Vulvodynia and vulvar vestibulitis: challenges in diagnosis and management. (1/23)

Vulvodynia is a problem most family physicians can expect to encounter. It is a syndrome of unexplained vulvar pain, frequently accompanied by physical disabilities, limitation of daily activities, sexual dysfunction and psychologic distress. The patient's vulvar pain usually has an acute onset and, in most cases, becomes a chronic problem lasting months to years. The pain is often described as burning or stinging, or a feeling of rawness or irritation. Vulvodynia may have multiple causes, with several subsets, including cyclic vulvovaginitis, vulvar vestibulitis syndrome, essential (dysesthetic) vulvodynia and vulvar dermatoses. Evaluation should include a thorough history and physical examination as well as cultures for bacteria and fungus, KOH microscopic examination and biopsy of any suspicious areas. Proper treatment mandates that the correct type of vulvodynia be identified. Depending on the specific diagnosis, treatment may include fluconazole, calcium citrate, tricyclic antidepressants, topical corticosteroids, physical therapy with biofeedback, surgery or laser therapy. Since vulvodynia is often a chronic condition, regular medical follow-up and referral to a support group are helpful for most patients.  (+info)

Cromolyn cream for recalcitrant idiopathic vulvar vestibulitis: results of a placebo controlled study. (2/23)

OBJECTIVE: Patients with chronic idiopathic vulvar vestibulitis have increased mast cells when biopsied, and cromolyn has been suggested as a treatment. The purpose of this study was to assess the efficacy of 4% cromolyn cream in women with vulvar vestibulitis. METHODS: A prospective, double blind, randomised, placebo controlled study was initiated at two centres. Patients with vulvar vestibulitis were assigned to apply cromolyn or placebo cream to the vestibule. Symptoms (burning, irritation) and signs (erythema, extent of erythema, tenderness) were recorded on a 0-3 scale. In the sexually active patient subgroup, dyspareunia was also evaluated. RESULTS: 13 of the 26 evaluable patients received cromolyn. Patients in the cromolyn arm were more likely to have failed therapy with amitriptyline (p = 0.05), but the two groups were otherwise similar upon study entry. Overall, scores decreased from a median of 9 to 5 (p = 0.001) during the study, but the level of improvement was similar between both groups. Improvement was unrelated to duration of symptoms, fluconazole use, or sexual activity. Five patients (38%) taking cromolyn and six (46%) taking placebo felt they had a 50% or greater reduction in symptoms. In the 21 sexually active patients, the total score decreased from a mean of 12 to 8 (p = 0.005), but there was no statistically significant difference between study arms. CONCLUSIONS: Cromolyn cream did not confer a significant benefit in patients with vulvar vestibulitis. The large placebo response suggests the need for large well controlled studies of other treatment modalities.  (+info)

A clinico-pathological study of vulval dermatoses. (3/23)

A long-term review of 108 women suffering from various forms of vulval dermatosis is described and a detailed analysis of those with chronic hypertrophic vulvitis, lichen sclerosus et atrophicus, and neurodermatitis is made. One case of neurodermatitis and two cases of lichen sclerosus progressed to carcinoma but no case of chronic hypertrophic vulvitis became malignant. It is possible that vulval dermatoses occur more commonly in the nulliparous than in the parous women and there is a slight preponderance of women who are blood group A. It is suggested that the term "leukoplakia" should be abandoned and that vulval lesions should be described in precise and meaningful histological terms.  (+info)

Use of oral contraceptive pills and vulvar vestibulitis: a case-control study. (4/23)

Vulvar vestibulitis is characterized by superficial pain during intercourse. Exploratory studies have suggested that oral contraceptives (OCs) could be associated with occurrence of vulvar vestibulitis. This 1995-1998 case-control study in Quebec, Canada, sought to reassess this association. Included were 138 women with vulvar vestibulitis whose symptoms had appeared in the previous 2 years and 309 age-matched controls who were consulting their physicians for reasons other than gynecologic problems or contraception. Cases and controls were interviewed to obtain a detailed history of OC use and information on potential confounding factors. Relative risks were estimated by using logistic regression. The authors found that 4 percent of cases had never used OCs compared with 17 percent of controls. The relative risk of vulvar vestibulitis was 6.6 (95 percent confidence interval: 2.5, 17.4) for ever users compared with never users. When OCs were first used before age 16 years, the relative risk of vulvar vestibulitis reached 9.3 (95 percent confidence interval: 3.2, 27.2) and increased with duration of OC use up to 2-4 years. The relative risk was higher when the pill used was of high progestogenic, high androgenic, and low estrogenic potency. The possibility that OC use may contribute to the occurrence of vulvar vestibulitis needs to be evaluated carefully.  (+info)

Capsaicin and the treatment of vulvar vestibulitis syndrome: a valuable alternative? (5/23)

OBJECTIVE: To assess the efficacy of topical capsaicin in the treatment of vulvar vestibulitis syndrome. STUDY DESIGN: Thirty-three consecutive women referred for vulvar vestibulitis syndrome were treated with topical capsaicin 0.05 %. The capsaicin cream was applied twice a day for 30 days, then once a Day for 30 days, and finally 2 times a week for 4 months. RESULTS: In 19 patients (59%), improvement of symptoms was recorded, but no complete remission was observed. Symptoms recurred in all patients after the use of capsaicin cream was discontinued. A return to a twice-weekly topical application of the cream resulted in the improvement of symptoms. Severe burning was reported as the only side effect by all the patients. CONCLUSION: Response to treatment was only partial, possibly due to the concentration of the compound being too low, or to the need for more frequent than daily applications. The therapeutic role of capsaicin should hence be confined to a last-choice medical approach.  (+info)

Vulvar vestibulitis and risk factors: a population-based case-control study in Oslo. (6/23)

Vulvar vestibulitis is a major cause of entry dyspareunia in young women. The aim of this study was to evaluate a self-reported history of bacterial vaginosis, candidiasis, use of oral contraception and nulli-pregnancy as risk factors for vestibulitis. A retrospective examination of medical records was performed for 45 patients with vestibulitis from a vulvar clinic in Oslo, median age 24 years, age range 19-49 years. Four controls per case were selected randomly from the same Oslo source population as the cases. Age-matching was not performed, as matching does not control for confounding in the case-control design. Controls anonymously answered a postal questionnaire, response rate 61%. The crude effect for the major potential predictors for vulvar vestibulitis was estimated, and stratification on age for the major potential predictors. The method of Mantel Haenszel was used to quantify confounders, and control for multi-confounders and the gradient effect of different covariates was performed. The major confounder was age. Independent risk factors for vestibulitis were nulli-pregnancy, odds ratio (OR) 8.4 (95% confidence interval (CI) 2.8-25.2) and bacterial vaginosis, OR 3.37 (95% CI 1.06-10.6). Adjusting for age diluted the effect of oral contraception and frequent treatment for candidiasis. This study is the third case-control study identifying bacterial vaginosis as a risk factor for vestibulitis. Thus, it remains to be investigated whether abnormal vulvo-vaginal microbiota belongs to the aetiology of vulvar vestibulitis.  (+info)

Multiple odontogenic abscesses. Thoracic and abdomino-perineal extension in an immuno competent patient. (7/23)

INTRODUCTION: Odontogenic infection (OI) may lead to death if it extends beyond the buccal area. The virulence of pathogens and the local and systemic status of the patient influence the propagation of the pathogen, either by anatomical continuity or haemematogenous dissemination. Several severe complications derived from OI have been reported in the head, neck and chest. However, OI with an abdominal component, caused by bacteraemia with dental foci or the direct passage of pus from the thorax to the abdomen, are unusual. CASE REPORT: We present the case of a young immunocompetent woman who, after false cure of an odontogenic abscess, again reported gynaecological symptoms. A network of connected abdomino-perineal, thoracic and cervical abscesses was discovered. DISCUSSION: The peculiarity and severity of this case is a reminder that treatment of an abscessed OI should include intravenous broad-spectrum antibiotics, together with surgical drainage of the purulent collections. Samples should be taken for culture and an antibiogram in order to use specific antibiotics if the initial empirical therapy shows resistance. The diagnosis and follow-up should be by CT, which in our patient showed anatomical continuity of the abscesses from the dental focus. The time sequence of the symptoms, in the absence of any other infectious cause, revealed the descending odontogenic nature of the process.  (+info)

Granulomatous cheilitis with granulomatous vulvitis: a rare association. (8/23)

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