Chronic vulvar pain, recurrent candidiasis and familial diabetic risk

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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The vagina: therapeutic role of estrogens

The vagina: therapeutic role of estrogens

Anna Maria Paoletti– Orcid , Manuela Neri2

1 – Full Professor of Gynecology and Obstetrics, University of Cagliari

2- Medical Director at the Gynecological Oncology Division of the Oncology Hospital of Cagliari, Brotzu Hospital (AOB)

Corresponding author: Anna Maria Paoletti

annapaoletti@unica.it


DOI: 10.53146/lriog1202125

Abstract

Estrogen plays a key role in the physiology of the vagina. The multi-layering of the vaginal epithelium is regulated by estrogen, as well as the function of the cervical glands, connective trophism, vascularization and the local immune system itself. All conditions of hypoestrogenism, be they physiological such as menopause, the menopausal transition period, the puerperium and jatrogens as treatments for estrogen dependent diseases, but also the use of hormonal contraceptives containing only progestin or low doses of ethinylestradiol are risk factors for atrophy of vagina and urinary tract, which is also modulated by estrogen. In all conditions of hypoestrogenism, detectable by a correct medical history, the Gynecologist must ask specific questions about the specific symptoms both in the fertile age and after the menopause, focusing on the genitourinary syndrome. A careful examination must make a differential diagnosis with dermatological or autoimmune diseases, and evaluate the intensity of the problem with internationally validated scales. Once the diagnosis has been established and contraindications to the use of estrogen have been excluded, the first-line treatment is the use of vaginal estrogens, such as estriol, estradiol or promestriene and conjugated estrogens. The proposed treatment must be monitored at regular intervals to assess its effectiveness, safety and acceptability.

Keywords: genitourinary syndrom; ospemifene; dyspareunia; vulvar atrophy; vaginal atrophy; dysuria.


Available in LRIOG Nr.2 – 2021

e-ISSN: 1824-0283


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The vagina: therapeutic role of ospemifene

La vagina: ruolo terapeutico dell’ospemifene

Novella Russo – Orcid

Demetra Medical Center: Center for Menopause

novella_russo@virgilio.it


DOI: 10.53146/lriog1202124

Abstract

The Genitourinary Syndrome of Menopause (GSM) is a progressive chronic condition that can be very bothersome for women. This disease, mainly due to the endocrinological changes occurring with menopause, is characterized by symptoms such as vaginal dryness, dyspareunia, itching, burning and dysuria. The marketing of a relatively new drug, Ospemifene, for the treatment of this clinical condition has given a new therapeutic option and prospective for a better quality of life in women affected by VulvoVaginal Atrophia (VVA). Ospemifene is a Selective Estrogen Receptor Modulator (SERM) and can also be prescibed to women with a history of breast cancer. The oral route of administration has shown to give higher adherence to treatment being preferable for many women to the vaginal route with a high satisfaction rate. In this article the main characteristics of the effects of Ospemifene on GSM have been elucidated and some of the most interesting studies have been illustrated. Women’s wording has been reported and particular attention given to their personal and familiar histories. Objective vulvar examination is described and aspects to be analysed in deep are reported. Therapeutic suggestions of a multimodal approach to the disease are made, although on this matter further scientific studies showing solid data are needed.

Keywords: genitourinary syndrom; ospemifene; dyspareunia; vulvar atrophy; vaginal atrophy; dysuria.


Available in LRIOG Nr.2 – 2021

e-ISSN: 1824-0283


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Regenerative vulvo-vaginal laser

Regenerative vulvo-vaginal laser: when, why, when

Filippo Murina – Orcid

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

filippomurina577@gmail.com


DOI: 10.53146/lriog1202114

Abstract

The use of lasers to treat gynaecological conditions including genitourinary syndrome of the menopause (GSM) has become increasingly popular over recent years. The evidence suggests laser therapy may be beneficial as a non-hormonal treatment in GSM. However, we do not know what the optimum treatment regime or interval is or what the role is for sexual hormones either before or in addition to laser treatment. It was demonstrated that a combination regimen of laser and ospemifene may improve clinical effectiveness. Application of the regenerative laser to the vestibule for vulvar pain and dyspareunia is a promising and safe treatment option in postmenopausal women with the use of appropriate parameters. Clinicians need to be aware of the limitations, risks and outcomes of laser therapy as well as the need for careful evaluation of women to ensure appropriate patient selection. Patients also need to be advised and counselled about realistic expectations of outcomes. Indiscriminate treatment of patients with little evaluation and assessment and counselling will lead to poor satisfaction outcomes and morbidity.

Keywords: laser; genitourinary syndrome of the menopause; dyspareunia; vulvar pain.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Vulvar pain and diagnosis of comorbidities

Vulvar pain and diagnosis of comorbidities
Key factors from the Vu-Net study on 1183 cases – part 1

Alessandra Grazziottin1 – Orcid, Dania Gambini 2 – Orcid, Filippo Murina3,4 – Orcid e i ricercatori del gruppo Vu-Net

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

2 – Alessandra 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/lriog120215

Abstract

The Vu-Net (Vulvodynia Network) project is aimed at investigating chronic vul- var pain and its medical and sexual comorbidities, given its remarkable impact on the quality of life of both women and couples. The reported incidence of chronic vulvar pain (lasting 3-6 months) in women is 16%. This cross-sectional study involved 1183 patients with chronic vulvar pain attending 21 Italian medical centers from December 2016 to November 2018. 70.7% of enrolled women were between 20 and 49 years of age. Main diagnoses were spontaneous or provoked vestibulodynia (70.8%) and generalized vulvodynia (27.3%). The main reason for consultation was introital pain on penetration (64.2%), together with associated sexual dysfunctions, such as vaginal dryness (29.8%), hypoactive sexual desire disorder (22.1%) and sexual arousal disorder (21.3%). 48.3% had prolonged pain, lasting 1 to 5 years, with a mean diagnostic delay of 4 years and 7 months. The main comorbidities that emerged from the study include high association with intestinal disorders (94.7%), in particular IBS (27.3%), constipation (23.5%), and food allergies (10.1%); bladder infections (37.4%) including recurrent cystitis (19.5%) and post-coital cystitis (17.9%); recurrent vulvovaginal candidiasis (32%); headache (25.7%); mental disorders (22.6%); allergies (17.5%); endometriosis (11.7%). 77.4% of the Vu-Net patients had previously been treated without improving their condition. The analysis of the comorbidities allows the gynecologist to recognize the clusters of patients that will obtain the best results when treated with a multimodal intervention.

Keywords: chronic vulvar pain; dyspareunia; vulvovaginal candidiasis; comorbidities.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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