Depression and Posttraumatic Stress Disorder Among Women with Vulvodynia: Evidence from the Population-Based Woman to Woman Health Study

Background: Psychological disorders may affect the pain experience of women with vulvodynia, but evidence remains limited. The present study aimed to describe the magnitude of the association of depression and posttraumautic stress disorder (PTSD) with the presence of vulvodynia in a nonclinical population from southeastern Michigan. Methods: Baseline data from 1,795 women participating in the Woman to Woman Health Study, a multiethnic population-based study, was used for this analysis. Validated screening questionnaires were conducted to assess vulvodynia, depression, and PTSD. Modified Poisson regression models with a robust variance estimation were used to estimate prevalence ratios (PR) and their 95% confidence intervals (CI) for the association between vulvodynia status and two mental health conditions, depression and PTSD. Results: In the adjusted models, women who screened positive for depression had a 53% higher prevalence of having vulvodynia (PR=1.53; 95% CI: 1.12, 2.10) compared with women who screened negative for depression. Women who screened positive for PTSD had more than a two-fold increase in the prevalence of having vulvodynia (PR=2.37; 95% CI: 1.07, 5.25) compared with women who screened negative for PTSD. Conclusions: The increased prevalence of vulvodynia among those screening positive for depression or PTSD suggests that these disorders may contribute to the likelihood of reporting vulvodynia. Alternatively, vulvodynia, depression, and PTSD may have a common pathophysiological and risk profile. Prospective studies are needed to improve our understanding of the temporal relation between mental health conditions and vulvar pain.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140131/1/jwh.2014.5001.pd

Genetic Differences May Reflect Differences in Susceptibility to Vulvodynia in General or in Spontaneous Remission Propensity

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110555/1/jsm12775.pd

Chronic vulvar pain in a cohort of post-menopausal women: Atrophy or Vulvodynia?

Abstract Background 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. Methods 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. Results 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. Conclusion 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.http://deepblue.lib.umich.edu/bitstream/2027.42/134593/1/40695_2016_Article_17.pd

Remission, Relapse, and Persistence of Vulvodynia: A Longitudinal Population-Based Study

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 ever (p?Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140139/1/jwh.2015.5397.pd

Multimodal Vulvar and Peripheral Sensitivity Among Women With Vulvodynia: A Case–Control Study

OBJECTIVE: To assess differences in vulvar and peripheral sensitivity between women with and without vulvodynia. METHODS: Women with vulvodynia (n = 41) and age-matched controls (n = 43) seen in the outpatient setting were evaluated via surveys, clinical examination, and multimodal sensory testing (pressure, heat, cold, vibration, and electrical stimulation). The relationships between sensitivity to various sensory modalities and case/control status, as well as by vulvodynia subgroups, were assessed using logistic regression. RESULTS: Women with vulvodynia were more sensitive to pressure and to electrical stimuli than were control women at the vulva (median, 22 vs 230 g and 0.495 vs 0.769 mA, respectively; P 0.025). Those reporting spontaneous pain versus provoked pain had greater pressure sensitivity to the thumb (median, 1850 vs 2690 g; P = 0.020) and greater electrical sensitivity at the introitus (0.450 vs 0.608 mA; P = 0.011), and those with primary versus secondary vulvodynia had substantially greater pressure sensitivity to the thumb (median, 2438 vs 3125 g, P = 0.004). However, having localized versus generalized vulvodynia was not associated with differences in pressure or electrical sensitivity. CONCLUSIONS: Sensitivities to pressure and electrical stimuli are greater among vulvodynia cases than among controls and support 2 previously defined subgroups-those reporting spontaneous pain versus those whose pain only occurred when provoked, and those with primary versus secondary vulvodynia

Candida Transmission and Sexual Behaviors as Risks for a Repeat Episode of Candida Vulvovaginitis

Objective: To assess associations between female and male factors and the risk of recurring Candida vulvovaginitis. Methods: A prospective cohort study of 148 women with Candida vulvovaginitis and 78 of their male sexual partners was conducted at two primary care practices in the Ann Arbor, Michigan, area. Results: Thirty-three of 148 women developed at least one further episode of Candida albicans vulvovaginitis within 1 year of follow-up. Cultures of Candida species from various sites of the woman (tongue, feces, vulva, and vagina) and from her partner (tongue, feces, urine, and semen) did not predict recurrences. Female factors associated with recurrence included recent masturbating with saliva (hazard ratio 2.66 [95% CI 1.17-6.06]) or cunnilingus (hazard ratio 2.94 [95% CI 1.12-7.68]) and ingestion of two or more servings of bread per day (p ≤ 0.05). Male factors associated with recurrences in the woman included history of the male masturbating with saliva in the previous month (hazard ratio 3.68 [95% CI 1.24-10.87]) and lower age at first intercourse (hazard ratio 0.83 [95% CI 0.71-0.96]). Conclusions: Sexual behaviors, rather than the presence of Candida species at various body locations of the male partner, are associated with recurrences of C. albicans vulvovaginitis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63382/1/154099903322643901.pd

Effects of oxygen-related damage on dwell-fatigue crack propagation in a P/M Ni-based superalloy : from 2D to 3D assessment

Effects of oxygen-related damage (i.e. oxidation and dynamic embrittlement) on fatigue crack propagation behavior in an advanced disc alloy have been assessed in air and vacuum under dwell-fatigue conditions at 725 oC. The enhanced fatigue crack propagation is closely related to oxygen-related damage at/ahead of the crack tip, which is determined by the testing environment, the dwell period and the crack propagation rate itself based on two dimensional (2D) observation of the crack tip in an optical microscope and scanning electron microscope. X-ray computed tomography has also been employed to examine the differences between three dimension (3D) crack morphology in air and vacuum conditions, and the crack features have been quantified in terms of crack opening displacements, secondary cracks and uncracked bridging ligaments. The results show that the fatigue crack propagation rate is related to the amount of secondary cracks, and the crack length increment in a loading cycle is related to the breaking/cracking of the uncracked bridging ligaments within the discontinuous cracking zone ahead of the crack tip as oxygen-related damage preferentially occurs in these highly deformed regions. By combination of 3D X-ray computed tomography and traditional 2D observation, a deeper understanding is provided of the mechanisms of oxygen-enhanced fatigue crack propagation behavior

Urogenital Symptoms and Pain History as Precursors of Vulvodynia: A Longitudinal Study

Abstract Background: We sought to assess vulvodynia incidence and risk factors among those with and without premorbid urogenital symptoms. Methods: Women's Health Registry members who completed a baseline assessment in 2004 were sent a 2-year and 4-year follow-up survey containing a validated screen for vulvodynia. Subgroup analysis of vulvodynia incidence rates was performed, and risk factors associated with incidence were assessed. Results: Of 1037 original enrollees, 723 (69.7%) completed consecutive surveys (initial and 2-year or initial, 2-year, and 4-year), 660 of whom did not have current or past vulvodynia at baseline. Of these 660, 71 (10.8%) first met criteria for vulvodynia within the 4-year period, for an annual incidence rate of 3.1% (95% confidence interval [CI] 2.5-4.0). Baseline strict controls were less likely to develop criteria for vulvodynia diagnosis (annual incidence rate of 1.4%) compared to those with an intermediate phenotype (presence of dyspareunia or history of short-term vulvar pain), for whom the incidence rate was 5.6% (p<0.001). Risk factors for incident vulvodynia differed between these two groups. Among the strict controls, an increased risk was noted among younger women (incidence rate ratio) [IRR] 3.6). For those with an intermediate phenotype, risk was increased among nonwhite women and those reporting pain with or after intercourse (IRR 2.2, 3.4, and 3.1, respectively). In both control groups, incident vulvodynia risk increased among those reporting urinary burning at enrollment (IRR 4.2 and 2.8 for strict and intermediate phenotype controls, respectively). Conclusions: The annual incidence of vulvodynia is substantial (3.1%) and is greater among women reporting a history of dyspareunia or vulvar pain that did not meet criteria for vulvodynia compared to those without this history, suggesting that generalized urogenital sensitivity may be a common underlying mechanism predating the clinical presentation of vulvodynia.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98465/1/jwh%2E2012%2E3566.pd

Role of oxygen in enhanced fatigue cracking in a PM Ni-based superalloy : stress assisted grain boundary oxidation or dynamic embrittlment?

The role of oxygen in enhanced fatigue cracking in an advanced Ni-based superalloy for turbine disc application has been evaluated in fatigue crack initiation and propagation stages along with static oxidation tests. It is found that the grain boundary oxide intrusion has a layered structure. The microstructure- and deformation-dependent grain boundary oxidation dominates the fatigue crack initiation and early propagation processes. As the crack propagates, this contribution arising from oxidation damage may gradually be overtaken by dynamic embrittlement processes until the mechanical damage outstrips the oxygen-related damage, resulting in a transition from intergranular to transgranular crack propagation