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Clinical eye – Sexual pain – penetration disorder: clinical history is key to optimize the diagnosis

Editor , ArticlesLRIOG 2022-1 , , , , , .
Clinical eye – Sexual pain – penetration disorder: clinical history is key to optimize the diagnosis

Alessandra Graziottin 1,2 – Orcid, Elena Boero 1 – Orcid

1 – Alessandra Graziottin Foundation for the cure and care of pain in women NPO

2 – Center of Gynecology and Medical Sexology, San Raffaele Resnati Hospital, Milan, Italy

Corresponding Author: Alessandra Graziottin

direzione@studiograziottin.it

DOI: 10.53146/lriog1202161

Abstract

Sexual pain at intercourse, or dyspareunia, is a common symptom affecting up to 1 in 5 women. Despite its high prevalence, sexual pain is still underdiagnosed. When recognized it is poorly characterized in its etiology and consequently undertreated by clinicians, especially when they are not trained in sexual medicine. Sexual pain always has precise biological causes and is often comorbid with other gynecological, pelvic, muscular, urinary, and/ or intestinal pathologies. Correct diagnosis and treatment of sexual pain require collecting a detailed clinical history aimed at identifying the most relevant predisposing, precipitating, and maintenance factors. The goal of the work is to provide the clinician with a questionnaire to make the anamnesis of sexual pain “physician-friendly”, and facilitate the in-depth diagnosis of sexual pain. The clinical reasoning is carefully discussed as well, to guide the reading of the symptoms and signs of the pathologies potentially responsible for sexual pain to identify a tailored multimodal therapy.

Keywords: sexual pain; superficial dyspareunia; deep dyspareunia; clinical history; vulvar pain; endometriosis.

Available in LRIOG Nr.1 – 2022

e-ISSN: 1824-0283

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Chronic vulvar pain, recurrent candidiasis and familial diabetic risk

Editor , , , , ArticlesLRIOG 2021-2 , , , , .
Chronic vulvar pain, recurrent candidiasis and familial diabetic risk
Critical factors emerged from the VuNet on 1183 women – Part II

Alessandra Graziottin1,2 – Orcid, Dania Gambini2, Elena Boero2– Orcid, Filippo Murina3,4 – Orcid, ricercatori del gruppo Vu-net 

1 – Center of Gynecology and Medical Sexology, H. San Raffaele Resnati Milan

2 – Graziottin Foundation for the treatment of pain in women – Onlus

3 – Lower Genital Tract Pathology Service, V. Buzzi Hospital – University of Milan

4 – Italian Vulvodynia Onlus Association

Corresponding author: Alessandra Graziottin

direzione@studiograziottin.it

DOI: 10.53146/lriog1202127

Abstract

The VuNet (Vulvodynia Network) Project is an observational study set out to investigate the epidemiological characteristics and comorbidities of chronic vulvar pain. It involved 1183 women, enrolled between December 2016 and November 2018 in 21 Italian medical centers. Supported by the collected evidence that 32% patients with vulvar pain were affected by recurrent vulvo- vaginal candidiasis (RVVC), this article aims at analyzing the role of Candida infections in the genesis of vulvar pain and dyspareunia, and diabetes, or familiarity for diabetes, as a key predisposing factor. The recurrent/persistent inflammation associated with an aberrant immune-allergic reaction to Candida antigens may be a strong co-factor for developing vestibulodynia in this cluster of patients. The co-prevalence of 17.5% patients reporting food or respiratory allergies suggests a parallel predisposition to the development of allergic reactions. The anamnesis revealed a higher rate of diabetes in first- and second-degree relatives of the patients, both from the mother’s (8.4%) and father’s side (8.6%), versus the Italian national prevalence of 5.3% for the population un- der 65. Genetic predisposition for diabetes alters the carbohydrate metabolism predisposing to vulvovaginal candidiasis. Collectively, our data highlight the importance of investigating metabolic vulnerabilities to diabetes, both in the patient and her family, and encourage appropriate lifestyles, including: a net reduction in the consumptions of glucose or saccharose, body weight control, and daily aerobic exercise to reduce peripheral insulin resistance. The ultimate goals are reducing predisposing factors for candidiasis, vestibulodynia and coital pain in this cluster of patients, and tailoring treatment accordingly.

Keywords: vulvovaginal candidiasis; vulvar pain; vestibolodynia; dyspareunia; diabetes.

Available in LRIOG Nr.2 – 2021

e-ISSN: 1824-0283

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Gonorrhea, a threatening infection in gynecology and obstetrics

Editor , , ArticlesLRIOG 2021-2 , , , , .
Gonorrhea, a threatening infection in gynecology and obstetrics

Alessandra Graziottin1,2 – Orcid , Elena Boero1– Orcid  , Chiara Limongi1 

1 –  Graziottin Foundation for the treatment of pain in women – Onlus

2 – Center of Gynecology and Medical Sexology, H. San Raffaele Resnati Milan

Corresponding author: Alessandra Graziottin

direzione@studiograziottin.it

DOI: 10.53146/lriog1202126

Abstract

Gonorrhea is the second most common sexually transmitted bacterial infection worldwide after chlamydia. Women present a different and unsuspected gender vulnerability, with diagnostic and therapeutic delays that can and must be avoided. Gonorrhea is caused by the vertically and sexually transmitted bacterium Neisseria gonorrhoeae, whose prevalence is aggressively increasing worldwide. Diagnostic and therapeutic timeliness in women is hampered by lack of specificity and short duration of cervico-vaginal symptoms, modesty of urethral symptoms (urethritis), and limited knowledge of both oral and anal infections. Another element of insidiousness is the underestimation of the risks that gonorrhea entails, in terms of infertility and obstetric complications, chronic pelvic pain and injuries in distant organs, including conjunctivitis and gonococcal arthritis. The danger of the diagnostic delay is also expressed in the persistent infectivity of the patient, who continues infecting his/her sexual partners, and the fetus, in case of pregnancy. Growing antibiotic resistance is another serious alarm. The aim of the work is: to identify the key points for timely and effective diagnosis and treatment of gonorrhea in gynecology and obstetrics, with a focus on vaginal, endometrial, tubal, and pelvic; amniotic, placental, and fetal; oral and systemic vulnerability. Diagnostic difficulties and the current lack of a vaccine will be analyzed. The ultimate goal is to enhance the diagnostic and therapeutic timeliness of the gynecologist, in order to avoid both persistent underlying infectivity and multiple long-term complications.

Keywords: gonorrhea; sexually transmitted infection; gender vulnerability; infertility; antibiotic resistance.

Available in LRIOG Nr.2 – 2021

e-ISSN: 1824-0283

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Staphylococcus aureus vulvitis

Editor , ArticlesLRIOG 2021-1 , , , .
Staphylococcus aureus vulvitis: an insidious infection that stresses the importance of appropriate intimate hygiene

Alessandra Grazziottin1,2 – Orcid, Elena Boero1 – Orcid

1 – Alessandra Graziottin Foundation for the treatment of pain in women – Onlus

2 – Gynecology and Medical Sexology Center, H. San Raffaele Resnati, Milan

Corresponding author: Alessandra Graziottin

direzione@studiograziottin.it

DOI: 10.53146/lriog1202113

Abstract

Why do folliculitis and other bacterial vulvar infections represent disorders of interest in the gynecological practice? Which predisposing, precipitating, and maintaining factors should be considered by the gynecologist when recurrent bacterial infections of vulvar skin become a clinical challenge? When is it appropriate to think of Staphylococcus aureus as a principle etiological agent? Why do S. aureus vulvar infections represent an emerging threat for women’s health? New hygienic and cosmetic practices, including over-zealous cleansing and micro- and macro-traumatic hair removal techniques, lead to a significant increase of vulvar infections in the clinical practice. Factors predisposing to bacterial vulvar infections, such as personal and familial diabetes and obesity, indicate to the gynecologist an alteration of the vulvar ecosystem, which can predispose to more severe pathologies. S. aureus, the main infectious agent, causes increasing medical concerns because of its pathogenic and invasive capacity. Moreover, the rapid ability of S. aureus of developing antibiotic resistances is even more challenging in surgical specialties, especially in obstetrics and gynecology, for the reduced availability of effective antibiotics for treatment. The gynecologist has an important educational role on the appropriate hygiene principles, to reduce bacterial vulvar infections, more threatening for their increasing invasive potential, especially in more vulnerable subjects.

Keywords: intimate hygiene; cutaneous infections; staphylococcus aureus; vulva.

Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283

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Syphilis: why the disease is more insidious in women

Editor , ArticlesLRIOG 2021-1 , , , , , .
Syphilis: why the disease is more insidious in women

Alessandra Grazziottin1,2 – Orcid, Elena Boero1 – Orcid

1 – Alessandra Graziottin Foundation for the treatment of pain in women – Onlus

2 – Gynecology and Medical Sexology Center, H. San Raffaele Resnati, Milan

Corresponding author: Alessandra Graziottin

direzione@studiograziottin.it

DOI: 10.53146/lriog1202112

Abstract

Why should syphilis be reconsidered in gynecological clinical practice? Why are women more vulnerable to late diagnosis? What are the key points for timely and effective diagnosis and treatment? What are the avoidable consequences of diagnostic and therapeutic delays? Syphilis is caused by the sexually and vertically transmitted bacterium Treponema pallidum. Syphilis, wrongly considered outdated, is making an aggressive comeback worldwide. From a medical point of view, diagnostic timeliness is hampered by: a lack of familiarity with this re-emerging disease and a consequent lack of consideration in the anamnestic picture and differential diagnosis; complex course, which alternates insidious and variable symptomatic phases, with periods of clinical latency, while the disease continues its pro-inflammatory and destructive action at the subclinical level. The late or missed diagnosis of syphilis leads to a prolonged infection, with permanent and at times fatal outcomes. The danger of a delay in diagnosis also results in persistent infectivity of the patients, who continue to infect their sexual partners, and the fetus, if pregnant. The aim of the work is: to identify the key points for timely and effective diagnosis and therapy of syphilis in gynecology, with a focus on vulvar and vaginal vulnerability; to analyze the reasons for its insidious hidden diffusibility; to discuss the diagnostic difficulties, the limited availability of the most effective drug, penicillin, the current lack of a vaccine and finally why it is difficult to follow the course of the disease and its therapy through laboratory diagnostics. The final goal is to enhance the diagnostic effectiveness of the gynecologist.

Keywords: syphilis; primary chancre; secondary syphilis; treponema pallidum; penicillin; vulva.

Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283

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