15401 - Clinical Aspects and Research Initiative VULVODYNIA...

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    VULVODYNIA Clinical Aspects and Research Initiative Gloria A. Bachmann, M.D. Nidhi Gupta, M.D. Women’s Health Institute UMDNJ-Robert Wood Johnson Medical School
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Defining Vulvodynia   The International Society for  Study of Vulvovaginal Diseases  (ISSVD) defines vulvodynia as  ‘chronic vulvar discomfort,  characterized by the woman’s  complaint of burning, stinging,  irritation or rawness’
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  Types of Vulvar Pain PAIN from an  IDENTIFIABLE  ETIOLOGY VULVODYNIA  Vulvar  Vestibulitis  Subtype   (provoked) Dysesthetic  Vulvodynia  Subtype   (unprovoked)
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Pain from an                 Identifiable Etiology Infections  such as chronic  vulvovaginitis caused by Candida or  other pathogens Dermatoses and Dermatitis  that  involve the vulva such as Lichen  Sclerosus, Lichen Planus, irritants and  allergic dermatitis Vaginismus
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  Vulvodynia:  Vulvar Vestibulitis Subtype Friedrich’s criteria  diagnostic : 1. 1. Severe pain on vestibular touch or  attempted vaginal entry. 2. 2. Tenderness to pressure localized within  the vulvar vestibule 3. 3. Physical findings confined to vestibular  erythema of various degrees Pain is provoked and localized Commonly seen in women aged 50  years or less
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Vulvodynia: Dysesthetic Vulvodynia Subtype Pain is constant and may be felt  beyond the confines of vulvar  vestibule Usually pain is unprovoked Diagnosed mainly in women who  are peri- or postmenopausal 
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Vulvodynia: Prevalence Statistics Harvard-based study (n=16,000)  estimates a 16% life time prevalence *   UMDNJ-based study estimates: 21% prevalence of chronic  gynecologic pain 13.5% prevalence of vulvodynia-type  pain *   Harlow BL, Stewart EG. A population-based  assessment of chronic unexplained vulvar pain: have  we underestimated the prevalence of vulvodynia?          J Am Med Women's Assoc 2003;58:82-88
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    Vulvodynia: Demographics   Older data suggest the highest  prevalence in white women Accounts for 10 million doctor  visits/year Upwards of 14 million women are  affected in their lifetime  Recent data suggest Hispanic women  80% more likely to have vulvar pain  than other racial groups  
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Etiology: Vulvar Vestibulitis Subtype Prior vulvovaginal Candidiasis Hypersensitivity to chemicals Human Papilloma virus infection High levels of urinary oxalates Neurological dysfunction 
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Candida Etiology:                Vulvar Vestibulitis Subtype
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15401 - Clinical Aspects and Research Initiative VULVODYNIA...

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