Dolore vulvo-vaginale, candidosi recidivante e rischio familiare per il diabete

Dolore vulvo-vaginale, candidosi recidivante e rischio familiare per il diabete
I fattori critici emersi dallo studio VuNet su 1183 casi – Parte II

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

1 – Centro di Ginecologia e Sessuologia medica, H. San Raffaele Resnati Milano

2 – Fondazione Alessandra Graziottin per la cura del dolore nella donna Onlus

3 – Servizio di Patologia del Tratto Genitale Inferiore, Ospedale V. Buzzi – Università degli Studi di Milano

4 – Associazione Italiana Vulvodinia Onlus

Autore di riferimento: 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.


Presente in LRIOG Nr.2 – 2021

e-ISSN: 1824-0283


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Gonorrhea, a threatening infection in gynecology and obstetrics

Gonorrhea, a threatening infection in gynecology and obstetrics

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

1 – Fondazione Graziottin per la cura del dolore nella donna, Onlus

2 – Centro di Ginecologia e Sessuologia medica, H. San Raffaele Resnati Milano

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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La vagina: quesiti clinici e bisogni terapeutici disattesi

La vagina: quesiti clinici e bisogni terapeutici disattesi

Alessandra Grazziottin1,2 – Orcid

1 – Fondazione Alessandra Graziottin per la cura del dolore nella donna Onlusa

2 – Direttrice del Centro di Ginecologia e Sessuologia Medica, H. San Raffaele Resnati, Milano

direzione@studiograziottin.it


DOI: 10.53146/lriog1202116

Abstract

This monograph was meant to share with colleagues a cultural, scientific and clinical perspective that is stimulating and of immediate impact for daily gynecological practice. In detail, we will analyze the sensitivity to many hormones and the close correlations between endocrine and sexual health; the factors that influence the variability of the vaginal ecosystem and in particular of the microbiota; the essential role of the pathogen biofilm that covers the mucosa and colonizes the vaginal environment and their correlation with vulnerability to sexually transmitted diseases. We then move on to the analysis of the vulnerability to birth trauma and iatrogenic damage; the evaluation of the correlation between vaginal health and pelvic floor tone up to the correlation of specific factors with vulnerability to sexual abuse.

Keywords: vagina; microbiota; hormonal sensitivity; sexual health.


Presente in LRIOG Nr.2 – 2021

e-ISSN: 1824-0283


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Vulviti da Staphylococcus aureus

Vulviti da Staphylococcus aureus: un’infezione insidiosa che sottolinea l’importanza di una appropriata igiene intima

Alessandra Grazziottin1,2 – Orcid, Elena Boero1 – Orcid

1 – Fondazione Graziottin per la cura del dolore nella donna, Onlus

2 – Centro di Ginecologia e Sessuologia medica, H. San Raffaele Resnati Milano

Autore di riferimento: 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.


Presente in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Sifilide: perché è una malattia più insidiosa nelle donne

Sifilide: perché è una malattia più insidiosa nelle donne

Alessandra Grazziottin1,2 – Orcid, Elena Boero1 – Orcid

1 – Fondazione Graziottin per la cura del dolore nella donna, Onlus

2 – Centro di Ginecologia e Sessuologia medica, H. San Raffaele Resnati Milano

Autore di riferimento: 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.


Presente in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Androgeni e sindrome genitourinaria della menopausa

Androgeni e sindrome genitourinaria della menopausa. Perché, quando e per chi sono indicati

Alessandra Graziottin – Orcid

Direttrice del Centro di Ginecologia e Sessuologia Medica, H. San Raffaele Resnati, Milano

Fondazione Alessandra Graziottin per la cura del dolore nella donna – Onlus

direzione@studiograziottin.it


DOI: 10.53146/lriog120212

Abstract

Why androgens – testosterone and dehydroepiandrosterone (DHEA) – can play a role in the treatment of the Genitourinary Syndrome of the Menopause? What evidence supports this? Androgens are essential sex hormones for women’s health. Biological evidence (“bio-evidence”) indicates the following: androgens reach high plasma levels in childbearing age; have cell receptors in major organs; the hormone-receptor interaction mediates androgen-mediated, somatic (brain, muscle, bone), sexual and reproductive functions; their deficiency causes symptoms of androgenic insufficiency. They have a trophic, sexual, anti-inflammatory, and reconstructive functions. DHEA launches puberty (adrenarche). Androgens reach their plasma peak at twenty years of age, then they undergo an age-dependent gradual fall. At the age of fifty, women have lost about 50% of testosterone and 60-70% of DHEA. Bilateral ovariectomy reduces testosterone by 80%. Their age-
dependent reduction, worsened by estrogen deficiency, contributes to systemic and genital aging and to the “low grade inflammation” typical of post-menopause. Genitourinary Syndrome of the Menopause includes vulvo-vaginal symptoms.

Keywords: androgens; prasterone; testosterone; genitourinary syndrome of the menopause (GSM).


Presente in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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