Measuring Treatment Outcomes in Women With Vulvodynia

Vulvodynia or vulvar pain syndrome is a chronic, heterogeneous, and multifactorial gynecological condition with an estimated prevalence of 9 - 12%, broad and substantial effect on quality of life due to physical disabilities, psychological distress and sexual dysfunction. A rationale therapeutic approach for the treatment of vulvodynia is still under investigation. A review of treatment modalities proposed by most of the clinicians involved in managing these patients advocated initially utilizing non-invasive therapies and then to proceed gradually to more aggressive therapies. A multidisciplinary approach that includes behavioral science and neuroimaging is required and recommended. Additionally a team approach should be utilized to test and evaluate therapies including pelvic floor physiotheraphy, psychotherapy, microbiology and pharmacology. It is my hope that this review will assist in the understanding of vulvodynia and its measuring treatment outcomes and will provide a thrust in the right direction to once and for all clarify this complex multifactorial disorder affecting women

Endometriosis in adolescence: A long-term follow-up fecundability assessment

OBJECTIVE: A long-term, follow-up study comparing mild and severe forms of endometriosis and their fecundability, on 28 women diagnosed with endometriosis in adolescence. METHODOLOGY: Twenty-eight patients were identified from a prospective cohort of 52 adolescents (ages 12 to 18 years) with operative diagnosis of endometriosis between July 1993 and December 1995. All patients presented with chronic pelvic pain unresponsive to conservative medical management. Diagnosis of pregnancy was made by sonographic identification of intrauterine pregnancy, positive serum human chorionic gonadotropin or pathological confirmation of products of conception. Patients were categorized as fertile or sub-fertile by having > 12 months of unprotected intercourse without conception. Follow-up was done for 8.6 years. RESULTS: Staging of endometriosis was performed according to the American Society for Reproductive Medicine standards. Stage I = 14.3%; Stage II = 39.3%; Stage III = 42.8%; Stage IV = 3.6%. Fecundability rates in each stage were statistically significant: Stage I (75%), Stage II (55%), Stage III (25%), Stage IV (0%) (p < .05). Rates of spontaneous abortion were not statistically significant. CONCLUSION: In our cohort, even at the earliest point in the natural life cycle of endometriosis there is an inverse relationship between stage of disease at diagnosis and fecundability

Vulvodynia

Vulvodynia or vulvar pain syndrome is a chronic, heterogeneous, and multifactorial disease with a high prevalence. This condition affects Caucasians, African Americans, Africans and Hispanic women, particularly those sexually active at child-bearing age. The etiology of this condition is complex and remains elusive. An accurate diagnosis requires a comprehensive history, physical examination and targeted diagnostic tests. Although many treatment options have been utilized, a rational therapeutic strategy is still under research. Psychological counseling and group support should be considered in all cases

Vulvodynia

Vulvodynia or vulvar pain syndrome is a chronic, heterogeneous, and multifactorial disease with a high prevalence. This condition affects Caucasians, African Americans, Africans and Hispanic women, particularly those sexually active at child-bearing age. The etiology of this condition is complex and remains elusive. An accurate diagnosis requires a comprehensive history, physical examination and targeted diagnostic tests. Although many treatment options have been utilized, a rational therapeutic strategy is still under research. Psychological counseling and group support should be considered in all cases

Reducing Emergency Births by Modification in Oxytocin Utilization

Background: The purpose of our study was to explore the correlation between the amount of oxytocin use and emergency vacuum, forceps, cesarean births and neonatal intensive care unit (NICU) response to fetal distress. In 2004, we restricted the criteria for oxytocin utilization for labor induction and augmentation. Methods: This retrospective study was carried out at a large private university tertiary care hospital- affiliated, and included data from the years 2005 to 2007. We utilized hospital data from vital statistics, labor and delivery, central pharmacy and NICU. Information obtained included maternal characteristics, annual birth data, indication and numbers of emergency vacuum, forceps and cesarean births, oxytocin utilization, and number of NICU responses to fetal distress. Results: The total number of deliveries during the studied period equaled14,184. The oxytocin utilization showed a reduction from 93.3% to 78.9%. The number of patients who did not receive oxytocin during labor increased from 6.7% to 21.1%. The correlation between the reduction of oxytocin utilization with the reduction of emergency cesarean births (10.9% to 5.07%), vacuum briths (9.1% to 8.5%), and forceps birth (4% to 2.3%) including NICU responses to fetal distress (P = 0.0001) revealed a significant statistical difference. The overall cesarean section rate did not indicate a significant increase 29.4% to 29.8% (P = 0.14) nor did the patient’s characteristics differ. Conclusion: In our population, reducing oxytocin appears to strongly correlate with a reduction in the number of emergency vacuum, forceps, cesarean births and NICU responses to fetal distress