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

Thirty-three women (mean age 45 years) attending a vulval pain clinic based in a department of genitourinary medicine were followed-up for a minimum of 6 months. All women had dysaesthetic vulvodynia and 11 (33%) also had features compatible with vulval vestibulitis. Thirty-two patients were treated with a tricyclic antidepressant drug and a complete response was recorded in 47%. Only four patients obtained less than 50% improvement in their symptoms. Treatment with tricyclic drugs was part of a package of interventions including intensive support and the opportunity to take up counselling. Under these circumstances, it is difficult to attribute the success of treatment to the effect of the medication alone and there is a need for well-designed randomised controlled trials to evaluate this and other therapeutic approaches.
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PMID:Response to treatment in dysaesthetic vulvodynia. 1252 81

This article presents data contributed by 428 highly educated, internet-savvy women who frequented various vulvar pain discussion lists. The age range was in the reproductive years and older and over 90% were Caucasians. No country of origin was given. They had a number of distressing symptoms, including vulvar pain at rest and with contact, burning, itching, redness, and inflammation. Most felt that they had either vulvar vestibulitis, vulvodynia, or both, although they had other vulvar conditions as well. Many felt that yeast infections, stress, antibiotics, infections, and chemicals played a contributing role. There were a number of comorbidities, including irritable bowel syndrome, fibromyalgia, and interstitial cystitis. Sexual abuse was not a major issue. The vulvar pain destroyed or altered then sex lives, lowered their self-esteem, and affected their relationships. Often, they relied upon understanding partners, support groups, and hobbies but not the medical profession for comfort.
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PMID:Characteristics of women with vulvar pain disorders: responses to a Web-based survey. 1273 88

This article is based on a vast clinical experience from patients presenting with widespread pain syndromes as well as dysfunctional symptoms from inner organs. A literature survey has been performed. Allodynia and hyperalgesia that partly explain the fibromyalgia and local myalgia syndromes seem to arise from a pathophysiological process of nociceptive sensitisation. It is proposed that the concept of "sensory sensitisation dysfunctional disorders" be applied to conditions like bronchial hyperreactivity, Da Costas syndrome, Dercum's disease (Adipositas dolorosa), dry eyes and mouth syndrome, fibromyalgia, gastralgia, globus hystericus, interstitial cystitis, chronic prostatitis, irritable bowel syndrome, photo- and phonosensitivity, rhinitis, tension headache, tinnitus, vestibulitis syndrome. These dysfunctional disorders cannot be satisfactorily explained by presently known pathophysiological models like ongoing inflammatory process, tissue degeneration, fibrosis, blood vessel diseases, tumours, immune reactions, toxic or deficiency conditions, metabolic disturbances. Neurogenic mechanisms also seem to play an important role in the pathophysiology of arthritic conditions, and might be worthwhile to include in forthcoming discussions concerning the aetiology of chronic inflammatory disease.
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PMID:[Sensory sensitization, part II: Pathophysiology in dysfunctional disorders. Understanding the inner life of the nerve pathways may explain hitherto unexplainable symptoms]. 1278 9

Coital pain is the leading symptom of two major sexual disorders, dyspareunia and vaginismus. According to the new International Classification on Female Sexual Disorders they are included under the category of "Sexual Pain Disorders". Dyspareunia has long been considered to be psychogenic. On the contrary, it has solid biological bases: location of pain and its characteristics are the strongest predictors of its organicity. Biological factors include hormonal, inflammatory, muscular, iatrogenic, neurologic, vascular, connective and immunitary causes. A specific pathology of pain is in play when the meaning of pain shifts from the "nociceptive" domain, when it signals an ongoing tissue damage, to the "neuropathic" dimension, when pain is generated within the pain system itself, with increased peripheral input and/or lowered central pain threshold, as happens in chronic vulvar vestibulitis. Vaginismus, with its associated defensive contraction of perivaginal muscles when intercourse is attempted, is credited to be the pelvic expression of a more general muscular defense posture, associated with a variable phobic attitude towards coital intimacy. Vaginismus may prevent intercourse in the most severe degrees, whilst in the milder ones it becomes a cause of dyspareunia. Psychosexual factors--loss of libido and arousal disorders, associated with, or secondary to, sexual pain related disorders--may contribute to the worsening of coital pain over time, alone or when associated to couple problems. The clinical approach should aim at diagnosing biological, psychosexual and context-dependent etiologies. The psychobiology of the experience of sexual pain needs to be addressed in a comprehensive, integrated and patient-centered perspective.
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PMID:Etiology and diagnosis of coital pain. 1283 36

The effectiveness of hypnotherapy in alleviating pain has been demonstrated with several disorders and diseases involving acute and chronic pain. Although hypnosis has been suggested as treatment for dyspareunia resulting from vulvar vestibulitis syndrome (VVS), empirical data and case reports showing its effectiveness have been lacking. This article presents a case report on the use of hypnotherapy to treat a 26-year-old woman suffering from VVS. Psychotherapy consisted of twelve sessions, of which eight were devoted to hypnosis. The goal of hypnosis was to help the client decrease her anticipatory anxiety, create a positive association of pleasure with intercourse, and create a sense of control over her pain. Despite having persistent pain during intercourse for 3 years with several partners, she experienced no more pain following treatment, and remained pain free at a 12-month follow up.
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PMID:Hypnotherapy as a treatment for vulvar vestibulitis syndrome: a case report. 1285 Nov 28

Vulvodynia is chronic vulvar burning/pain without clear medical findings. The etiology of vulvodynia is unknown and health care professionals should thoroughly rule out specific, treatable causes or factors such as dermatoses or group B Streptococcus infections. Vulvodynia is divided into 2 classes: vulvar vestibulitis syndrome is vestibule-restricted burning/pain and is elicited by touch; dysesthetic vulvodynia is burning/pain not limited to the vestibule and may occur without touch/pressure. After diagnosis, critical factors in successful patient management include education and psychological support/counseling. Unfortunately, clinical trials on potential vulvodynia therapies have been few. Standard therapy includes treating neuropathic pain (eg, tricyclic medications, gabapentin) thought to play a role. Additional therapies may be considered: pelvic floor rehabilitation combined with surface electromyography, interferon alfa, estrogen creams, and surgery. Importantly, any therapy should be accompanied by patient education and psychological support. Because definitive data on effective therapies are lacking, further clinical investigations of treatment options are warranted.
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PMID:New concepts in vulvodynia. 1453

Vulvar vestibulitis is believed to be the most frequent cause of dyspareunia in premenopausal women, with the symptoms affecting the patient's life in several ways. We therefore assessed the level of depression and state anxiety in women with vulvar vestibulitis and their partners, and the association of depression and state anxiety with genital symptoms. In this prospective study, 30 women were included at their first visit, and the diagnosis was set. They were asked to fill in questionnaires concerning genital symptoms, pain and well-being, and the results were compared with those of healthy, age-matched and sex-matched controls. Twelve partners were included and their level of depression and anxiety was assessed. Our results indicate that women with vestibulitis show symptoms and signs of depression compared to controls and this must be considered when meeting and treating these women. A depressive status in their partners may indicate the presence of relational problems.
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PMID:Vulvar vestibulitis: evidence of depression and state anxiety in patients and partners. 1460 7

Vulvar vestibulitis syndrome (VVS) is a common cause of dyspareunia in pre-menopausal women. Previous quantitative sensory test (QST) studies have demonstrated reduced vestibular pain thresholds in these patients. Here we try to find whether QST findings correlate to disease severity. Thirty-five vestibulitis patients, 17 with moderate and 18 with severe disorder, were compared to 22 age matched control women. Tactile and pain thresholds for mechanical pressure and thermal pain were measured at the posterior fourcette. Magnitude estimation of supra-threshold painful stimuli were obtained for mechanical and thermal stimuli, the latter were of tonic and phasic types. Pain thresholds were lower and supra-threshold magnitude estimations were higher in VVS patients, in agreement with disease severity. Cut-off points were defined for results of each test, discriminating between moderate VVS, severe VVS and healthy controls, and allowing calculation of sensitivity and specificity of the various tests. Our findings show that the best discriminative test was mechanical pain threshold obtained by a simple custom made 'spring pressure device'. This test had the highest kappa value (0.82), predicting correctly 88% of all VVS cases and 100% of the severe VVS cases. Supra-threshold pain magnitude estimation for tonic heat stimulation also had a high kappa value (0.73) predicting correctly 82% overall with a 100% correct diagnosis of the control group. QST techniques, both threshold and supra-threshold measurements, seem to be capable of discriminating level of severity of this clinical pain syndrome.
Pain 2004 Jan
PMID:Vulvar vestibulitis severity--assessment by sensory and pain testing modalities. 1471 88

This study investigated the roles of vaginal spasm, pain, and behavior in vaginismus and the ability of psychologists, gynecologists, and physical therapists to agree on a diagnosis of vaginismus. Eighty-seven women, matched on age, relationship status, and parity, were assigned to one of three groups: vaginismus, dyspareunia resulting from vulvar vestibulitis syndrome (VVS), and no pain with intercourse. Diagnostic agreement was poor for vaginismus; vaginal spasm and pain measures did not differentiate between women in the vaginismus and dyspareunia/VVS groups; however, women in the vaginismus group demonstrated significantly higher vaginal/pelvic muscle tone and lower muscle strength. Women in the vaginismus group also displayed a significantly higher frequency of defensive/avoidant distress behaviors during pelvic examinations and recalled past attempts at intercourse with more affective distress. These data suggest that the spasm-based definition of vaginismus is not adequate as a diagnostic marker for vaginismus. Pain and fear of pain, pelvic floor dysfunction, and behavioral avoidance need to be included in a multidimensional reconceptualization of vaginismus.
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PMID:Vaginal spasm, pain, and behavior: an empirical investigation of the diagnosis of vaginismus. 1473 86

Vulval problems are common in gynaecological practice. Pain syndromes of the vulva should be considered once infection and dermatological causes of vulval symptoms have been excluded. This article covers vulval vestibulitis and dysaesthetic vulvodynia, the two subgroups of vulval pain syndromes.
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PMID:The management of vulval pain syndromes. 1568 62


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