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Bernard L Harlow - One of the best experts on this subject based on the ideXlab platform.
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characterizing differences in thymic function in women with and without Vulvodynia a community based study
Journal of Lower Genital Tract Disease, 2021Co-Authors: Sydney K Willis, Allison E Aiello, Devavani Chatterjea, Julie A E Nelson, Patricia L Hibberd, Bernard L HarlowAbstract:OBJECTIVE The aim of the study was to evaluate the association between Vulvodynia and thymic function. MATERIALS AND METHODS In this case-control study of 200 clinically confirmed cases of Vulvodynia and 205 general population controls residing in the Minneapolis/Saint Paul metropolitan area, we used DNA extracted from whole blood to measure levels of signal joint T-cell receptor excision circles (sjTRECs), a measure of thymic output. We used logistic regression to evaluate the association between Vulvodynia and thymic function. RESULTS In 405 participants (aged 18-40 years), we observed an association between decreasing thymic function and increasing age. Women with Vulvodynia had a steeper decline in sjTREC values across age categories compared with women without Vulvodynia. In addition, at younger ages, women with Vulvodynia had higher sjTREC values compared with women without Vulvodynia. In older women, those with Vulvodynia had lower sjTREC than those without Vulvodynia. When accounting for recency of vulvar pain onset, women with a shorter time since pain onset had higher thymic function compared with women with a longer time since vulvar pain onset. CONCLUSIONS These findings suggest that at younger ages, women with Vulvodynia have higher thymic output and a more precipitous decline of thymic function than those without Vulvodynia. It also seems that a strong immune inflammatory response is present proximate to the onset of vulvar pain and may wane subsequently over time.
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characteristics of the vaginal microbiome in women with and without clinically confirmed Vulvodynia
American Journal of Obstetrics and Gynecology, 2020Co-Authors: Lisa Bedford, Samantha E Parker, Elyse Davis, Elizabeth Salzman, Sharon L Hillier, Betsy Foxman, Bernard L HarlowAbstract:Abstract Background Vulvodynia (idiopathic vulvar pain) affects up to 8% of women by age 40, has a poorly understood etiology, and variable treatment efficacy. Several risk factors are associated with Vulvodynia from history of yeast infections to depression and allergies. Recent work suggests an altered immune inflammatory mechanism plays a role in Vulvodynia pathophysiology. As the vaginal microbiome plays an important role in local immune-inflammatory responses, we evaluated the vaginal microbiome among women with Vulvodynia compared to controls as one component of the immune system. Objective Characterize the vaginal microbiome in women with clinically-confirmed Vulvodynia and age-matched controls and assess its overall association with Vulvodynia, and how it may serve to modify other factors that are associated with Vulvodynia as well. Study Design: We conducted a case-control study of 234 Minneapolis/Saint Paul area women with clinically-confirmed Vulvodynia and 234 age-matched controls clinically confirmed with no history of vulvar pain. All participants provided vulvovaginal swab samples for culture-based and non-culture (sequencing) based microbiological assessments; background and medical history questionnaires on demographic characteristics, sexual and reproductive history, and history of psychosocial factors. Vaginal microbiome diversity was assessed using the Shannon Alpha Diversity Index. Data were analyzed using logistic regression. Results Culture and molecular-based analyses of the vaginal microbiome showed few differences between cases and controls. However, among women with alpha diversity below the median (low), there was a strong association between increasing numbers of yeast infections and Vulvodynia onset, relative to comparable time periods among controls (age-adjusted odds ratio [OR] 8.1, 95% CI: 2.9-22.7 in those with 5 or more yeast infections). Also among women with low diversity microbiomes, we observed a strong association between moderate-to-severe childhood abuse, antecedent anxiety, depression, and high levels of rumination and Vulvodynia with ORs from 1.83 to 2.81. These associations were not observed in women with high diversity microbiomes. Conclusions Although there were no overall differences in microbiome profiles between cases and controls, vaginal microbiome diversity influenced associations between environmental and psychosocial risk factors and Vulvodynia. However, it is unclear whether vaginal diversity modifies the association between the risk factors and Vulvodynia or is altered as a consequence of the associations.
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early life chronic stressors rumination and the onset of Vulvodynia
The Journal of Sexual Medicine, 2019Co-Authors: Maheruh Khandker, Bernard L Harlow, Sonya S Brady, Sarah A Rydell, Rachel M Turner, Pamela J SchreinerAbstract:Abstract Introduction Vulvodynia is a debilitating, chronic vulvar pain condition. Community-based case-control studies have consistently shown associations between early-life chronic stressors and Vulvodynia onset. Aim We examined rumination as a specific stress response involved in the psychobiological mechanism of Vulvodynia. Methods A psychosocial survey with questions specific to early-life traumatic events and rumination were administered to 185 matched case-control pairs of women with and without Vulvodynia. Conditional logistic regression was used to examine associations between rumination constructs (ie, total rumination, emotion-focused, instrumental, and searching for meaning) and Vulvodynia onset. Conditional logistic regression was also used to determine whether these associations depended on early-life stressors (ie, severity of childhood abuse and of self-reported antecedent traumatic events). Age at interview, antecedent pain disorders, any childhood abuse, and antecedent psychiatric morbidity were included as covariates. Main Outcome Measures We estimated the odds of rumination in relation to the onset of Vulvodynia within a community-based and clinically confirmed sample of women with and without Vulvodynia. Results Vulvodynia was associated with the highest tertile of emotion-focused (odds ratio [OR] = 2.1; 95% CI = 1.2, 3.2) and instrumental (OR = 2.1; 95% CI = 1.1, 4.0) rumination. These associations were attenuated after additional adjustment for antecedent psychiatric morbidity. Among women who reported rumination about early-life stressors before vulvar pain in cases or matched reference age in control subjects, those with Vulvodynia were >2 times more likely to report the highest tertile of total rumination (OR = 2.3; 95% CI = 1.1, 5.0) compared with those without Vulvodynia. Clinical Implications Healthcare providers may be able to identify subsets of women who could benefit from preventive measures before the development of Vulvodynia. Strength & Limitations This is the first study to use a community-based and clinically confirmed sample of women with and without Vulvodynia to examine the associations between rumination about early-life trauma and the onset of Vulvodynia. However, as with all retrospective studies, the reporting of information (eg, traumatic events) was subject to recall bias and misclassification. Conclusion Our findings indicate that a prolonged cognitive stress response (ie, rumination) may be 1 important mechanism by which early-life chronic stressors contribute to the onset Vulvodynia. Prospective studies are recommended to examine whether and how cognitive, affective, and physiological components of prolonged stress responses interact to influence the development of Vulvodynia. Understanding both the psychobiological and behavioral mechanisms may help in addressing and treating individuals to potentially reverse the development of Vulvodynia. Khandker M, Brady SS, Rydell SA, et al. Early-life Chronic Stressors, Rumination, and the Onset of Vulvodynia. J Sex Med 2019;16:880–890.
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recurrent yeast infections and Vulvodynia can we believe associations based on self reported data
Journal of Womens Health, 2017Co-Authors: Devavani Chatterjea, Bernard L Harlow, Samantha E Parker, Rachel E Caron, Matthew P Fox, Ruby H N NguyenAbstract:Abstract Objective: We determined whether self-reported new or recurrent yeast infections were a risk factor for and/or consequence of Vulvodynia and then determined the extent to which various levels of misclassification of self-reported yeast infections influenced these results. Materials and Methods: In this case–control study we retrospectively assessed self-reported new and recurrent yeast infections prior and subsequent to first vulvar pain onset among 216 clinically confirmed cases and during a similar time period for 224 general population controls. Results: A history of >10 yeast infections before Vulvodynia onset was strongly but imprecisely associated with currently diagnosed Vulvodynia after adjustment for age, age at first intercourse, and history of urinary tract infections [adjusted odds ratio = 5.5, 95% confidence interval (CI) 1.7–17.8]. Likewise, a history of Vulvodynia was associated with a twofold risk of subsequent new or recurrent onset of yeast infections after adjustment for age, a...
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remission of vulvar pain among women with primary Vulvodynia
Journal of Lower Genital Tract Disease, 2015Co-Authors: Ruby H N Nguyen, Charu Mathur, Erin M Wynings, David A Williams, Bernard L HarlowAbstract:OBJECTIVE To determine whether rates of remission differed among women with primary versus secondary Vulvodynia. METHODS Using a community-based observational study based in Minneapolis/St. Paul, 138 clinically confirmed cases of Vulvodynia between 18 and 40 years old were classified as primary (vulvar pain starting at the time of sexual debut or first tampon insertion) or secondary (vulvar pain starting after a period of pain-free intercourse) and queried regarding their pain history to determine whether they had ever experienced any vulvar pain-free time (remission) or pain-free time lasting 3 months or longer. RESULTS Remission prevalence was 26% (9/34) for women in the shortest quartile of duration of vulvar pain (<3.8 y) and 38% (13/34) for the longest quartile of duration (≥13 y). After adjusting for vulvar pain duration, generalized vestibular pain, medical treatment, body mass index, and history of pregnancy, women who had primary Vulvodynia were 43% less likely to report remission (95% CI = 0.33-0.99) than women with later onset (secondary cases). The association was strengthened when restricting to only remissions lasting 3 months or longer (adjusted risk ratio = 0.43, 95% CI = 0.22-0.84). Generalized vestibulodynia and obesity also reduced the likelihood of remission. CONCLUSIONS Our study underscores the heterogeneity of Vulvodynia and provides evidence that primary Vulvodynia may have a less wavering course and, as such, a potentially different underlying mechanism than that of secondary Vulvodynia.
Barbara D. Reed - One of the best experts on this subject based on the ideXlab platform.
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environmental exposure history and Vulvodynia risk a population based study
Journal of Womens Health, 2019Co-Authors: Barbara D. Reed, Hope K. Haefner, Melissa A Plegue, Kimberly S Mckee, Sung Kyun Park, Siobán D. HarlowAbstract:Abstract Background: Risk factors for Vulvodynia continue to be elusive. We evaluated the association between past environmental exposures and the presence of Vulvodynia. Materials and Methods: The...
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does degree of vulvar sensitivity predict Vulvodynia characteristics and prognosis
The Journal of Pain, 2017Co-Authors: Barbara D. Reed, Siobán D. Harlow, Hope K. Haefner, Melissa A Plegue, Ananda SenAbstract:Abstract Although women with Vulvodynia typically have increased vulvar sensitivity, data on characteristics associated with the degree of vulvar sensitivity are lacking. We measured vulvar sensitivity using cotton swab test and vulvodolorimeter among a subset of 335 women, aged younger than 70 years, in the longitudinal Woman to Woman Health Study. Comparing the Vulvodynia screening results from their online/paper survey to that at the time of the examination, 42 women had ongoing Vulvodynia, 66 had a recent remission, 22 control participants had a recent onset of Vulvodynia, and 205 control participants remained asymptomatic. Vulvar sensitivity was greater in each Vulvodynia group compared with the control group ( P P = .025), pain after intercourse ( P = .008), describing the pain as a “pressure,” “burning,” or “irritating” ( P = .015, P = .005, and P = .006, respectively), with increased severity of pain ever ( P = .012), and with subsequent persistent or relapsing Vulvodynia ( P 1 for the cotton swab summary score best differentiated case from control participants (sensitivity 71.9%; specificity 72.0%). Although 13.8% of women with Vulvodynia had no increased sensitivity on cotton swab testing, they did not differ in most clinical characteristics or clinical course from those with increased vulvar sensitivity. Perspective This study showed that women with Vulvodynia have more vulvar sensitivity than control women, but the spectrum of sensitivity is broad. Furthermore, those with and without vulvar sensitivity did not differ in most vulvar pain characteristics or in prognosis, suggesting a positive swab test is not required to substantiate the diagnosis.
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chronic vulvar pain in a cohort of post menopausal women atrophy or Vulvodynia
Women's Midlife Health, 2016Co-Authors: Susanna D Mitro, Siobán D. Harlow, John F Randolph, Barbara D. ReedAbstract:Although postmenopausal vulvar pain is frequently attributed to vaginal atrophy, such symptoms may be due to Vulvodynia, a chronic vulvar pain condition. Given the limited research on Vulvodynia in postmenopausal women, the objective of this study was to provide preliminary population-based data on the associations of vaginal symptoms, serum hormone levels and hormone use with chronic vulvar pain in a multiethnic sample of post-menopausal women. We used data from 371 participants at the Michigan site of the Study of Women’s Health Across the Nation (SWAN) who participated in the 13th follow-up visit. Women completed a validated screening instrument for Vulvodynia and provided information on additional vaginal symptoms as well as demographic characteristics, and hormone use by questionnaire. Blood samples were obtained to assess hormone levels. We compared women who screened positive for Vulvodynia and women with past or short-duration vulvar pain to women without vulvar pain, using Chi-squared and Fisher’s Exact tests. Relative odds ratios and 95 % confidence intervals were calculated using multinomial logistic regression models adjusting for age, body mass index, and race/ethnicity. Current chronic vulvar pain consistent with Vulvodynia was reported by 4.0 % of women, while 13.7 % reported past but not current chronic vulvar pain or short-duration vulvar pain symptoms. One quarter of women who reported current chronic vulvar pain did not report vaginal dryness. Women with current chronic and with past/short duration vulvar pain symptoms were more likely to have used hormones during the preceding year than women without vulvar pain symptoms (13.3 %, 17.6 %, 2.0 %, respectively; p < .01). Increased relative odds of current vulvar pain symptoms were associated with each log unit decrease in serum dehydroepiandrosterone-sulfate, estradiol and testosterone levels at the previous year’s visit. Some women who experience chronic vulvar pain symptoms do not report vaginal dryness, and others report continued or first onset of pain while using hormones. Vulvodynia should be considered in the differential diagnosis of postmenopausal women presenting with vulvar pain symptoms.
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remission relapse and persistence of Vulvodynia a longitudinal population based study
Journal of Womens Health, 2016Co-Authors: Barbara D. Reed, Siobán D. Harlow, Melissa A Plegue, Ananda SenAbstract:Abstract Background: Vulvodynia has been considered to be a chronic disorder. We sought to estimate the probability of and risk factors for remission, relapse, and persistence among women screening positive for Vulvodynia. Methods: Survey-based assessment in a longitudinal population-based study of women (the Woman to Woman Health Study) who screened positive for Vulvodynia and completed at least four follow-up surveys. Outcome measures included remission without relapse, relapse (after remission), and persistence of a positive Vulvodynia screen. Multinomial regression was used to assess factors associated with outcomes. Results: Of 441 women screening positive for Vulvodynia during the study, 239 completed 4 additional surveys. Of these, 23 (9.6%) had consistently positive Vulvodynia screens, 121 (50.6%) remitted without relapse, and 95 (39.7%) relapsed following remission. Overall, factors associated with both relapse and persistence (compared with remission alone) included increased severity of pain ev...
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presence of spontaneous pain and comorbid pain conditions identifies Vulvodynia subgroups
Journal of Lower Genital Tract Disease, 2016Co-Authors: Barbara D. Reed, Melissa A Plegue, David A Williams, Ananda SenAbstract:OBJECTIVE The aims of the study were to define the heterogeneity of Vulvodynia by determining data-driven subgroups within the Vulvodynia diagnosis using exploratory cluster analysis and to characterize the subgroups identified. MATERIALS AND METHODS Included were participants in the longitudinal population-based study of Vulvodynia in southeast Michigan who screened positive for Vulvodynia at least once during the study. A cluster analysis using variables reflecting vulvar pain characteristics and comorbid pain conditions was conducted. Variables reflecting best separation of clusters were used to assign participants to subgroup categories. Demographic, psychiatric, general health, and other vulvar pain characteristics were summarized for each subgroup, followed by multinomial regression and pairwise comparisons of subgroups on these factors. RESULTS Of 441 women screening positive for Vulvodynia during the course of the study, 393 were eligible on the basis of data requirements. Cluster analysis suggested that best subgroup separation was based on the following 2 variables: (1) presence or absence of spontaneous vulvar pain and (2) presence or absence of other comorbid pain conditions. Subgroups did not differ by age or ethnicity. The subgroup having spontaneous pain and other comorbid conditions demonstrated greatest morbidity in general health measures, psychiatric disorders, and other vulvar pain measures. Primary versus secondary Vulvodynia did not vary between subgroups and did not assist in subgroup separation in the cluster analysis. DISCUSSION Subgroups based on exploratory cluster analysis demonstrated that presence of spontaneous pain and the presence of comorbid pain conditions resulted in best separation of groups. Presence of both spontaneous pain and other comorbid pain conditions identified the group with greatest morbidity.
Hope K. Haefner - One of the best experts on this subject based on the ideXlab platform.
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environmental exposure history and Vulvodynia risk a population based study
Journal of Womens Health, 2019Co-Authors: Barbara D. Reed, Hope K. Haefner, Melissa A Plegue, Kimberly S Mckee, Sung Kyun Park, Siobán D. HarlowAbstract:Abstract Background: Risk factors for Vulvodynia continue to be elusive. We evaluated the association between past environmental exposures and the presence of Vulvodynia. Materials and Methods: The...
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diagnosis and management of Vulvodynia in postmenopausal women
Maturitas, 2018Co-Authors: Pedro Vieirabaptista, Hope K. Haefner, Libby Edwards, Gilbert G G Donders, Lynnette Margesson, Faustino R PerezlopezAbstract:Vulvodynia, defined as vulvar pain or burning sensation for more than 3 months, without an identifiable cause, can occur at any age. In this paper, the authors address the classification, epidemiology, etiology, diagnosis, and treatment of this condition, focusing on postmenopausal women. In postmenopausal women, vulvar pain and dyspareunia can often be attributed to low levels of estrogen resulting in vulvovaginal atrophy. While correction of vulvovaginal atrophy is an important part of the management of these patients, it will usually be insufficient to manage Vulvodynia. The treatment of Vulvodynia includes general care measures, topical, oral, or injectable agents, psychological approaches, pelvic floor rehabilitation and, in some cases, surgery. No particular intervention has been shown to be superior, so a "trial and error" strategy is usually used.
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does degree of vulvar sensitivity predict Vulvodynia characteristics and prognosis
The Journal of Pain, 2017Co-Authors: Barbara D. Reed, Siobán D. Harlow, Hope K. Haefner, Melissa A Plegue, Ananda SenAbstract:Abstract Although women with Vulvodynia typically have increased vulvar sensitivity, data on characteristics associated with the degree of vulvar sensitivity are lacking. We measured vulvar sensitivity using cotton swab test and vulvodolorimeter among a subset of 335 women, aged younger than 70 years, in the longitudinal Woman to Woman Health Study. Comparing the Vulvodynia screening results from their online/paper survey to that at the time of the examination, 42 women had ongoing Vulvodynia, 66 had a recent remission, 22 control participants had a recent onset of Vulvodynia, and 205 control participants remained asymptomatic. Vulvar sensitivity was greater in each Vulvodynia group compared with the control group ( P P = .025), pain after intercourse ( P = .008), describing the pain as a “pressure,” “burning,” or “irritating” ( P = .015, P = .005, and P = .006, respectively), with increased severity of pain ever ( P = .012), and with subsequent persistent or relapsing Vulvodynia ( P 1 for the cotton swab summary score best differentiated case from control participants (sensitivity 71.9%; specificity 72.0%). Although 13.8% of women with Vulvodynia had no increased sensitivity on cotton swab testing, they did not differ in most clinical characteristics or clinical course from those with increased vulvar sensitivity. Perspective This study showed that women with Vulvodynia have more vulvar sensitivity than control women, but the spectrum of sensitivity is broad. Furthermore, those with and without vulvar sensitivity did not differ in most vulvar pain characteristics or in prognosis, suggesting a positive swab test is not required to substantiate the diagnosis.
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factors associated with Vulvodynia incidence
Obstetrics & Gynecology, 2014Co-Authors: Barbara D. Reed, Laurie J. Legocki, Hope K. Haefner, Ananda Sen, Melissa A Plegue, Siobán D. HarlowAbstract:Vulvodynia is a vulvar pain disorder that is typically chronic, and occurs in women of all ages and ethnic groups. The pain varies from mild to excruciating, and may be provokable or spontaneous or both. Vulvodynia is known to be present in over 8% of women, and to affect women across the lifespan and across ethnic and socioeconomic groups. However, information on the onset (incidence) of Vulvodynia is limited, and factors associated with this onset are not well understood. Women with vulvar pain are infrequently evaluated by medical providers, and most affected women remain undiagnosed and untreated. The availability of survey-based screening tests for Vulvodynia (1, 2) has allowed longitudinal epidemiological assessment of women in the community. The objective of this study was to determine the incidence of Vulvodynia in the population-based sample of women in the Woman-to-Woman Health Study, and to assess risk factors that may predict this new onset.
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oral contraceptive use and risk of Vulvodynia a population based longitudinal study
British Journal of Obstetrics and Gynaecology, 2013Co-Authors: Barbara D. Reed, Siobán D. Harlow, Laurie J. Legocki, Hope K. Haefner, Brenda W Gillespie, Margaret E Helmuth, Ananda SenAbstract:Objective To assess whether the risk of Vulvodynia is associated with previous use of oral contraceptives (OCs). Design Longitudinal population-based study. Setting Four counties in south-east Michigan, USA. Population A population-based sample of women, aged 18 years and older, enrolled using random-digit dialling. Methods Enrolled women completed surveys that included information on demographic characteristics, health status, current symptoms, past and present OC use, and a validated screen for Vulvodynia. The temporal relationship between OC use and subsequent symptoms of Vulvodynia was assessed using Cox regression, with OC exposure modelled as a time-varying covariate. Main outcome measure Vulvodynia, as determined by validated screen. Results Women aged <50 years who provided data on OC use, completed all questions required for the Vulvodynia screen, and had first sexual intercourse prior to the onset of Vulvodynia symptoms were eligible (n = 906). Of these, 71.2% (n = 645) had used OCs. The Vulvodynia screen was positive in 8.2% (n = 74) for current Vulvodynia and in 20.8% (n = 188) for past Vulvodynia. Although crude cross-tabulation suggested that women with current or past Vulvodynia were less likely to have been exposed to OCs prior to the onset of pain (60.7%), compared with those without this disorder (69.3%), the Cox regression analysis identified no association between Vulvodynia and previous OC use (HR 1.08, 95% CI 0.81–1.43, P = 0.60). This null finding persisted after controlling for ethnicity, marital status, educational level, duration of use, and age at first OC use. Conclusion For women aged <50 years of age, OC use did not increase the risk of subsequent Vulvodynia.
Maheruh Khandker - One of the best experts on this subject based on the ideXlab platform.
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early life chronic stressors rumination and the onset of Vulvodynia
The Journal of Sexual Medicine, 2019Co-Authors: Maheruh Khandker, Bernard L Harlow, Sonya S Brady, Sarah A Rydell, Rachel M Turner, Pamela J SchreinerAbstract:Abstract Introduction Vulvodynia is a debilitating, chronic vulvar pain condition. Community-based case-control studies have consistently shown associations between early-life chronic stressors and Vulvodynia onset. Aim We examined rumination as a specific stress response involved in the psychobiological mechanism of Vulvodynia. Methods A psychosocial survey with questions specific to early-life traumatic events and rumination were administered to 185 matched case-control pairs of women with and without Vulvodynia. Conditional logistic regression was used to examine associations between rumination constructs (ie, total rumination, emotion-focused, instrumental, and searching for meaning) and Vulvodynia onset. Conditional logistic regression was also used to determine whether these associations depended on early-life stressors (ie, severity of childhood abuse and of self-reported antecedent traumatic events). Age at interview, antecedent pain disorders, any childhood abuse, and antecedent psychiatric morbidity were included as covariates. Main Outcome Measures We estimated the odds of rumination in relation to the onset of Vulvodynia within a community-based and clinically confirmed sample of women with and without Vulvodynia. Results Vulvodynia was associated with the highest tertile of emotion-focused (odds ratio [OR] = 2.1; 95% CI = 1.2, 3.2) and instrumental (OR = 2.1; 95% CI = 1.1, 4.0) rumination. These associations were attenuated after additional adjustment for antecedent psychiatric morbidity. Among women who reported rumination about early-life stressors before vulvar pain in cases or matched reference age in control subjects, those with Vulvodynia were >2 times more likely to report the highest tertile of total rumination (OR = 2.3; 95% CI = 1.1, 5.0) compared with those without Vulvodynia. Clinical Implications Healthcare providers may be able to identify subsets of women who could benefit from preventive measures before the development of Vulvodynia. Strength & Limitations This is the first study to use a community-based and clinically confirmed sample of women with and without Vulvodynia to examine the associations between rumination about early-life trauma and the onset of Vulvodynia. However, as with all retrospective studies, the reporting of information (eg, traumatic events) was subject to recall bias and misclassification. Conclusion Our findings indicate that a prolonged cognitive stress response (ie, rumination) may be 1 important mechanism by which early-life chronic stressors contribute to the onset Vulvodynia. Prospective studies are recommended to examine whether and how cognitive, affective, and physiological components of prolonged stress responses interact to influence the development of Vulvodynia. Understanding both the psychobiological and behavioral mechanisms may help in addressing and treating individuals to potentially reverse the development of Vulvodynia. Khandker M, Brady SS, Rydell SA, et al. Early-life Chronic Stressors, Rumination, and the Onset of Vulvodynia. J Sex Med 2019;16:880–890.
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is chronic stress during childhood associated with adult onset Vulvodynia
Journal of Womens Health, 2014Co-Authors: Maheruh Khandker, Sonya S Brady, Elizabeth G Stewart, Bernard L HarlowAbstract:Abstract Background: Vulvodynia is an unexplained chronic vulvar pain condition. Case-control studies provide opportunities to examine potential mechanisms by which Vulvodynia may develop. Findings inform etiological models that can be tested in subsequent prospective studies. Methods: A survey of interpersonal relationships and the Structured Clinical Interview for DSM-IV Axis I Disorders was administered to 215 case-control pairs of women with and without Vulvodynia. Conditional logistic regression was used to examine associations between affect-based chronic stressors (i.e., living in fear of abuse, perceived abuse, and antecedent mood disorders) with Vulvodynia. These associations were then examined among women with and without a history of childhood abuse. Results: Among women with a history of severe childhood abuse, those with Vulvodynia had three times the odds of living in fear of any abuse compared to women without Vulvodynia (95% confidence interval: 1.0, 11.0), after adjustment for childhood p...
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the influence of depression and anxiety on risk of adult onset Vulvodynia
Journal of Womens Health, 2011Co-Authors: Maheruh Khandker, Sonya S Brady, Allison F Vitonis, Richard F Maclehose, Elizabeth G Stewart, Bernard L HarlowAbstract:Abstract Background: Studies have shown that women with Vulvodynia are more psychologically distressed than women without Vulvodynia. These studies, however, have not effectively established temporal associations between diagnosed psychiatric disorders and Vulvodynia. Methods: The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) was administered to 240 case-control pairs of women with and without Vulvodynia. Interviews established age at first onset of diagnosed mood and anxiety disorder. Age information was used to determine whether the first episode of mood and/or anxiety was antecedent or subsequent to the first onset of Vulvodynia symptoms. Conditional logistic regressions tested whether antecedent depression or anxiety was more likely among women with or without Vulvodynia. Cox proportional hazards modeling was then used to estimate risk of subsequent new or recurrent onset of mood or anxiety disorder. Results: After adjusting for education, race, age at menarche, age at first tampon ...
Ananda Sen - One of the best experts on this subject based on the ideXlab platform.
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does degree of vulvar sensitivity predict Vulvodynia characteristics and prognosis
The Journal of Pain, 2017Co-Authors: Barbara D. Reed, Siobán D. Harlow, Hope K. Haefner, Melissa A Plegue, Ananda SenAbstract:Abstract Although women with Vulvodynia typically have increased vulvar sensitivity, data on characteristics associated with the degree of vulvar sensitivity are lacking. We measured vulvar sensitivity using cotton swab test and vulvodolorimeter among a subset of 335 women, aged younger than 70 years, in the longitudinal Woman to Woman Health Study. Comparing the Vulvodynia screening results from their online/paper survey to that at the time of the examination, 42 women had ongoing Vulvodynia, 66 had a recent remission, 22 control participants had a recent onset of Vulvodynia, and 205 control participants remained asymptomatic. Vulvar sensitivity was greater in each Vulvodynia group compared with the control group ( P P = .025), pain after intercourse ( P = .008), describing the pain as a “pressure,” “burning,” or “irritating” ( P = .015, P = .005, and P = .006, respectively), with increased severity of pain ever ( P = .012), and with subsequent persistent or relapsing Vulvodynia ( P 1 for the cotton swab summary score best differentiated case from control participants (sensitivity 71.9%; specificity 72.0%). Although 13.8% of women with Vulvodynia had no increased sensitivity on cotton swab testing, they did not differ in most clinical characteristics or clinical course from those with increased vulvar sensitivity. Perspective This study showed that women with Vulvodynia have more vulvar sensitivity than control women, but the spectrum of sensitivity is broad. Furthermore, those with and without vulvar sensitivity did not differ in most vulvar pain characteristics or in prognosis, suggesting a positive swab test is not required to substantiate the diagnosis.
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remission relapse and persistence of Vulvodynia a longitudinal population based study
Journal of Womens Health, 2016Co-Authors: Barbara D. Reed, Siobán D. Harlow, Melissa A Plegue, Ananda SenAbstract:Abstract Background: Vulvodynia has been considered to be a chronic disorder. We sought to estimate the probability of and risk factors for remission, relapse, and persistence among women screening positive for Vulvodynia. Methods: Survey-based assessment in a longitudinal population-based study of women (the Woman to Woman Health Study) who screened positive for Vulvodynia and completed at least four follow-up surveys. Outcome measures included remission without relapse, relapse (after remission), and persistence of a positive Vulvodynia screen. Multinomial regression was used to assess factors associated with outcomes. Results: Of 441 women screening positive for Vulvodynia during the study, 239 completed 4 additional surveys. Of these, 23 (9.6%) had consistently positive Vulvodynia screens, 121 (50.6%) remitted without relapse, and 95 (39.7%) relapsed following remission. Overall, factors associated with both relapse and persistence (compared with remission alone) included increased severity of pain ev...
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presence of spontaneous pain and comorbid pain conditions identifies Vulvodynia subgroups
Journal of Lower Genital Tract Disease, 2016Co-Authors: Barbara D. Reed, Melissa A Plegue, David A Williams, Ananda SenAbstract:OBJECTIVE The aims of the study were to define the heterogeneity of Vulvodynia by determining data-driven subgroups within the Vulvodynia diagnosis using exploratory cluster analysis and to characterize the subgroups identified. MATERIALS AND METHODS Included were participants in the longitudinal population-based study of Vulvodynia in southeast Michigan who screened positive for Vulvodynia at least once during the study. A cluster analysis using variables reflecting vulvar pain characteristics and comorbid pain conditions was conducted. Variables reflecting best separation of clusters were used to assign participants to subgroup categories. Demographic, psychiatric, general health, and other vulvar pain characteristics were summarized for each subgroup, followed by multinomial regression and pairwise comparisons of subgroups on these factors. RESULTS Of 441 women screening positive for Vulvodynia during the course of the study, 393 were eligible on the basis of data requirements. Cluster analysis suggested that best subgroup separation was based on the following 2 variables: (1) presence or absence of spontaneous vulvar pain and (2) presence or absence of other comorbid pain conditions. Subgroups did not differ by age or ethnicity. The subgroup having spontaneous pain and other comorbid conditions demonstrated greatest morbidity in general health measures, psychiatric disorders, and other vulvar pain measures. Primary versus secondary Vulvodynia did not vary between subgroups and did not assist in subgroup separation in the cluster analysis. DISCUSSION Subgroups based on exploratory cluster analysis demonstrated that presence of spontaneous pain and the presence of comorbid pain conditions resulted in best separation of groups. Presence of both spontaneous pain and other comorbid pain conditions identified the group with greatest morbidity.
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factors associated with Vulvodynia incidence
Obstetrics & Gynecology, 2014Co-Authors: Barbara D. Reed, Laurie J. Legocki, Hope K. Haefner, Ananda Sen, Melissa A Plegue, Siobán D. HarlowAbstract:Vulvodynia is a vulvar pain disorder that is typically chronic, and occurs in women of all ages and ethnic groups. The pain varies from mild to excruciating, and may be provokable or spontaneous or both. Vulvodynia is known to be present in over 8% of women, and to affect women across the lifespan and across ethnic and socioeconomic groups. However, information on the onset (incidence) of Vulvodynia is limited, and factors associated with this onset are not well understood. Women with vulvar pain are infrequently evaluated by medical providers, and most affected women remain undiagnosed and untreated. The availability of survey-based screening tests for Vulvodynia (1, 2) has allowed longitudinal epidemiological assessment of women in the community. The objective of this study was to determine the incidence of Vulvodynia in the population-based sample of women in the Woman-to-Woman Health Study, and to assess risk factors that may predict this new onset.
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oral contraceptive use and risk of Vulvodynia a population based longitudinal study
British Journal of Obstetrics and Gynaecology, 2013Co-Authors: Barbara D. Reed, Siobán D. Harlow, Laurie J. Legocki, Hope K. Haefner, Brenda W Gillespie, Margaret E Helmuth, Ananda SenAbstract:Objective To assess whether the risk of Vulvodynia is associated with previous use of oral contraceptives (OCs). Design Longitudinal population-based study. Setting Four counties in south-east Michigan, USA. Population A population-based sample of women, aged 18 years and older, enrolled using random-digit dialling. Methods Enrolled women completed surveys that included information on demographic characteristics, health status, current symptoms, past and present OC use, and a validated screen for Vulvodynia. The temporal relationship between OC use and subsequent symptoms of Vulvodynia was assessed using Cox regression, with OC exposure modelled as a time-varying covariate. Main outcome measure Vulvodynia, as determined by validated screen. Results Women aged <50 years who provided data on OC use, completed all questions required for the Vulvodynia screen, and had first sexual intercourse prior to the onset of Vulvodynia symptoms were eligible (n = 906). Of these, 71.2% (n = 645) had used OCs. The Vulvodynia screen was positive in 8.2% (n = 74) for current Vulvodynia and in 20.8% (n = 188) for past Vulvodynia. Although crude cross-tabulation suggested that women with current or past Vulvodynia were less likely to have been exposed to OCs prior to the onset of pain (60.7%), compared with those without this disorder (69.3%), the Cox regression analysis identified no association between Vulvodynia and previous OC use (HR 1.08, 95% CI 0.81–1.43, P = 0.60). This null finding persisted after controlling for ethnicity, marital status, educational level, duration of use, and age at first OC use. Conclusion For women aged <50 years of age, OC use did not increase the risk of subsequent Vulvodynia.
