Consulting a Patient on Hormonal Contraception: A Clinical Case of Vulvar Vestibulitis

This article presents a clinical case of a 23-year-old female who developed vulvodynia and dyspareunia while taking combined oral contraceptives (OCs). The case study shows that physicians should not recommend any combination of OCs over another to reduce weight gain, headache, breast tenderness, breakthrough bleeding, sexual dysfunction, dyspareunia, and decreased libido. Hormonal contraception counseling should be based on known, evidence-based recommendations and not be limited to the unnecessary substitution of one drug for another.

Psychological-physiological characteristics of vaginismus

While vaginismus can occur in some women during the first sexual intercourse, and sometimes in women who have not had any problems during previous sexual intercourse, this diagnosis can occur over time, depending on a traumatic event or problem they are experiencing. Vaginismus is divided into primary and secondary according to the time of its formation. The following are the reasons for the formation of the secondary form: Problems between couples A traumatic birth experience Abortion Exposure to sexual assault Rough gynecological examination, etc. One of the points to note is that the diagnosis of vaginismus may include additional symptoms. These are: Apareunia, Dyspareunia and Vulvar Vestibulitis Syndrome (VVS, Vulvar Vestibulitis). Although the symptoms we have listed are very similar to vaginismus, they are completely different from each other. Key words: vaginismus, trauma, Attachment, types of vaginismus, couple relationships, Dyspareunia, Vulvar vestibulitis, Aparoni

Fibromyalgia

Clinicians often encounter individuals who present with pain that they cannot adequately explain based on the degree of damage or inflammation noted in peripheral tissues. This typically prompts an evaluation looking for a cause of the pain. If no cause is found, these individuals are often given a diagnostic label that merely connotes that the patient has chronic pain in a region of the body, without an underlying mechanistic cause. Fibromyalgia (FM) is merely the current term for widespread musculoskeletal pain for which no alternative cause can be identified. This review covers the epidemiology, etiology/genetics, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, and complications and prognosis of FM. Figures show underlying mechanisms that can cause chronic pain; an individual’s “set point” or “volume control setting” for pain as set by a variety of factors, including the levels of neurotransmitters that either facilitate pain or reduce pain transmission; the 2011 Fibromyalgia Survey Criteria; symptoms and syndromes frequently seen in individuals with FM; the distribution of the 2011 Fibromyalgia Survey scores in a large cohort of individuals undergoing joint replacement surgery; and an algorithm showing the importance of dually focused treatment for FM and other chronic pain conditions. Tables list clinical characteristics of centralized pain, pharmacologic therapies for FM, and nonpharmacologic therapies for FM. This review contains 6 figures, 9 tables, and 78 references. Keywords: Fibromyalgia, chronic low back pain, headache, temporomandibular joint disorder, gastrointestinal disorder, irritable bowel syndrome (IBS), nonulcer dyspepsia, or esophageal dysmotility, interstitial cystitis, chronic prostatitis, vulvodynia, vulvar vestibulitis, and endometriosis

Fibromyalgia

Clinicians often encounter individuals who present with pain that they cannot adequately explain based on the degree of damage or inflammation noted in peripheral tissues. This typically prompts an evaluation looking for a cause of the pain. If no cause is found, these individuals are often given a diagnostic label that merely connotes that the patient has chronic pain in a region of the body, without an underlying mechanistic cause. Fibromyalgia (FM) is merely the current term for widespread musculoskeletal pain for which no alternative cause can be identified. This review covers the epidemiology, etiology/genetics, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, and complications and prognosis of FM. Figures show underlying mechanisms that can cause chronic pain; an individual’s “set point” or “volume control setting” for pain as set by a variety of factors, including the levels of neurotransmitters that either facilitate pain or reduce pain transmission; the 2011 Fibromyalgia Survey Criteria; symptoms and syndromes frequently seen in individuals with FM; the distribution of the 2011 Fibromyalgia Survey scores in a large cohort of individuals undergoing joint replacement surgery; and an algorithm showing the importance of dually focused treatment for FM and other chronic pain conditions. Tables list clinical characteristics of centralized pain, pharmacologic therapies for FM, and nonpharmacologic therapies for FM. This review contains 6 figures, 9 tables, and 78 references. Keywords: Fibromyalgia, chronic low back pain, headache, temporomandibular joint disorder, gastrointestinal disorder, irritable bowel syndrome (IBS), nonulcer dyspepsia, or esophageal dysmotility, interstitial cystitis, chronic prostatitis, vulvodynia, vulvar vestibulitis, and endometriosis

Fibromyalgia

Clinicians often encounter individuals who present with pain that they cannot adequately explain based on the degree of damage or inflammation noted in peripheral tissues. This typically prompts an evaluation looking for a cause of the pain. If no cause is found, these individuals are often given a diagnostic label that merely connotes that the patient has chronic pain in a region of the body, without an underlying mechanistic cause. Fibromyalgia (FM) is merely the current term for widespread musculoskeletal pain for which no alternative cause can be identified. This review covers the epidemiology, etiology/genetics, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, and complications and prognosis of FM. Figures show underlying mechanisms that can cause chronic pain; an individual’s “set point” or “volume control setting” for pain as set by a variety of factors, including the levels of neurotransmitters that either facilitate pain or reduce pain transmission; the 2011 Fibromyalgia Survey Criteria; symptoms and syndromes frequently seen in individuals with FM; the distribution of the 2011 Fibromyalgia Survey scores in a large cohort of individuals undergoing joint replacement surgery; and an algorithm showing the importance of dually focused treatment for FM and other chronic pain conditions. Tables list clinical characteristics of centralized pain, pharmacologic therapies for FM, and nonpharmacologic therapies for FM. This review contains 6 figures, 9 tables, and 78 references. Keywords: Fibromyalgia, chronic low back pain, headache, temporomandibular joint disorder, gastrointestinal disorder, irritable bowel syndrome (IBS), nonulcer dyspepsia, or esophageal dysmotility, interstitial cystitis, chronic prostatitis, vulvodynia, vulvar vestibulitis, and endometriosis

Vulvodynia: A Review of the Literature

Objective: To evaluate the literature and educate the pharmacy community about the different treatment options for vulvodynia. Data Sources: Searches were performed through MEDLINE (1946-May 2018) using OVID and EBSCOhost, and Excerpta Medica (1974-May 2018) using EMBASE. Search terms included vulvar vestibulitis syndrome, vestibulodynia, vulvodynia, vulvar pain, provoked vulvar vestibulitis, and vulvodynia treatment. References of all relevant articles were then used to find additional applicable articles. Study Selection and Data Extraction: This review includes articles in the English language and human trial literature. Twenty-five trials explored the use of oral and topical medications in the treatment of vulvodynia. Data Synthesis: Vulvodynia is a poorly understood disease with an unknown etiology. Oral tricyclic antidepressants and gabapentin continue to be the most commonly used treatments for vulvodynia pain. This is due to their ease of use and patient preference. Topical treatments that have efficacy data are amitriptyline, gabapentin, lidocaine, baclofen, and hormones. This route of administration avoids systemic adverse effects and interpatient variability that accompanies oral administration. Alternative therapies more commonly used include physiotherapy, psychotherapy, and surgery. Treatment length may vary due to dose titrations and potential changes in medication therapy. Conclusions: Several medication and alternative therapies may be effective in treating vulvodynia. Current studies used wide dosing ranges, making it difficult to standardize therapy. No consistent method of assessing pain was used between studies, as well as a limited number being randomized and placebo controlled. Additional research is needed to increase knowledge and further develop vulvodynia treatments.

The Joint Work of Gynecologist and Psychologist in the Treatment of Sexual Pain Disorders and Vulvar Vestibulitis and the Use of Visnadina

Objective: Actually, sexual pain disorders could be interpreted in a much broader sense to include also non-coital sex disorders (for example clitoris pain or vulvar vestibulis pain during petting). The Vulvar Vestibulitis (VV) sums up the complexity of interacting values in the genesis of pain. The VV is a clinical disorder characterized by three symptoms for excellence: 1) Acute vestibule pain at any attempt of penetration; 2) Tenderness caused by pressure in the vaginal vestibule: if we consider the entrance to the vaginal orifice as a clock face, the pain is at its greatest in the 5 and 7 areas; 3) Erythema of various degrees in the vaginal vestibule. Design and Method: Vulvar vestibulitis as a multi system disorder involves the mucosa of the vaginal vestibule and can become home to an intense inflammatory response; it also involves the immune system with the proliferation of painful nerve endings, the nervous system, the muscular and vascular system. Symptoms associated with VV can be of a urinary nature, with an urgent need to urinate after intercourse, or chronic cystitis or the onset of pain with the same characteristics as dyspareunia during a gynecological examination and so on. Results: In an outpatients setting which differs from the usual psychological/gynecological one, the presence of two specialists, that is a psychologist and a gynecologist at the gynecological examination may help. During the checkup when the speculum is inserted into the vagina to get a direct observation of the structure of the vagina, any lesions caused by chronic inflammation of the vaginal vestibule can be highlighted. The psychologist on the other side of the bed keeping direct eye contact with the patient can help her to manage the anxiety or pain linked to the moment of finger penetration or with the use of diagnostic instruments, as well as breathing management through autogenic training which will lower any anxiety-related situations. Eye contact can also keep the patient anchored to the real situation and keep her in touch with reality which can easily be distorted in a panic situation. Conclusions: In these conditions the gynecologist can carry out his examination, with penetration for example giving the patient a direct experience of it which in turn can act as a positive feedback for future experience. The use of Visnadina (Refeel Spray) is particularly useful for patients who suffer generally from painful sex and sexual arousal disorders. Refeel Spray was the product used as the reference sample in these cases.