Clinical eye – Sexual pain – penetration disorder: clinical history is key to optimize the diagnosis
Alessandra Graziottin 1,2 – , Elena Boero 1 –
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
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
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Chronic vulvar pain, recurrent candidiasis and familial diabetic risk
Critical factors emerged from the VuNet on 1183 women – Part II
Alessandra Graziottin1,2 – , Dania Gambini2, Elena Boero2– , Filippo Murina3,4 – , 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
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
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