Overnight 5% Lidocaine Therapy for Treatment of Vulvar Vestibulitis

Vulvar vestibulitis is clinically similar to PHN in that it appears to have variable degrees of severity. Similar to PHN, majority of women with VVS have touch-invoked allodynia. As such, one might see a similar reduction in pain of VVS using established treatments for PHN with touch invoked allodynia. The objective of this study was to assess the response of women with VVS to treatment with prolong local anesthetics, 5% lidocaine ointment.Master of Public Healt

Erythema and Burning Pain in the Vulva: A Possible Phenotype of Erythromelalgia

We report a case of burning vulvar pain accompanied by erythema responding to an oral combination of a benzodiazepine and a beta blocker. The positive response to two medication classes used in the treatment of erythromelalgia supports the possibility of a localized manifestation of this disorder in the genital region

Incidence and Risk Factors for Pelvic Pain After Mesh Implant Surgery for the Treatment of Pelvic Floor Disorders

Our aim was to assess incidence and risk factors for pelvic pain after pelvic mesh implantation

Performance Characteristics of Novel Instruments for Mucosal and Pelvic Muscle Pain Sensitivity Assessment

Background: Despite considerable advances in our understanding of mechanisms operative in persistent pain states, little is known about the pathophysiology of chronic pain in gynecology. Advances in the field have been critically impaired by lack of methodology and conceptual models to investigate the joint and independent contribution of pelvic muscle and mucosa to persistent pain. Using provoked vestibulodynia (PVD) as our model, we set to develop novel instruments for assessing mucosal and muscle pain sensitivity. PVD is a clinical diagnosis rendered after excluding other conditions and is diagnosed when genital palpation of vulvar mucosa with a cotton swab is painful. PVD is a heterogeneous diagnosis. Other conditions associated with PVD, such as myofasical dysfunction (i.e., difficulty with muscle relaxation and pain), psychological distress (i.e., anxiety and somatization), and nongenital somatic pain in response to thermal and mechanical stimuli, are thought to be secondary to a persistent pain state. PVD is clinically subdivided into two subgroups (primary and secondary) based on onset of pain. Primary VVS is defined when the onset of pain was with the first act of intercourse or tampon use. Secondary VVS is characterized by a pain free interval prior to the onset of pain. We hypothesized that the experience of pain in the primary subgroup of women with PVD may be driven by pelvic muscle (akin to orofacial pain), with the mucosa acting as a referral site

How is Post-Traumatic Stress Disorder in a Chronic Pelvic Pain Population Associated with Altered Surgical Outcome?

Background: The link between post-traumatic stress disorder (PTSD) and chronic pain conditions, specifically pelvic pain, has long been established. Within a chronic pelvic pain (CPP) population, the prevalence of PTSD is 31%, compared with 10% of women in the general population. In this group, the diagnosis of PTSD is usually associated with exposure to sexual and physical abuse. CPP is known to be a difficult diagnosis, in that many patients are refractory to treatment or suffer relapses. Meanwhile, PTSD alone is associated with overall poorer health outcomes. However, there is limited information on how pre-existing PTSD affects CPP in regards to treatment outcomes and disease trajectory. Objective: To determine if a diagnosis of PTSD is associated with differences in long-term pain outcomes among a CPP population treated with surgery

Investigation into Levels of Pain, Quality of Life, and Depression by Stage of Endometriosis

Objective: Despite the high prevalence of endometriosis, controversy exists surrounding the association between the stage of endometriosis and long-term treatment outcomes. The objective of the present study was to investigate the postsurgical long-term pain, quality-of-life, and psychological distress among women with differing stages of endometriosis. Methods: This cross-sectional study was conducted between 2008 and 2009. Women who had undergone surgery for pelvic pain at UNC Hospitals from 2003 to 2006 were mailed questionnaires to collect information on demographics, pain, sexual dysfunction, quality of life, and depression. Descriptive statistics and ANOVAs were used to examine the distribution of these variables by stage of endometriosis. Results: The study population included women aged 22 to 50 years old (mean age 36 years). Of the 82 women, 38 (46%) were classified as having stage 1 endometriosis, 26 (32%) having stage 2 endometriosis, 13 (16%) having stage 3 endometriosis, and 5 (6%) having stage 4 endometriosis. Across the four stages, there was no pattern of increased overall pain, pelvic pain, quality-of-life, or depression with increasing stage of endometriosis. The mean scores (standard deviation) on an adapted version of the McGill Pain Questionnaire for total pain were 8.0 (7.8), 10.4 (10.8), 4.6 (7.5), and 9.4 (13.4) for stages 1, 2, 3, and 4, respectively (ANOVA p-value 0.34). The mean scores for intensity of pelvic pain (possible score range of 0-5) were 1.5 (1.4), 1.7 (1.4), 1.0 (1.6), and 1.6 (0.9), respectively (ANOVA p-value 0.56). Using the SF12 quality-of-life measure the mean (standard deviation) mental and physical component standardized scores were 43.2 (10.3) and 45.6 (11.7) for stage 1, 45.5 (11.4) and 44.1 (10.2) for stage 2, 47.3 (12.8) and 50.4 (9.4) for stage 3, and 36.0 (14.8) and 43.3 (8.7) for stage 4 (ANOVA p-values 0.30 and 0.39 for the mental and physical components, respectively). Finally, scores on the Beck Depression Inventory were also similar by stage, although women with stage 4 endometriosis did score higher than the other three stages [stage 1: 9.2 (7.9), stage 2: 10.9 (7.5), stage 3: 8.3 (8.4) and stage 4: 16.2 (12.3)] (ANOVA p-value 0.26). Conclusions: These results indicate that long-term treatment outcomes in women undergoing laparoscopic surgery for pelvic pain may not be related to the stage of endometriosis. Regardless of endometriosis stage, most women were found to have residual pain symptoms. Further research to understand chronic pain, quality-of-life, and psychological distress and endometriosis is warranted. Summary: This study has shown that among women who underwent surgery for pelvic pain at UNC Hospitals, level of pain, quality-of-life, and depression do not increase with increasing stage of endometriosis

Trends in Pharmacy Compounding for Women’s Health in North Carolina: a Focus on Vulvodynia

Background: The Safe Drug Compounding Act of 2007 threatens to adversely affect many patients who rely on compounded medications to treat medical conditions for which no adequate commercially manufactured medication is available. Currently, no standard treatment for vulvodynia exists and many women rely on compounded medications to control the symptoms of this complex condition. In order to better understand the importance of compounding pharmacies in the provision of women’s health services and to identify trends in compounding for vulvodynia, we developed an online survey with the assistance of the University of North Carolina’s Odum Institute. The survey was distributed to compounding pharmacies across North Carolina. Our a priori hypothesis was that many areas of women’s health, specifically vulvo-vaginal disorders, rely heavily on compounding pharmacies and the services they provide. Objective: To establish the prevalence of medications compounded for women’s health issues across North Carolina. To identify trends in compounding for vulvodynia, with particular emphasis on the types and combinations of medications used

Vulvar Vestibulitis Syndrome: an Evaluation of Long Term Surgical Outcomes

VVS is a complex disorder affecting upward of 10% of reproductive age women and it is the most common diagnosis among women with persistent complaints of entry dyspareunia. Nevertheless, the etiology and optimal treatment for VVS remains unknown. A range of therapeutics is utilized for treatment of this condition with variable response rate. Surgical removal of vestibular mucosa is the most common treatment for tractable cases with a reported response rate as high as 80%. However, it is often difficult to compare effectiveness of studies for surgical treatment of VVS (i.e., postvestibulectomy) due to short duration of follow up and subjective measures of pain and quality of life. Thus, the objective of this study was to investigate long term pain report, sexual function, and psychological distress among women who had undergone vestibulectomy for the treatment of refractory VVS at our tertiary pelvic pain clinic at the U. of North Carolina, Chapel Hill

Interval Change in Postoperative Pain Reports and Psychological Characteristics among Women with Endometriosis

Background: Endometriosis affects 2.5-3.3% of reproductive age women and is a common diagnosis among women with chronic pelvic pain. Treatment for endometriosis ranges from conservative medical therapies to radical surgery. Endometriosis is an indication for 25-35% of laparoscopies and 10-15% of hysterectomies each year. Although the majority of women with endometriosis respond to conservative medical therapy, those with persistent pain often undergo hysterectomy. However, there exists limited data on the contribution of disease specific (e.g. stage of endometriosis) versus non-specific (e.g. biopsychosocial) factors on treatment outcomes (e.g. clinical pain report). We sought to investigate these factors at baseline as well as short and long term follow-up intervals for surgical endometriosis patients. Objective: To evaluate the contribution of disease specific versus biopsychosocial factors on surgical treatment outcomes at 1-year and 3-6 years post-surgery for endometriosis

Genitofemoral and Perineal Neuralgia After Transobturator Midurethral Sling

Midurethral slings successfully treat stress urinary incontinence through a minimally invasive vaginal approach. Postoperative pain related to sling placement can occur and poses both diagnostic and treatment dilemmas