Developments in vulvovaginal care

Current Opinion in Obstetrics and Gynecology

Volumn 14, Issue 5, 2002, Pages 483-488

  Stewart, Elizabeth Gunther ^a,b  

^a HARVARD MEDICAL SCHOOL   (United States)

^b NONE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CANDIDA; DIAGNOSTIC ACCURACY; DYSPAREUNIA; HUMAN; LICHEN SCLEROSUS ET ATROPHICUS; PRIORITY JOURNAL; REVIEW; SEXUALITY; VAGINA; VAGINITIS; VULVA; VULVAR VESTIBULITIS; VULVODYNIA;

DIAGNOSIS, DIFFERENTIAL; FEMALE; HUMANS; VAGINAL DISEASES; VULVAR DISEASES;

EID: 0036823067     PISSN: 1040872X     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001703-200210000-00007     Document Type: Review

References (48)

1. Allen-Davis JT, Beck A, Parker R, et al. Assessment of vulvovaginal complaints: accuracy of telephone triage and in-office diagnosis. Obstet Gynecol 2002; 99:18-22. This illuminating prospective study challenges the idea that the telephone is ah effective tool to diagnose and treat vulvovaginal complaints. Additionally, the poor agreement between practitioners' diagnoses and microbiologic and microscopic data mandate further study into optimal diagnosis of vulvovaginitis.
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5. Ferris DG, Nyirjesy P, Sobel JD, et al. Over-the-counter antifungal drug misuse associated with patient-diagnosed vulvovaginal candidiasis. Obstet Gynecol 2002; 99:419-425. A time-location sample of women purchasing over-the-counter antifungals with clinical examination and pertinent laboratory tests confirms the inaccuracy of self-diagnosis. Here is confirmation, long suspected by clinicians, that millions of tubes of antifungals are being used to treat contactants, dermatoses, vulvodynia and probably vulvar carcinoma.
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18. Morris MC, Rogers PA, Kinghorn GR. Is bacterial vaginosis a sexually transmitted infection? Sex Transm Infect 2001; 77:63-68. A prospective cross sectional study with huge numbers is somewhat limited by a study population that is not broadly representative and did not collect information on smoking and contraceptive use, but still gives thoughtful insight on the sexual associations of bacterial vaginosis.
19. Holzman C, Leventhal JM, Qiu H, et al. Factors linked to bacterial vaginosis in nonpregnant women. Am J Public Health. 2001; 91:1664-1670. A cross sectional study over three clinic sites used the Nugent score to diagnose bacterial vaginosis; compelling evidence of a 50% reduction in bacterial vaginosis (both adjusted and unadjusted) speaks for hormonal effects among women who had used them in the past 6 months.
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23. Moodley P, Connolly C, Sturm AW. Interrelationships among human immunodeficiency virus type 1 infection, bacterial vaginosis, trichomoniasis, and the presence of yeasts. J Infec Dis 2002; 185:69-73. Significant risk factors associated with infections and associations among infections were carefully determined among Zulu women at a sexually transmitted disease clinic. A logistic model was used to test whether sexually transmitted infections were independently associated with HIV.
24. Koumans EH, Kendrick JS. Preventing adverse sequelae of bacterial vaginosis: a public health program and research agenda [Review]. Sex Transm Dis 2001; 28:292-297. Report of the Centers for Disease Control conference gives an up-to-date summary of current knowledge of bacterial vaginosis and issues a call for action.
25. McCormack WM, Covino JM, Thomason JL, et al. Comparison of clindamycin phosphate vaginal cream with triple sulfonamide vaginal cream in the treatment of bacterial vaginosis. Sex Transm Dis 2001; 28:569-575. A double blind, randomized multicenter study reconciles the reports of Gardner and Dukes, who found triple sulfonamide highly effective, with more recent studies suggesting otherwise.
26. Kekki M, Kurki T, Pelkonen J, et al. Vaginal clindamycin in preventing preterm birth and peripartal infections in asymptomatic women with bacterial vaginosis: a randomized, controlled trial. Obstet Gynecol 2001; 97:643-648. This multicenter, randomized, double blind, placebo-controlled trial produced the same negative outcome as the well noted Carey et al. study in NEJM 2000 in white women with no history of preterm birth.
27. Taylor-Robinson D, Rosenstein I. Bacteriotherapy may be useful in treating bacterial vaginosis [Letter]. Br Med J 2001; 323:1128. This letter to the editor beautifully summarizes a promising bacterial vaginosis treatment that is still on the drawing board.
28. Wines N, Willsteed E. Menopause and the skin. Australas J Dermatol 2001; 42:149-148. This illuminating review of all aspects of estrogen and the skin gives a plan for the lifetime management lichen sclerosus requires.
29. Neill SM, Ridley CM. Management of anogenital lichen sclerosus. Clin Experimtal Dermatol 2001; 26:637-643. A comprehensive summary shows a clinician all that goes into managing the complexities of this dermatosis.
30. Rouzier R, Haddad B, Deyrolle C, et al. Penneoplasty for the treatment of introital stenosis related to vulvar lichen sclerosus. Am J Obstet Gynecol 2002; 186:49-52. A questionnaire was used to assess patient satisfaction; while the study has small numbers, the 86% success rate suggests significant improvement in dyspareunia can be achieved for women with introital stenosis from lichen sclerosus.
31. Scurry J, Whitehead J, Healey M. Histology of lichen sclerosus varies according to site and proximity to carcinoma. Am J Dermatopathology 2001; 23:413-418. A review of biopsies discusses why squamous cell hyperplasia is an inappropriate designation for the thickening associated with lichen sclerosus.
32. Gross T, Wagner A, Ugurel, et al. Identification of TIA- 1+ and granzyme B+ cytotoxic T cells in lichen sclerosus et atrophicus. Dermatology 2001; 202:198-202. Recent developments in immunohistochemistry made it possible to identify potentially cytotoxic T lymphocytes in a small study of both male and female, genital and extragenital skin biopsies.
33. Danielsson I, Eisemann M, Sjoberg I, Wikman M. Vulvar vestibulitis: a multi-factorial condition. Br J Obstet Gynaecol 2001; 108:456-461. A case controlled study with small numbers used questionnaires to study differences in somatic symptoms and personality dimensions between women with VVS and controls.
34. Meana M, Binik YM, Khalife S, et al. Dyspareunia: sexual dysfunction or pain syndrome? J Nerv Ment Dis 1997; 185:561-569.
35. Bohm-Starke N, Hilliges M, Blomgren B, et al. Increased blood flow and erythema in the posterior vestibular mucosa in vulvar vestibulitis. Obstet Gynecol 2001; 98:1067-1074. A meticulously done study used laser doppler perfusion imaging in women with VVS and controls to map significant increases in perfusion values in cases compared with controls.
36. Bohm-Starke N, Hilliges M, Brodda-Jansen G, et al. Psychophysical evidence of nociceptor sensitization in vulvar vestibulitis syndrome. Pain 2001; 94:177-183. In another well designed study of cases and controls, the Swedish researchers found highly statistically significant differences that may explain mechanical allodynia and hyperalgesia in the area around the vaginal introitus. In addition, they provide the first published data of normal values for temperature and pain in this area.
37. Bergeron S, Binik YM, Khalife S, et al. Vulvar vestibulitis syndrome: reliability of diagnosis and evaluation of current diagnostic criteria. Obstet Gynecol 2001; 98:45-51. Kappa values reflecting substantial inter-rater agreement highlight this important study showing that VVS can be reliably diagnosed in women with dyspareunia; we need to re-examine Friedrich's criteria.
38. Bornstein J, Maman M, Abramovici H. "Primary" versus "secondary" vulvar vestibulitis: one disease, two variants. Am J Obstet Gynecol 2001; 184:28-31. One hundred and twenty-three women undergoing perineoplasty for VVS were compared with regard to multiple variables.
39. Gerber S, Bongiovanni AM, Ledger WJ, Witkin SS. A deficiency in interferon-alpha production in women with vulvar vestibulitis. Am J Obstet Gynecol 2002; 186:361-364. Human papilloma virus as a cause of VVS receives another blow in this elegant study from Cornell that rejuvenates flagging interest in interferon as a VVS treatment unrelated to the presence of human papilloma virus.
40. Metts J. Interstitial cystitis: urgency and frequency syndrome. Am Fam Physician 2001;64:1199-1206. A review of this chronic painful condition raises the important criticism of the traditional rigid diagnostic criteria but still uses them in the section on diagnosis. The article includes helpful patient handouts on interstitial cystitis.
41. Parsons CL, Bullen M, Kahn BS, et al. Gynecologic presentation of interstitial cystitis as detected by intravesical potassium sensitivity. Obstet Gynecol 2001; 98:127-132. This uncontrolled trial at three centers will need further verification but has the potential to facilitate the diagnosis of a frequently unrecognized and unconsidered condition in the cause of pelvic and vulvar pain.
42. Fischer M, Marsch WC. Vulvodynia: an indicator or even an early symptom of vulvar cancer. Cutis 2001; 67:235-238. The report of three cases of malignancy with pain emphasizes the importance of histologic examination of all visible vulvar lesions before using the term vulvodynia.
43. 2 laser treatment can cause scar formation and fragility of the mucous membrane leading to local pain suggesting the diagnosis of vulvodynia.
44. Heim LJ. Evaluation and differential diagnosis of dyspareunia. Am Fam Physician 2001; 15; 63:1535-1544. A family practitioner gives complete coverage of common and uncommon etiologies of dyspareunia; helpful tables of history questions to ask and common differential diagnoses for painful sex are included.
45. Graziottin A, Castoldi E, Montorsi F, et al. Vulvodynia: the challenge of "unexplained" genital pain. J Sex Marital Ther 2001; 27:503-512. This presents an elegant discussion of the clinical syndrome of unexplained vulvar pain. Sexual dysfunction and psychological disability focuses on the complexity of the nervous system supplying the vulva and a multifactorial approach to diagnosis and treatment.
46. Mariani L. Vulvar vestibulitis syndrome: an overview of non-surgical treatment. Eur J Obstet Gynecol Reprod Biol 2002; 101:109-112. A complete review of medical management emphasizes a multimodal approach to treatment of VVS.
47. Slowinski J. Multimodal sex therapy for the treatment of vulvodynia: a clinician's view. J Sex Marital Ther 2001; 27:607-613. Anecdotal clinical experience of the author emphasizes that, whether the cause of pain is clear or not, dealing with its consequences is possible with a multimodal approach.
48. Harlow B, Wise LA, Stewart EG. Prevalence and predictors of chronic lower genital tract discomfort. Am J Obstet Gynecol 2001; 185:545-550. A pilot study surveyed a random sample to show that women from the general population are willing to provide sensitive information on lower genital tract discomfort and that vulvar pain may be a silent epidemic.