Enhanced synthesis of proinflammatory cytokines by vulvar vestibular fibroblasts: implications for vulvar vestibulitis

Foster, David C.; Piekarz, Katherine H.; Murant, Thomas I.; LaPoint, Randi; Haidaris, Constantine G.; Phipps, Richard P.

doi:10.1016/j.ajog.2006.12.038

Cited by 63 publications

(79 citation statements)

References 34 publications

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“…On the one hand, primary dyspareunia could mainly be the result of inherent pathophysiological abnormalities (e.g., congenital defect of urogenital sinus-derived epithelium, genetic variants reducing the ability to fight pathogens/increasing the proinflammatory response, impairment in pain-regulatory mechanisms) combined with psychosocial characteristics like trait anxiety (Babula, Linhares, Bongiovanni, Ledger, & Witkin, 2008;Burrows, Klingman, Pukall, & Goldstein, 2008;Granot et al, 2004). Conversely, biomedical and behavioral factors (e.g., OC, infections, nonindicated self-treatment) may mostly explain secondary dyspareunia by creating prolonged inflammation of the vulvar mucosa and peripheral sensitization (Bohm-Starke, Hilliges, Falconer, & Rylander, 1998;Foster et al, 2007).…”

Section: Discussionmentioning

confidence: 96%

Biopsychosocial Factors Associated with Dyspareunia in a Community Sample of Adolescent Girls

Landry

Bergeron

2010

Arch Sex Behav

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Although various biopsychosocial factors have been associated with dyspareunia, research to date has focused on retrospective reports of adult women, and lack of consensus regarding etiology remains. By targeting girls at the beginning of their reproductive life, this study aimed to examine the biomedical, behavioral, and psychosocial correlates of chronic painful intercourse in sexually active adolescents compared to pain-free girls. With written informed consent, data were obtained from 1425 girls (12-19 year olds) from seven metropolitan high schools using self-report questionnaires pertaining to gynaecologic/biomedical history, physical/psychological/sexual abuse, anxiety, depression, attitudes towards sexuality, and social support. While the chronic painful intercourse (n = 51) and pain-free comparison group (n = 167) did not differ significantly on biomedical variables, painful intercourse was associated with significantly more pain during tampon insertion, and avoidance of tampons was linked to a fourfold risk of experiencing pain during sex. Cases also reported engaging in significantly more detrimental vulvar hygiene habits than pain-free girls, whereas no significant group differences were observed for self-treatment using over-the-counter antifungal preparations. Sexual abuse, fear of physical abuse, and trait anxiety were identified as significant psychosocial correlates of chronic painful intercourse. A logistic regression further identified pain during first tampon insertion and trait anxiety as statistical predictors of adolescent pain during intercourse. In addition to a possible intrinsic dysfunction in central pain processing, findings suggest that psychological variables, such as anxiety, play a significant role in painful intercourse's very first manifestations in adolescent girls.

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Section: Discussionmentioning

confidence: 96%

Biopsychosocial Factors Associated with Dyspareunia in a Community Sample of Adolescent Girls

Landry

Bergeron

2010

Arch Sex Behav

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“…Production of inflammatory cytokines such as Interleukin (IL)-1, IL-6, tumor necrosis factor ␣ and IL-8 follow infection with this organism [20,21] , similar to the cytokines found in the vestibular tissue of localized vulvodynia after incubation with ␣ -melanophore-stimulating hormone plus yeast [22] . A possible similarity in genetic disposition to infection may be involved in the etiologic role of H. pylori and localized vulvodynia.…”

Section: Discussionmentioning

confidence: 90%

A Search for <i>Helicobacter pylori</i>in Localized Vulvodynia

Geva

Sabo

Levy³

et al. 2008

Gynecol Obstet Invest

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Background: We noted that several patients presenting with both localized vulvodynia (vulvar vestibulitis) and peptic symptoms reported a resolution of dyspareunia after receiving a full treatment course for Helicobacter pylori. Methods: Women with localized vulvodynia were interviewed regarding symptoms of peptic disease. Those with peptic symptoms underwent a blood test for the presence of antibodies to H. pylori and were referred to a gastroenterology consultation. In all women, vestibular biopsies were obtained and stained for H. pylori. Healthy vestibular tissues as well as archival negative and positive gastric tissues served as controls. Results: Of the blood antibody tests, 12 (80%) were positive. None of the patients had evidence of H. pylori in the vestibule. Eleven women received triple therapy for eradication of H. pylori. Eight (73%) reported complete relief of dyspareunia and of gastric symptoms. Conclusion: Our study found no immunohistochemical evidence of H. pylori infection in the vestibule but suggested a possible role for anti-H. pylori treatment in localized vulvodynia.

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“…The former point is supported by an experimental mouse model of LPV that confirmed that repeated vulvovaginal infections with C. albicans are sufficient to cause chronic vulvar pain behavior and increased vulvar peptidergic innervation, a finding that parallels observations in the clinical literature [2,4]. Furthermore, some women with chronic vulvar pain may be exceptionally vulnerable to C. albicans exposure, as indicated by enhanced contact sensitivity to intradermal C. albicans injections and increased fibroblast-mediated cytokine production [7,11]. The question remains, how does the vestibule uniquely mediate these symptoms, and how can we differentiate normal vulvar nociceptive processes from pathological ones?…”

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confidence: 76%

What is special about the vulvar vestibule?

Farmer

2015

Pain

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The pathological underpinnings of localized provoked vulvodynia (LPV), the most prevalent cause of vulvar pain that is frequently comorbid with other variants of chronic pelvic pain, have evaded clinicians and scientists for decades. This commentary describes the background and implications of the findings presented by Foster et al. [6] in this issue. An emphasis is on reasons why the vulvar vestibule—an embryologically distinct band of tissue demarcating the internal female reproductive tract and external vulva—should exhibit a propensity for fibroblast-mediated proinflammatory responses to commonly encountered yeast in healthy women, as well as women with LPV. Foster and colleagues’ findings have the potential to advance the clinical assessment of women with LPV, facilitate the identification of mechanistically distinct comorbid pelvic pain conditions, and guide future animal model development to optimize their clinical relevance.

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Enhanced synthesis of proinflammatory cytokines by vulvar vestibular fibroblasts: implications for vulvar vestibulitis

Cited by 63 publications

References 34 publications

Biopsychosocial Factors Associated with Dyspareunia in a Community Sample of Adolescent Girls

Biopsychosocial Factors Associated with Dyspareunia in a Community Sample of Adolescent Girls

A Search for <i>Helicobacter pylori</i>in Localized Vulvodynia

What is special about the vulvar vestibule?

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