluria. The symptoms were significantly reduced in three months, and the patient was pain free after one year. She was able to resume normal work, family, sexual and recreational activities. Withdrawal of the calcium citrate resulted in a return of the symptoms; reinstitution alleviated them. These findings suggest that further study of individualized metabolic factors that may underlie vulvodynia is warranted.
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PMID:Calcium citrate for vulvar vestibulitis. A case report. 181

Until recently, vulvar diseases have not been given sufficient attention by gynecologists. This might be attributable to the timidity of patients with chronic vulvar pruritus, tumor or dyspareunia, which delays diagnosis and treatment. In addition, the nomenclature of vulvar disease was complicated by having been adapted from various dermatological disorders. Only following the establishment of the International Society for the Study of Vulvar Disease (ISSVD) and of specialized clinics, has awareness increased and more attention is now being paid to vulvar disorders. The findings in 242 patients seen during the first year of operation of a vulvar clinic were analyzed. The most common presenting symptom was chronic vulvar pruritus. Non-neoplastic epithelial disorder (dystrophy) was the most common histological finding in the 79 women with pruritus, while 2 were diagnosed as having vulvar intraepithelial neoplasia, and 1 had basal cell carcinoma. In contrast, vulvar vestibulitis was the main diagnosis in 34 women referred for vulvar pain (vulvodynia). Vulvodynia was also associated with other inflammatory processes and with human papilloma virus (HPV) lesions (condylomata). The primary finding in 26 women referred for evaluation of a vulvar "tumor" was epidermal cyst. In only 55 (75.5%) of the 73 referred for suspected HPV lesions was the histologic diagnosis confirmatory. In addition, a few vulvar ulcers were associated with HPV. A single treatment with carbon dioxide laser eradicated the HPV lesions in 93% of the cases. The vulvar clinic contributes to the ambulatory gynecological service by concentrating diagnosis and treatment in a single specialized unit and increases understanding of, and interest in vulvar disease.
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PMID:[The vulvar clinic]. 207 59

During a 3-year period, 30 patients were referred for symptoms of vulvar pain characteristic of the vulvar vestibulitis syndrome. Colposcopic examination with a blue filter and pathologic biopsy revealed evidence of papillomavirus in 17 patients. Interferon alpha-2b recombinant was injected intradermally into the vestibule in a specific pattern three times weekly for 4 weeks. Fifteen women responded favorably with total absence of vulvar pain. Five women reported flu-like symptoms as a result of the injections. Patients without evidence of papillomavirus failed to respond to interferon therapy. Women with evidence of vulvar papillomavirus failed to respond to placebo but did respond to retreatment with interferon; vulvar biopsy specimens after therapy were negative. Interferon alpha-2b recombinant appears to offer an inexpensive, safe alternative to the more traumatic therapies currently recommended in the specific subset of vulvar vestibulitis patients in whom papillomavirus can be confirmed.
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PMID:Interferon therapy for condylomatous vulvitis. 253 13

Vulvar pain syndrome (vulvar vestibulitis, vulvodynia, burning vulvar syndrome) was first described at the end of the last century. Although more than 100 years have passed, the cause(s) of the disorder remains elusive. This review of the literature endeavors to collate the known facts relating to vulvar pain syndrome and to expose those hypothetical etiologies which fall short of establishing any scientific foundation. The diagnosis of vulvar pain syndrome is established on the basis of historical data which detail a rather abrupt onset of vestibular itching, burning, dryness which may be intermittent or continuous. Commonly, patients present with a history of chronic treatment for recurrent fungal infections. Sexual relations become uncomfortable or intolerable. Unanimously, the patients describe a panorama of topical creams and ointments which fail to alleviate the symptoms. Physical examination typically verifies hyperesthesia of the vestibular skin when touched lightly with a cotton-tipped applicator. Similarly, the vestibular skin shows varying degrees of redness. The treatment programs for vulvar pain syndrome are as diverse as the multitude of etiological hypotheses. This review includes data pointing out those therapeutic measures that appear valueless and that may add to the patient's chronic discomfort.
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PMID:Vulvar pain syndrome: a review. 747 16

Thirty-three women diagnosed as suffering from vulvar vestibulitis syndrome, marked by a significant history of long-term moderate to severe chronic introital dyspareunia and tenderness of the vulvar vestibule, were selected for treatment. Patients were given a computerized electromyographic evaluation of the pelvic floor muscles and were then provided with portable electromyographic biofeedback instrumentation and instructions on the conduct of daily, at-home, biofeedback-assisted pelvic floor muscle rehabilitation exercises. They received intermittent evaluations of pelvic floor muscles to ensure compliance and monitor their progress and symptom changes. The results show that after an average of 16 weeks of practice, pelvic floor muscle contractions increased 95.4%, resting tension levels decreased 68%, and the instability of the muscle at rest decreased by 62%. Subjective reports of pain decreased an average of 83%. Twenty-eight patients had abstained from intercourse for an average of 13 months. Twenty-two of these 28 patients resumed intercourse by the end of the treatment period. Six month follow-up indicated maintenance of therapeutic benefits.
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PMID:Treatment of vulvar vestibulitis syndrome with electromyographic biofeedback of pelvic floor musculature. 762 58


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