Vulvodynia: A practical guide in treatment strategies

Santangelo, Giusi; Ruggiero, Giuseppe; Murina, Filippo; Donato, Violante Di; Perniola, Giorgia; Palaia, Innocenza; Fischetti, Margherita; Casorelli, Assunta; Giannini, Andrea; Dio, Camilla Di; Muzii, Ludovico; Panici, Pierluigi Benedetti; Bogani, Giorgio

doi:10.1002/ijgo.14815

Cited by 6 publications

(4 citation statements)

References 85 publications

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“…FDAapproved CBHT products are primarily indicated to treat vasomotor symptoms and symptoms of vulvar and vaginal atrophy in women associated with menopause. However, collected testimony from marketing claims and CBHT advocates asserts that CBHT is effective and safe for treating a broad spectrum of indications outside of those for FDA-approved BHT products, including antiaging concerns (e.g., longer, fuller hair, and smoother skin), sexual health, joint pain, general chronic pain, insomnia, cardiovascular diseases, and various mental health disorders [45].…”

Section: Assessment and Diagnosismentioning

confidence: 99%

Spotlight on Compounded Bioidentical Hormones

Santangelo,

Lagana,

Giannini

et al. 2023

Gynecol Obstet Invest

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Background: The role of hormonal replacement therapy in menopause is under debate. The premature closure of the Women’s Health Initiative (WHI) study in 2002 is still a source of concern among treating physicians. Objectives: The interest in alternatives to conventional hormone therapy has significantly increased. The adoption of personalized steroid hormone galenic preparations, formulated by compounding pharmacies, has recently spread. Methods: In June 2023, an extensive literature search was conducted by different authors to identify relevant studies in various databases (MEDLINE, Embase, Pubmed, and Cochrane). The studies that met the inclusion and exclusion criteria were further analyzed, and relevant data were extracted and analyzed for each paper. Any discrepancies between the investigators were resolved through a consensus approach. Outcomes: The primary outcomes observed included the clinical utility of CBHT. This study reviewed the current evidence on the utility of compounded bioidentical hormones, concluding that improving knowledge and awareness of bioidentical hormones is necessary to consider their use in clinical practice. Conclusion and Outlook: These formulations might provide effective options to best tailor therapies to each patient.

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Section: Assessment and Diagnosismentioning

confidence: 99%

Spotlight on Compounded Bioidentical Hormones

Santangelo,

Lagana,

Giannini

et al. 2023

Gynecol Obstet Invest

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“…The treatment of vulvodynia requires a multidimensional and tailored approach (1,25). According to some authors, a three-step treatment may be considered (26).…”

Section: Managementmentioning

confidence: 99%

Vulvodynia: when a training program to increase muscle mass in the lower limbs does some good!

Tiranini,

Cantamessi,

Serra

et al. 2023

AboutOpen

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Vulvodynia is a chronic pain condition, without clearly identifiable and visible causes, associated with disability, sexual disfunction, and impaired quality of life. It is frequently under-reported and under-diagnosed, resulting in significant emotional burden. The pathophysiology of vulvodynia is complex and multidimensional. According to the integrated biopsychosocial model, main triggers of vulvodynia may be biological (infectious or inflammatory conditions inducing severe or prolonged nociceptive or neuropathic pain, genetic predisposition, hormonal imbalance), psychological (depression, anxiety), sexual (traumatic experiences, unhealthy intimate relationship), and social (adverse childhood experiences). The diagnostic approach is based on accurate medical history exploring the characteristics and timing of vulvar pain, as well as the presence of other chronic pain conditions that are often comorbid. Pelvic examination (vulvar and vaginal appearance, cotton swab test for vulvar sensitivity, pelvic floor evaluation) supports the diagnosis and excludes secondary vulvar pain disorders. Considering that pain is a complex human experience within a multidimensional frame, the best therapeutic strategy should be multidisciplinary encompassing different therapeutic targets. Pharmacological therapies have anti-nociceptive, neuromodulating, and anti-inflammatory purposes and include both topical and systemic treatments (antidepressants, anticonvulsants, hormonal creams). Physical therapy consists of pelvic floor physiotherapy, electrostimulation, and neuromodulation techniques, while cognitive behavioral therapy, psychosexual intervention, and neurobiological education address the psychosocial dimension of vulvodynia. If results are insufficient, a surgical approach is allowed. We present a clinical case linking amelioration of vulvodynia to a training program to increase muscle mass, especially in the lower limbs, in a girl reporting an eating disorder.

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“… 7 , 8 Current treatments for vulvodynia include physiotherapy (e.g., pelvic floor exercises), muscle relaxants, nerve blocks, anti-depressants, anti-epileptic medication, cognitive behavioural therapy, and surgery. 9 – 12 Treatment outcomes show low success rates, highlighting the need for further research as well as the adoption of a multidisciplinary, multimodal, and biopsychosocial approach to treatment. 13 , 14 Self-management strategies (i.e., cognitive, behavioural, and physical techniques to address the physiological and emotional aspects of living with vulva pain) can help to relieve certain symptoms and prevent further irritation; 15 however, the extent of use and effectiveness of self-management approaches is not known.…”

Section: Introductionmentioning

confidence: 99%

Help-seeking experiences and intimate partner support in vulvodynia: A qualitative exploration

Lountzi,

Durand

2024

Womens Health (Lond Engl)

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Background: Vulvodynia is a poorly understood chronic pain condition characterized by persistent and unexplained pain in the vulva. Given the intimate nature of the pain, partners may play an important role in promoting self-management and help-seeking behaviours among women with vulvodynia. Objectives: The current study aimed to explore the role of partner support in pain experiences and help-seeking behaviours among women with vulvodynia. Design: A qualitative interpretive design was used. Methods: Ten women with vulvodynia ( M age = 37.9 years) were interviewed using a semi-structured non-directive topic guide. Data were analysed using reflexive thematic analysis. Results: Three themes around help-seeking experiences were constructed from the data: (1) ‘It’s Been a Battle’ – Failed by the Healthcare System; (2) ‘It’s Just the Vulva’ – Dismissed by Healthcare Professionals; and (3) ‘I Diagnosed Myself’ – The Patient Becomes the Expert. Participants described negative help-seeking experiences characterized by long delays to diagnosis, lack of awareness and understanding from healthcare professionals, minimization of symptoms, and having to advocate for and demand care. A further three themes pertaining to partner support were also developed: (1) ‘That Person to Listen to You’ – Source of Emotional Support; (2) ‘Why Don’t You Try This?’ – Finding Solutions Together; and (3) ‘He Forgets that it’s Still There’ – Vulvodynia is a Foreign Concept. Partners provided emotional support and showed empathy and understanding, and practical support by accompanying women to medical appointments and help with pain management. However, participants felt partners’ understanding of vulvodynia was limited and that this impacted their relationships. Conclusions: Findings highlight a lack of continuity of care and multidisciplinary approach to treatment, with help-seeking experiences being mainly negative in this sample. Increasing public awareness of vulvodynia and improving healthcare access is crucial to improving physical and psychological outcomes for this group. Partners can play an important role in supporting people with vulvodynia; however, other outlets of support should be further explored.

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Vulvodynia: A practical guide in treatment strategies

Cited by 6 publications

References 85 publications

Spotlight on Compounded Bioidentical Hormones

Spotlight on Compounded Bioidentical Hormones

Vulvodynia: when a training program to increase muscle mass in the lower limbs does some good!

Help-seeking experiences and intimate partner support in vulvodynia: A qualitative exploration

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