Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I

Vesna Harni; Damir Babic; Suzana Ljubojevic-Hadzavdic; Dubravko Barisic

doi:doi:10.11648/j.jgo.20221006.12

| Peer-Reviewed

Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I

Vesna Harni, Damir Babic, Suzana Ljubojevic-Hadzavdic, Dubravko Barisic

Published in Journal of Gynecology and Obstetrics (Volume 10, Issue 6)

Received: 16 October 2022 Accepted: 3 November 2022 Published: 10 November 2022

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

This study aimed to investigate the presence, type, and arrangement of nonspecific lesions considering the different histologies of the three vulvar rings in women with chronic vulvar discomfort to obtain reference data for the diagnostic procedure and a better understanding of women with chronic vulvar distress. The distribution of nonspecific lesions in the vulva based on vulvar rings was monitored as a secondary outcome measure within the framework of the prospective experimental study using diagnostic interventions called DATRIV, which included a total of 328 consecutive participants. Four patient groups were distinguished according to their medical history, structured International Society for the Study of Vulvovaginal Disease vulvodynia questionnaire results, and clinical examination, including inspection and cotton swab test. Asymptomatic participants were classified into normal vulva (N = 82) and impaired vulvar skin (N = 82) groups. Patients with chronic vulvar discomfort were categorized into groups of patients with primary, idiopathic vulvar distress/vulvodynia (N=82), and secondary complaints caused by vulvar dermatosis (N=82). Three rings vulvoscopy form data were used to collect clinical data, which were analyzed using StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). This study was approved by the Institutional Review Board of Polyclinic Harni, and all patients provided written informed consent. Nonspecific changes in the outer vulvar ring were significantly more common in patients with vulvar dermatosis (70.7%). The opposite pattern of lesion incidence was observed, with a considerably higher frequency of nonspecific findings in the inner vulvar ring in patients with vulvodynia (98.8%) and impaired vulvar skin (96.3%). The inner vulvar ring in patients with vulvodynia demonstrated a peculiar and characteristic profile with significantly more frequent findings of erythema (92.7%), punctuations (54.9%), ischemia (48.8%), and papillae (25.6%). A high presence of nonspecific lesions in the middle vulvar ring was documented in all participants, with an evident distinction in the appearance and allocation of these findings between patients with vulvodynia and vulvar dermatosis. By establishing the characteristic pattern of the type and distribution of nonspecific lesions in patients with vulvodynia, the Budapest criteria for considering vulvodynia as chronic reflex pain syndrome (CRPS) type 1, formerly sympathetic dystrophy, are met. Due to the specific three rings anatomy of the vulva, revised Budapest criteria are proposed. This study creates a unique opportunity to introduce vulvoscopy in the differential diagnosis of chronic, primary, and secondary vulvar discomfort.

Published in	Journal of Gynecology and Obstetrics (Volume 10, Issue 6)
DOI	10.11648/j.jgo.20221006.12
Page(s)	243-252
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Vulvar Discomfort, Vulvodynia, Vulvar Dermatosis, Three Rings Vulvoscopy, Vulvar Lesions, Chronic Reflex Pain Syndrome (CRPS), Budapest Criteria

References

[1]	Moyal-Barracco M, Lynch P. 2003 ISSVD terminology and classification vulvodynia: a historical perspective. J Reprod Med 2004; 49: 772-7.
[2]	ISSVD Vulvodynia Pattern Questionnaire. Available at: https://netforum.avectra.com/temp/ClientImages/ISSVD/3ef9c6ea-aac7-4d2b-a37f-058ef9f11a67.pdf Last accessed May 23, 2015.
[3]	Bornstein J, Goldstein AT, Stockdale CK, Bergeron S, Pukall C, Zolnoun D, et al. 2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia. J Lower Genit Tract Dis 2016; 20: 126-30.
[4]	Torres-Cueco R.; Nohales-Alfonso F. Vulvodynia - It Is Time to Accept a New Understanding from a Neurobiological Perspective. Int J Environ Res Public Health 2021; 18: 6639. DOI: 10.3390/ ijerph18126639.
[5]	International Association for the Study of Pain, Subcommittee on Taxonomy. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Pain Supplement 1986; 3: S1-S226.
[6]	Byrne MA, Walker MM, Leonard J, Pryce D, Taylor-Robinson D. Recognising covert disease in women with chronic vulval symptoms attending an STD clinic: value of detailed examination including colposcopy. Genitourin Med 1989; 65: 46-9.
[7]	Micheletti L, Preti M, La Monica F. La vulvoscopia, no debe ser destinada como el examen colposcopico de la vulva. [Vulvoscopy should not be intended as colposcopic examination of the vulva.] AMATGI 2011; 4: 29-34.
[8]	Audisio T, Zarazaga J, Vainer O. A Classification of Vulvoscopic Findings for Clinical Diagnosis. J Lower Genit Tract Dis 1999; 3: 7-18.
[9]	van Beurden M, van der Vange N, de Craen AJM, Tjong-A-Hung SP, ten Kate FJW, ter Schegget J, et al. Normal findings in vulvar examination and vulvoscopy. J Br Obstet Gynaecol 1997; 104: 320-4.
[10]	Kesic V. Colposcopy of the vulva, perineum and anal canal. Chapter in Bosze P, Luesley DM. EACG Course Book on Colposcopy. Budapest, Primed-X-Press; 2003.
[11]	Harni V, Babic D, Hadzavdic S, Barisic D. Diagnostic Accuracy of the Vulvoscopy Index for Detection of Vulvar Dermatosis (DATRIV Study, Part 1). Journal of Gynecology and Obstetrics 2022; Vol. 10, No. 1, 39-47. DOI: 10.11648.j.jgo.20221001.16.
[12]	Harni V, Babic D, Hadzavdic S, Barisic D. Clinical Value of the N-S-P Scheme for Detection of Vulvar Dermatosis (DATRIV Study, Part 2). Journal of Gynecology and Obstetrics 2022; Vol. 10, No. 3, 159-166. DOI: 10.11648.j.jgo.20221003.11.
[13]	Friedrich EG Jr. Vulvar vestibulitis syndrome. J Reprod Med 1987; 32: 110-4.
[14]	Haefner H, Collins M, Davis GD, Edwards L, Foster D, Hartmann E, et al. The Vulvodynia Guideline. J Lower Genit Tract Dis 2005; 9: 40-51.
[15]	Stockdale CK, Lawson HW. 2013 Vulvodynia Guideline Update. J Lower Genit Tract Dis 2014; 18: 93-100.
[16]	Bornstein J, Sideri M, Tatti S, Walker P, Prendiwille W, Haefner HK. 2011 Terminology of the Vulva of the International Federation for Cervical Pathology and Colposcopy. J Lower Genit Tract Dis 2012; 16: 290-5.
[17]	Reid R, Greenberg MD, Daoud Y, Husain M, Selvaggi S, Wilkinson E. Colposcopic findings in women with vulvar pain syndromes. A preliminary report. J Reprod Med 1988; 33: 523-532.
[18]	Harni V, Babic D, Barisic D. "Three Rings Vulvoscopy" – A New Approach to the Vulva. Gynaecol Perinatol 2015; 24: 37-45. Available at: https://www.poliklinika-harni.hr/images/publikacije/Harni-V-Three-Rings-Vulvoscopy-Gyn-Per-2015.pdf
[19]	Micheletti L, Preti M, Bogliatto F and Lynch P. Vulvology A Proposal for a Multidisciplinary Subspecialty. J Reprod Med 2002; 47 (9): 715-7. Available at: http: //hdl.handle.net/2318/40198
[20]	Murphy R. Training in the diagnosis and management of vulvovaginal diseases. J Reprod Med 2007; 52 (2): 87-92.
[21]	Venkatesan A, Farsani T, O'Sullivan P, Berger T. Identifying competencies in vulvar disorder management for medical students and residents: a survey of US vulvar disorder experts. J Low Genit Tract Dis 2012; 16 (4): 398-402. DOI: 10.1097/LGT.0b013e318245152b.
[22]	ISSVD - the World for Vulvovaginal Education and Research. https://www.issvd.org/
[23]	Edwards C, Dogra N, Antanrajakumar A, Saeangapani A, Selk A. Vulvovaginal Disease Education in Canadian and American Gynecology Residency Programs: A Survey of Program Directors. J Low Genit Tract Dis 2018; 22 (3): 242-250. DOI: 10.1097/LGT.0000000000000390.
[24]	Marinoff SC, Turner ML. Vulvar vestibulitis syndrome. Dermatol Clin 1992; 10 (2): 435-44.
[25]	Meets, JF. Vulvodynia and vulvar vestibulitis: challenges in diagnosis and management. Am Fam Physician 1999; 59 (6): 1547-56, 1561-2.
[26]	Reed B. Vulvodynia: Diagnosis and Management. Am Fam Physician 2006; 73 (7): 1231-8.
[27]	Gardella C. Vulvar vestibulitis syndrome. Curr Infect Dis Rep 2006; 8 (6): 473-80. DOI: 10.1007/s11908-006-0022-8.
[28]	Michlewitz H, Kennison RD, Turksoy RN, Fertitta LC. Vulvar vestibulitis--subgroup with Bartholin gland duct inflammation. Obstet Gynecol 1989; 73 (3 Pt 1): 410-3.
[29]	Petersen E. Frauen mit chronischen Vulvabeschwerden. Frauenarzt 2012; 53 (3): 246-52. Available at: https://www.frauenarzt.de/index.php/heftarchiv/53-jahrgang-2012/frauenarzt-3-12/468-fa-2012-3-fort-frauen-mit-chronischen-vulvabeschwerden/file
[30]	Bohm-Starke N, Hilliges M, Blomgren B, Falconer C, Rylander E. Increased blood flow and erythema in the posterior vestibular mucosa in vulvar vestibulitis (1). Obstet Gynecol 2001; 98 (6): 1067-74. DOI: 10.1016/s0029-7844(01)01578-2.
[31]	Chan NP, Zimarowski MJ. Vulvar dermatoses: a histopathologic review and classification of 18 cases. J Cutan Pathol 2015: 42: 510–518. DOI: 10.1111/cup.12541.
[32]	Simpson RC, Thomas KS, Leighton P, Murphy R. Diagnostic criteria for erosive lichen planus affecting the vulva: an international electronic-Delphi consensus exercise. British Journal of Dermatology 2013; 169: 337–343.
[33]	Foster DC, Hasdey JD. Elevated Tissue Levels of Interleukin-l/3 and Tumor Necrosis Factor-a in Vulvar Vestibulitis. Obstet Gynecol 1997; 89: 291-6.
[34]	Wang Y, Song E, Bai B, Vanhoutte PM. Toll-like receptors mediating vascular malfunction: lessons from receptor subtypes. Pharm & Therap 2016; 18: 91-100. DOI: 10.1016/j.pharmthera.2015.12.005.
[35]	Hartmann D, Sarton J, Chronic pelvic floor dysfunction, Best Practice & Research Clinical Obstetrics and Gynaecology 2014. DOI: 10.1016/j.bpobgyn.2014.07.008.
[36]	Gentilcore-Saulnier E, McLean L, Goldfinger C, et al. Pelvic floor muscle assessment outcomes in women with and without provoked vestibulodynia and the impact of a physical therapy program. J Sex Med 2010; 7: 1003e22.
[37]	Kennedy CM, Nygaard IE, Saftlas A, Burns LT, Torner JC, Galask RP. Vulvar disease: A pelvic floor pain disorder? Am J Obstet Gynecol 2005; 192: 1829–35.
[38]	Stewart EG, Berger BM. Parallel pathologies? Vulvar vestibulitis and interstitial cystitis. J Reprod Med 1997; 42: 131-4.
[39]	de Jong JMJ, van Lunsen RHW, Robertson EA, Stam LNE, Lammes FB. Focal vulvitis: a psychosexual problem for which surgery is not the answer. J Psychosom Obstet Gynecol 1995; 16: 85-91.
[40]	Paavonen J. Diagnosis and treatment of vulvodynia. Ann Med 1995; 27: 175-81.
[41]	Foster DC, Robinson JC, Davis KM. Urethral pressure variation in women with vulvar vestibulitis syndrome. Am J Obstet Gynecol 1993; 169: 107-12.
[42]	Westrom LV, Willen R. Vestibular nerve fiber proliferation in vulvar vestibulitis syndrome. Obstet Gynecol 1998; 91: 572-6.
[43]	Comiter C. Sacral neuromodulation for the symptomatic treatment of refractory interstitial cystitis: a prospective study. J Urol 2003; 169: 1369-73.
[44]	Casale R, Elam M. Normal sympathetic nerve activity in a reflex sympathetic dystrophy with marked skin vasoconstriction. Journal of the Autonomic Nervous System 1992; (41): 215-220.
[45]	Harden RN, Bruehl, Perez RSGM, Birklein F, Marinus J, Maihofner C. et al. Validation of proposed diagnostic criteria (the "Budapest Criteria") for Complex Regional Pain Syndrome. Pain 2010; 150 (2): 268–274. DOI: 10.1016/j.pain.2010.04.030.

Cite This Article

Plain Text BibTeX RIS

APA Style

Vesna Harni, Damir Babic, Suzana Ljubojevic-Hadzavdic, Dubravko Barisic. (2022). Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I. Journal of Gynecology and Obstetrics, 10(6), 243-252. https://doi.org/10.11648/j.jgo.20221006.12

Copy | Download

ACS Style

Vesna Harni; Damir Babic; Suzana Ljubojevic-Hadzavdic; Dubravko Barisic. Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I. J. Gynecol. Obstet. 2022, 10(6), 243-252. doi: 10.11648/j.jgo.20221006.12

Copy | Download

AMA Style

Vesna Harni, Damir Babic, Suzana Ljubojevic-Hadzavdic, Dubravko Barisic. Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I. J Gynecol Obstet. 2022;10(6):243-252. doi: 10.11648/j.jgo.20221006.12

Copy | Download

@article{10.11648/j.jgo.20221006.12,
  author = {Vesna Harni and Damir Babic and Suzana Ljubojevic-Hadzavdic and Dubravko Barisic},
  title = {Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I},
  journal = {Journal of Gynecology and Obstetrics},
  volume = {10},
  number = {6},
  pages = {243-252},
  doi = {10.11648/j.jgo.20221006.12},
  url = {https://doi.org/10.11648/j.jgo.20221006.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20221006.12},
  abstract = {This study aimed to investigate the presence, type, and arrangement of nonspecific lesions considering the different histologies of the three vulvar rings in women with chronic vulvar discomfort to obtain reference data for the diagnostic procedure and a better understanding of women with chronic vulvar distress. The distribution of nonspecific lesions in the vulva based on vulvar rings was monitored as a secondary outcome measure within the framework of the prospective experimental study using diagnostic interventions called DATRIV, which included a total of 328 consecutive participants. Four patient groups were distinguished according to their medical history, structured International Society for the Study of Vulvovaginal Disease vulvodynia questionnaire results, and clinical examination, including inspection and cotton swab test. Asymptomatic participants were classified into normal vulva (N = 82) and impaired vulvar skin (N = 82) groups. Patients with chronic vulvar discomfort were categorized into groups of patients with primary, idiopathic vulvar distress/vulvodynia (N=82), and secondary complaints caused by vulvar dermatosis (N=82). Three rings vulvoscopy form data were used to collect clinical data, which were analyzed using StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). This study was approved by the Institutional Review Board of Polyclinic Harni, and all patients provided written informed consent. Nonspecific changes in the outer vulvar ring were significantly more common in patients with vulvar dermatosis (70.7%). The opposite pattern of lesion incidence was observed, with a considerably higher frequency of nonspecific findings in the inner vulvar ring in patients with vulvodynia (98.8%) and impaired vulvar skin (96.3%). The inner vulvar ring in patients with vulvodynia demonstrated a peculiar and characteristic profile with significantly more frequent findings of erythema (92.7%), punctuations (54.9%), ischemia (48.8%), and papillae (25.6%). A high presence of nonspecific lesions in the middle vulvar ring was documented in all participants, with an evident distinction in the appearance and allocation of these findings between patients with vulvodynia and vulvar dermatosis. By establishing the characteristic pattern of the type and distribution of nonspecific lesions in patients with vulvodynia, the Budapest criteria for considering vulvodynia as chronic reflex pain syndrome (CRPS) type 1, formerly sympathetic dystrophy, are met. Due to the specific three rings anatomy of the vulva, revised Budapest criteria are proposed. This study creates a unique opportunity to introduce vulvoscopy in the differential diagnosis of chronic, primary, and secondary vulvar discomfort.},
 year = {2022}
}

Copy | Download

TY  - JOUR
T1  - Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I
AU  - Vesna Harni
AU  - Damir Babic
AU  - Suzana Ljubojevic-Hadzavdic
AU  - Dubravko Barisic
Y1  - 2022/11/10
PY  - 2022
N1  - https://doi.org/10.11648/j.jgo.20221006.12
DO  - 10.11648/j.jgo.20221006.12
T2  - Journal of Gynecology and Obstetrics
JF  - Journal of Gynecology and Obstetrics
JO  - Journal of Gynecology and Obstetrics
SP  - 243
EP  - 252
PB  - Science Publishing Group
SN  - 2376-7820
UR  - https://doi.org/10.11648/j.jgo.20221006.12
AB  - This study aimed to investigate the presence, type, and arrangement of nonspecific lesions considering the different histologies of the three vulvar rings in women with chronic vulvar discomfort to obtain reference data for the diagnostic procedure and a better understanding of women with chronic vulvar distress. The distribution of nonspecific lesions in the vulva based on vulvar rings was monitored as a secondary outcome measure within the framework of the prospective experimental study using diagnostic interventions called DATRIV, which included a total of 328 consecutive participants. Four patient groups were distinguished according to their medical history, structured International Society for the Study of Vulvovaginal Disease vulvodynia questionnaire results, and clinical examination, including inspection and cotton swab test. Asymptomatic participants were classified into normal vulva (N = 82) and impaired vulvar skin (N = 82) groups. Patients with chronic vulvar discomfort were categorized into groups of patients with primary, idiopathic vulvar distress/vulvodynia (N=82), and secondary complaints caused by vulvar dermatosis (N=82). Three rings vulvoscopy form data were used to collect clinical data, which were analyzed using StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). This study was approved by the Institutional Review Board of Polyclinic Harni, and all patients provided written informed consent. Nonspecific changes in the outer vulvar ring were significantly more common in patients with vulvar dermatosis (70.7%). The opposite pattern of lesion incidence was observed, with a considerably higher frequency of nonspecific findings in the inner vulvar ring in patients with vulvodynia (98.8%) and impaired vulvar skin (96.3%). The inner vulvar ring in patients with vulvodynia demonstrated a peculiar and characteristic profile with significantly more frequent findings of erythema (92.7%), punctuations (54.9%), ischemia (48.8%), and papillae (25.6%). A high presence of nonspecific lesions in the middle vulvar ring was documented in all participants, with an evident distinction in the appearance and allocation of these findings between patients with vulvodynia and vulvar dermatosis. By establishing the characteristic pattern of the type and distribution of nonspecific lesions in patients with vulvodynia, the Budapest criteria for considering vulvodynia as chronic reflex pain syndrome (CRPS) type 1, formerly sympathetic dystrophy, are met. Due to the specific three rings anatomy of the vulva, revised Budapest criteria are proposed. This study creates a unique opportunity to introduce vulvoscopy in the differential diagnosis of chronic, primary, and secondary vulvar discomfort.
VL  - 10
IS  - 6
ER  -

Copy | Download

Author Information

Vesna Harni

Department of Obstetrics and Gynaecology, Polyclinic Harni, Zagreb, Croatia
Damir Babic

Department of Pathology and Cytology, University Hospital Center, Zagreb, Croatia
Suzana Ljubojevic-Hadzavdic

Department of Dermatovenereology, University Hospital Center, Zagreb, Croatia
Dubravko Barisic

Department of Obstetrics and Gynaecology, Kardinal Schwarzenberg Klinikum GmbH, Schwarzach im Pongau, Austria

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Vesna Harni, Damir Babic, Suzana Ljubojevic-Hadzavdic, Dubravko Barisic. (2022). Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I. Journal of Gynecology and Obstetrics, 10(6), 243-252. https://doi.org/10.11648/j.jgo.20221006.12

Copy | Download

ACS Style

Vesna Harni; Damir Babic; Suzana Ljubojevic-Hadzavdic; Dubravko Barisic. Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I. J. Gynecol. Obstet. 2022, 10(6), 243-252. doi: 10.11648/j.jgo.20221006.12

Copy | Download

AMA Style

Vesna Harni, Damir Babic, Suzana Ljubojevic-Hadzavdic, Dubravko Barisic. Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I. J Gynecol Obstet. 2022;10(6):243-252. doi: 10.11648/j.jgo.20221006.12

Copy | Download

@article{10.11648/j.jgo.20221006.12,
  author = {Vesna Harni and Damir Babic and Suzana Ljubojevic-Hadzavdic and Dubravko Barisic},
  title = {Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I},
  journal = {Journal of Gynecology and Obstetrics},
  volume = {10},
  number = {6},
  pages = {243-252},
  doi = {10.11648/j.jgo.20221006.12},
  url = {https://doi.org/10.11648/j.jgo.20221006.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20221006.12},
  abstract = {This study aimed to investigate the presence, type, and arrangement of nonspecific lesions considering the different histologies of the three vulvar rings in women with chronic vulvar discomfort to obtain reference data for the diagnostic procedure and a better understanding of women with chronic vulvar distress. The distribution of nonspecific lesions in the vulva based on vulvar rings was monitored as a secondary outcome measure within the framework of the prospective experimental study using diagnostic interventions called DATRIV, which included a total of 328 consecutive participants. Four patient groups were distinguished according to their medical history, structured International Society for the Study of Vulvovaginal Disease vulvodynia questionnaire results, and clinical examination, including inspection and cotton swab test. Asymptomatic participants were classified into normal vulva (N = 82) and impaired vulvar skin (N = 82) groups. Patients with chronic vulvar discomfort were categorized into groups of patients with primary, idiopathic vulvar distress/vulvodynia (N=82), and secondary complaints caused by vulvar dermatosis (N=82). Three rings vulvoscopy form data were used to collect clinical data, which were analyzed using StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). This study was approved by the Institutional Review Board of Polyclinic Harni, and all patients provided written informed consent. Nonspecific changes in the outer vulvar ring were significantly more common in patients with vulvar dermatosis (70.7%). The opposite pattern of lesion incidence was observed, with a considerably higher frequency of nonspecific findings in the inner vulvar ring in patients with vulvodynia (98.8%) and impaired vulvar skin (96.3%). The inner vulvar ring in patients with vulvodynia demonstrated a peculiar and characteristic profile with significantly more frequent findings of erythema (92.7%), punctuations (54.9%), ischemia (48.8%), and papillae (25.6%). A high presence of nonspecific lesions in the middle vulvar ring was documented in all participants, with an evident distinction in the appearance and allocation of these findings between patients with vulvodynia and vulvar dermatosis. By establishing the characteristic pattern of the type and distribution of nonspecific lesions in patients with vulvodynia, the Budapest criteria for considering vulvodynia as chronic reflex pain syndrome (CRPS) type 1, formerly sympathetic dystrophy, are met. Due to the specific three rings anatomy of the vulva, revised Budapest criteria are proposed. This study creates a unique opportunity to introduce vulvoscopy in the differential diagnosis of chronic, primary, and secondary vulvar discomfort.},
 year = {2022}
}

Copy | Download

TY  - JOUR
T1  - Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I
AU  - Vesna Harni
AU  - Damir Babic
AU  - Suzana Ljubojevic-Hadzavdic
AU  - Dubravko Barisic
Y1  - 2022/11/10
PY  - 2022
N1  - https://doi.org/10.11648/j.jgo.20221006.12
DO  - 10.11648/j.jgo.20221006.12
T2  - Journal of Gynecology and Obstetrics
JF  - Journal of Gynecology and Obstetrics
JO  - Journal of Gynecology and Obstetrics
SP  - 243
EP  - 252
PB  - Science Publishing Group
SN  - 2376-7820
UR  - https://doi.org/10.11648/j.jgo.20221006.12
AB  - This study aimed to investigate the presence, type, and arrangement of nonspecific lesions considering the different histologies of the three vulvar rings in women with chronic vulvar discomfort to obtain reference data for the diagnostic procedure and a better understanding of women with chronic vulvar distress. The distribution of nonspecific lesions in the vulva based on vulvar rings was monitored as a secondary outcome measure within the framework of the prospective experimental study using diagnostic interventions called DATRIV, which included a total of 328 consecutive participants. Four patient groups were distinguished according to their medical history, structured International Society for the Study of Vulvovaginal Disease vulvodynia questionnaire results, and clinical examination, including inspection and cotton swab test. Asymptomatic participants were classified into normal vulva (N = 82) and impaired vulvar skin (N = 82) groups. Patients with chronic vulvar discomfort were categorized into groups of patients with primary, idiopathic vulvar distress/vulvodynia (N=82), and secondary complaints caused by vulvar dermatosis (N=82). Three rings vulvoscopy form data were used to collect clinical data, which were analyzed using StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). This study was approved by the Institutional Review Board of Polyclinic Harni, and all patients provided written informed consent. Nonspecific changes in the outer vulvar ring were significantly more common in patients with vulvar dermatosis (70.7%). The opposite pattern of lesion incidence was observed, with a considerably higher frequency of nonspecific findings in the inner vulvar ring in patients with vulvodynia (98.8%) and impaired vulvar skin (96.3%). The inner vulvar ring in patients with vulvodynia demonstrated a peculiar and characteristic profile with significantly more frequent findings of erythema (92.7%), punctuations (54.9%), ischemia (48.8%), and papillae (25.6%). A high presence of nonspecific lesions in the middle vulvar ring was documented in all participants, with an evident distinction in the appearance and allocation of these findings between patients with vulvodynia and vulvar dermatosis. By establishing the characteristic pattern of the type and distribution of nonspecific lesions in patients with vulvodynia, the Budapest criteria for considering vulvodynia as chronic reflex pain syndrome (CRPS) type 1, formerly sympathetic dystrophy, are met. Due to the specific three rings anatomy of the vulva, revised Budapest criteria are proposed. This study creates a unique opportunity to introduce vulvoscopy in the differential diagnosis of chronic, primary, and secondary vulvar discomfort.
VL  - 10
IS  - 6
ER  -

Copy | Download