Bibliografia Medico-Scientifica • Vulvodinia.info

**Aida Blanchett** il Ven 04 Mar 2011, 23:59

Vulvodinia. Strategie di diagnosi e cura
Graziottin, Alessandra; Murina, Filippo
2011, Milano, Springer Verlag • http://www.springer.com/medicine/gynecology/book/978-88-470-1898-3?changeHeader

La vulvodinia. Linee di indirizzo per la gestione diagnostica e terapeutica
Dionisi Barbara; Murina Filippo; Puliatti Maria
2011, Roma, CIC Editore http://www.gruppocic.com/scheda_libri.php?ID=795

Il Dolore Intimo Vulvare e perineale
Vincenti, Ezio
2009, Padova, Piccin Editore • http://www.piccin.it/libri/9788829920167/il-dolore-intimo-vulvare-e-perineale.html

Vulvodinia
Spano, Nicoletta
2010, Milano, CUEM Editore • il manuale è consultabile online sul sito della dott.ssa: vestibolite.net

Il dolore femminile
a cura di Maria Puliatti
AA.VV.
2007, Salerno, Ecomind Srl

Vulvodinia e vestibolite vulvare
A cura di Luigi Benassi e Alessandra Graziottin
AA.VV.
2006, Roma, CIC Editore

Il dolore segreto. Le cause e le terapie del dolore femminile durante i rapporti sessuali
Graziottin, Alessandra
2005, Milano, Arnolodo Mondadori Editore

The Vulvodynia Survival Guide
Glazer, Howard, I., PhD., Rodke, Gae, M.D.
2002, Oakland, CA, New Harbinger Publications.

Link

http://www.gynevra.it/rubriche/libri.asp?ID=13&anno;=2005

http://www.alessandragraziottin.it/ew/ew_articoli/aquot/dolore%20segreto.jpg
http://www.alessandragraziottin.it/articoli.php?ANNO=2005&ART;_TYPE=AQUOT&EW;_FATHER=500&pageNo;=ND
> Vulvodinia ("vestibolite") • Etiopatogenesi e semeiologia - ruolo mastocita - polimorfismo genico - ipertono pavimento pelvico
> relazione Cistite - Vulvodinia (V post >> Lazzeri,Montorsi: Eur. Urol. 60(2011)78-80) +
+ precisazione in merito all'Epitelio di Transizione
> relazione Cistite Interstiziale - Vulvodinia

> CI (Cistite Interstiziale)
> Allodinia.info
> Allodinia.info II
> Gate Control Theory
> dolore neuropatico

Schede mediche prof.ssa Graziottin

schede mediche online in libera consultazione:
vestibolite vulvare
I parte http://www.fondazionegraziottin.org/it/scheda.php?EW_CHILD=10498
II parte http://www.fondazionegraziottin.org/it/scheda.php?EW_CHILD=10533
III parte http://www.fondazionegraziottin.org/it/scheda.php?EW_CHILD=10576
Corso su "Vulvodinia: semeiotica differenziale del dolore vulvare e delle comorbilità associate" - Obiettivi di apprendimento
Anni disponibili: 2010 2009 2008
http://www.fondazionegraziottin.org/it/articolo.php?EW_CHILD=13774
Interviste audiostream della prof. Graziottin:
"Dolore ai rapporti e vestibolite vulvare: guarire si può"
http://www.fondazionegraziottin.org/it/scheda.php?EW_CHILD=11064
"Dolore ai rapporti: tutte le strategie per guarire"
http://www.fondazionegraziottin.org/it/scheda.php?EW_CHILD=11066
"Il mastocita - Prima parte
Funzioni fisiologiche, fattori e conseguenze dell'iperattivazione"
http://www.fondazionegraziottin.org/it/scheda.php?EW_CHILD=13014
"Il mastocita - Seconda parte
Ruolo nel processo infiammatorio e nella genesi del dolore cronico"
http://www.fondazionegraziottin.org/it/scheda.php?EW_CHILD=13040
"Il mastocita - Terza parte
Ruolo nella patogenesi della vestibolite vulvare"
http://www.fondazionegraziottin.org/it/scheda.php?EW_CHILD=13072
Pubblicazioni dei siti della prof.ssa Graziottin
"Vulvodynia: a state-of-the-art consensus on definitions, diagnosis and management "
http://www.fondazionegraziottin.org/it/scheda.php?EW_CHILD=10194
"Vulvar Vestibulitis Syndrome: a Clinical Approach"
http://www.fondazionegraziottin.org/it/scheda.php?EW_CHILD=10268
"La vestibolite vulvare: prospettive terapeutiche"
http://www.fondazionegraziottin.org/it/scheda.php?EW_CHILD=10921
"La vestibolite vulvare: aspetti fisiopatologici e clinici"
http://www.fondazionegraziottin.org/it/scheda.php?EW_CHILD=10919
"La percezione del dolore pelvico cronico nella donna: fattori predittivi e implicazioni cliniche"
http://www.fondazionegraziottin.org/it/scheda.php?EW_CHILD=11186
"Dolore pelvico cronico: comorbilità e implicazioni psicosomatiche"
http://www.fondazionegraziottin.org/it/scheda.php?EW_CHILD=12180
"Neuropathic pain in vulvar vestibulitis: Diagnosis and treatment"
http://www.fondazionegraziottin.org/it/scheda.php?EW_CHILD=10816
Pubblicazioni del dottor Glazer

Howard I. Glazer Ph.D. is a Clinical Associate Professor at the Weill College of Medicine of Cornell University/New York Presbyterian Hospital, with a professional practice focus on surface electromyography in the diagnosis and treatment of lower urogenital tract, gastrointestinal tract, and sexual pain and dysfunction. . He is a Clinical Associate Professor at Cornell University Medical College/ New York Presbyterian Hospital, a member of the

International Society for the Study of Vulvovaginal Disease (ISSVD), a member of the Medical Board of the National Vulvodynia Association (NVA), and a member of the Editorial Advisory Board of the chronic pelvic pain section for OBGYN.net. His background combines neurophysiology/ neurochemistry, learning theory, sex therapy, behavioral medicine and electromyography. Dr. Glazer provides individual clinical services, training workshops, in-office speciality training, and he is actively involved in several multidisciplinary and multinational research projects.

http://www.vulvodynia.com/bio_med.htm
http://www.vulvodynia.com/bio_art.htm
Blibliografia Vulvodinia dr. Glazer
http://www.vulvodynia.com/bibliog.htm

Link Swab Test
http://www.vulvodiniapuntoinfo.com/h3-swab-test-q-tip-test
http://www.sciencedirect.com/science/article/pii/S0304395901004420
http://iopscience.iop.org/0967-3334/28/12/008;jsessionid=E8BC963F861F17BF2508F24792C384B0.c1
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2756618/
http://fx.damasgate.com/vulvar-vestibulitis-syndrome/
http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-0250&html;=1
http://www.articleco.com/Article/Vulvar-Vestibulitis-Syndrome/309779
http://www.jocmr.org/index.php/JOCMR/article/viewArticle/526/300

Link da Google Scholar
http://scholar.google.it/scholar?q=vulvodinia&hl;=it&btnG;=Cerca&lr;=
http://scholar.google.it/scholar?q=vestibolite&hl;=it&btnG;=Cerca&lr;=
http://scholar.google.it/scholar?q=vestibulodinia&hl;=it&btnG;=Cerca&lr;=
http://scholar.google.it/scholar?q=sindrome+della+vestibolite+vulvare&hl;=it&btnG;=Cerca&lr;=

Da MedicItalia
http://www.medicitalia.it/02it/notizia.asp?idpost=36710

Da Paginemediche.it
http://news.paginemediche.it/it/232/comunicati/ginecologia-e-ostetricia/comunicati-stampa/detail_98206_i-dati-sulla-vulvodinia-in-italia-dalla-conoscenza-alla-ricerca.aspx?c1=39&c2;=400

Risultati dello studio ESOVIA
http://www.salus.it/ginecologia-c31/i-dati-sulla-vulvodinia-in-italia--dalla-conoscenza-alla-ricerca-2359.html

Da Scientific Commons
http://en.scientificcommons.org/#search_string=vulvodynia
http://en.scientificcommons.org/#search_string=vulvar%20vestibulitis
http://en.scientificcommons.org/#search_string=vulvar%20vestibulitis%20syndrome

**Aida Blanchett** il Ven 22 Apr 2011, 20:49

The mastcell, director of chronic pelvic pain orchestra: implications for the gynaecologist

http://www.fondazionegraziottin.org/it/scheda.php?EW_CHILD=14610

Dal Journal of Rheumatology sul polimorfismo genico e l'MBL

http://www.jrheum.org/content/31/3/442.abstract

correlazione vv - MBL

alcuni articoli interessanti (in inglese)

http://www.biomedexperts.com/Profile.bme/1546904/Steven_S_Witkin

**Aida Blanchett** il Ven 06 Mag 2011, 21:38

http://www.fondazionegraziottin.org/it/scheda.php?EW_CHILD=14654

Dolore pelvico cronico: mastociti e fisiopatologia delle comorbilità

**Aida Blanchett** il Mar 10 Mag 2011, 07:43

"L'Adelmidrol nelle iperalgesie vulvovaginali nel post-parto e puerperio", Dott. Demetrio Costantino, Dirigente Medico I livello Azienza USL Ferrara Centro Salute Donna, pubblicazione dell' 11 marzo 2011

http://www.mcrferrara.org/download/relazioni/11marzo2011/Costantino.pdf

**Aida Blanchett** il Lun 23 Mag 2011, 09:11

In allegato

File allegati

: 2180 - mastociti e comorbilit.pdf Leggetelo e scaricatelo! ;)Non hai il permesso di scaricare i file.(136 kb) Scaricato 2 volte

**Aida Blanchett** il Gio 16 Giu 2011, 01:31

• Da National Institutes of Health

http://search2.google.cit.nih.gov/search?site=NIH_Master&client;=NIHNEW_frontend&proxystylesheet;=NIHNEW_frontend&output;=xml_no_dtd&filter;=0&getfields;=*&q;=vulvodinia&btnG.x;=0&btnG.y;=0

• Da Pubmed
Proliferazione delle fibre nervose vestibolari • Pubmed
Incremento dell'espressione dei recettori nocicettivi VR1 nel tesuto vestibolare • Pubmed
Riduzione dell'espressione dei recettori estrogenici nel tessuto vestibolare • Pubmed

Incremento di mastociti e del prodotto della loro degranulazione nel tessuto vestibolare • Pubmed
Presenza in elevata percentuale in donne con vestibolodinia di un polimorfismo genico, avente come risultato le seguenti alterazioni:
• ridotta capacità nell'arginare l'infiammazione • Pubmed
• amplificazione della risposta infiammatoria • Pubmed
• ridotta capacità di combattere la colonizzazione/infezione della Candida albicans • Pubmed

Studi inerenti la sensibilizzazione centrale nelle donne con vestibolodinia hanno dimostrato alti livelli di attività cerebrale nella corteccia somatosensoriale ed in quella insulare,durante l'applicazione di una pressione in corrispondenza del vestibolo posteriore • Pubmed

Alterazioni del pattern di contrattilità della muscolatura del pavimento pelvico • Pubmed

(schema delle pubblicazioni Pubmed tratto dal sito vulvodinia.eu - http://www.vulvodinia.eu/cause.html)

• Ultime pubblicazioni PubMed (arco temporale ultimo decennio)
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&term;=vulvodynia%20&db;=pubmed&orig;_db=pubmed&cmd;_current=Limits&pmfilter;_EDatLimit=added%20to%20PubMed%20in%20the%20last%2010%20years
http://orwh.od.nih.gov/health/CRISPvulvodynia.pdf
http://orwh.od.nih.gov/health/VulvoFactSheet_Spanish.pdf
• Ricerche cliniche in corso (riferito alla data di pubblicazione del presente post)
http://clinicaltrials.gov/ct2/results?term=vulvodynia

**Aida Blanchett** il Mar 28 Giu 2011, 01:42

per motivi di spazio lascio il link a pdf meta, in cui si trova molto materiale
http://www.pdfmeta.com/search.php?newwindow=1&safe;=high&cof;=FORID:10&cx;=017786792536956866424:fcudjo_sq-y&q;=vulvodinia&as;_q=more:all#1303

**Aida Blanchett** il Gio 06 Ott 2011, 03:51

[Ricercatori] del National Sun Yat-Sen Universit di Taiwan, stanno studiando una sostanza estratta dalle barriere coralline che sembra lenire il dolore alle articolazioni nervose.

I test sono stati condotti su un gruppo di topi, che ricordiamo manifestano sintomi e reazioni alle cure molto simili a quelle dell'uomo, ed è stato rilevato che questa sostanza, denominata "capnellene", ricavata dal corallo che è presente nei fondali di Green

Island, sembra in grado di rinforzare i tessuti che avvolgono i nervi riducendo le manifestazioni dolorose.

Al momento, scrive nella ricerca il dottor Zhi-Hong Wen, autore dello studio, sono ben pochi i medicinali in grado di conseguire questo

risultato, e lo studio del capnellene potrebbe portare alla produzione di un'intera categoria di agenti farmaceutici in grado di calmare il dolore ai nervi, nell'attesa di trovare una cura efficace.

http://www.tuttimedici.com/index.php?modulo=news&id;=1265

Qui la ricerca scientifica --> http://www.medicalnewstoday.com/articles/159674.php

Capnellene, a natural marine compound derived from soft coral, attenuates chronic constriction injury-induced neuropathic pain in rats.

Yen-Hsuan Jean, WuFu Chen, Chun-Sung Sung, Chan-Yih Duh, Shi-Ying Huang, Chan-Shing Lin, Ming-Hon Tai, Shun-Fen Tzeng and Zhi-Hong Wen

doi:10.1111/j.1476-5381.2009.00323.x

British Journal of Pharmacology

**Aida Blanchett** il Ven 14 Ott 2011, 17:16

The Relationship Of Interstitial Cystitis/Painful Bladder Syndrome to Vulvodynia.

Carrico D., Sherer K., Peters KM.

Source

The WISH Program, Department of Urology Beaumont Hospital, Royal Oak, MI, USA.
Abstract

• Introduction Many patients have interstitial cystitis/painful bladder syndrome (IC/PBS), a condition of frequency, urgency, and pain affecting more than 1 million women in the United States. The vulva, not the urethra or bladder, may actually be the site of some of the reported pain in women with IC/PBS.

• Purpose The purpose of this study was to identify the presence of vulvodynia in women diagnosed with IC/PBS.

• Method A mailed survey was used to identify women with IC/PBS who also reported vulvar pain. The survey also identified related factors, such as menstrual/hormonal status, sexual function, abuse, and sequence of vulvar and bladder pain from adolescence to adulthood.

Results Four-hundred-sixteen women with a documented diagnosis of IC/PBS were mailed a survey. The response rate was 49.6%, with 197 completed surveys returned. Results include vulvar pain in adolescence reported by 10.9% of the respondents, while vulvar pain in adulthood was reported by 48.4% of the women. During the last year, 62.7% of the respondents reported vulvar pain.

Ninety-five percent (95%) of the women reported having been sexually active in adulthood, but one-third were not currently sexually active; 27% reported fear of pain as the reason. An abuse history was reported by 28.5% of the women. Of the women who were postmenopausal (two-thirds of the group), 38% used hormone replacement therapy. Birth history showed no correlation to vulvar pain.

• Conclusions The chronic pain that IC/PBS patients feel may not be totally related to their bladder, but instead, may be vulvar pain.
The incidence of abuse, past pelvic surgeries, pelvic floor dysfunction, and the chronologic sequence of co-morbid symptoms should be further assessed.
http://www.ncbi.nlm.nih.gov/pubmed/19718938
Urol Nurs. 2009 Jul-Aug;29(4):233-8.

**Aida Blanchett** il Ven 13 Gen 2012, 19:21

http://www.ncbi.nlm.nih.gov/pubmed?term=vulvodynia

**Aida Blanchett** il Ven 03 Feb 2012, 00:23

“Focus sulla vulvodinia” del dr. Filippo Murina, Pelviperineologia, giugno 2010, pubblicato in http://www.vulvodiniapuntoinfo.com/t36-vulvodinia-impr-vestibolite-o-etiopatogenesi-e-semeiologia-ruolo-mastocita-polimorfismo-genico-ipertono-pavimento-pelvico

1. Haefner, H.K., Collins, M.E., Davis, G.D., et Al. The vulvodynia guideline, J Lower Genital Tract Disease, 9 (2005) 40-51.

2. Sarma, A.V., Foxman, B., Bayirli, B., Haefner, H. and Sobel, J., Epidemiology of vulvar vestibulitis syndrome; an exploratory case-control study, Sex Tran Inf, 75 (1999) 320-6.

3. B abula, O., Danielsson, I., Sjoberg, I., Ledger, W.J. and Witkin, S.S., Altered distribution of mannose-binding lectin alleles at exon I codon 54

in women with vulvar vestibulitis syndrome, Am J Obstet Gynecol, 191 (2004) 762-6.

4. Gerber, S., Bongiovanni, A.M., Ledger, W.J. and Witkin, S.S., Defective regulation of the proinflammatory immune response in women with vulvar vestibulitis syndrome, Am J Obstet Gynecol, 186 (2002) 696-700.

5. Gerber, S., Bongiovanni, A.M., Ledger, W.J. and Witkin, S.S., Interleukin- 1beta polymorphism in women with vulvar vestibulitis syndrome, Eur J Obstet Gynecol Reprod Biol, 107 (2003) 74-7.

6. Glazer, H.I., Jantos, M., Hartmann, E.H. and Swenclonis, C., Electromyographic comparisons of the pelvic floor in women with dysesthetic vulvodynia and asymptomatic women, J Reprod Med, 43 (1998) 959-962

7. Glazer, H.I., Dysesthetic vulvodynia. Long-term follow-up after treatment with surface electromyography-assisted pelvic floor muscle rehabilitation, J Reprod Med, 45 (2000) 798-802.

8. Murina F, Bianco V, Radici G, Felice R, Di Martino M, Nicolini U. Transcutaneous electrical nerve stimulation to treat vestibulodynia: a randomised controlled trial. BJOG Aug 2008; 115:1165-1170

9. Murina F, Tassan P, Roberti P, Bianco V. Treatment of vulvar vestibulitis with submucous infiltrations of methylprednisolone and lidocaine. J Low Genit Tract Dis. 2002 Jan;6(1):62

10. Glazer HI, Rodke G, Swencionis C, Hertz R, Young AW. Treatment of vulvar vestibulitis syndrome with electromiographic biofeedback of

pelvic floor muscolature. J Reprod Med 1995;40:283-90

**Aida Blanchett** il Lun 27 Feb 2012, 14:39

1. Bachmann GA, Rosen R, Pinn VW, Utian WH, Ayers C, Basson R, et al. Vulvodynia: a state-of-the-art consensus on definitions, diagnosis and management. J Reprod Med 2006;51:447-56.

Cited Here... | PubMed

2.Foster DC, Hasday JD. Elevated tissue levels of interleukin-1 beta and tumor necrosis factor-alpha in vulvar vestibulitis. Obstet Gynecol

1997;89:291-6.

Cited Here... | View Full Text | PubMed | CrossRef

3.Haefner HK, Collins ME, Davis GD, Edwards L, Foster DC, Hartmann ED, et al. The vulvodynia guideline. J Low Genit Tract Dis 2005;9:40-51.

Cited Here... | View Full Text | PubMed | CrossRef

4.Jeremias J, Ledger WJ, Witkin SS. Interleukin 1 receptor antagonist gene polymorphism in women with vulvar vestibulitis. Am J Obstet Gynecol 2000;182:283-5.

Cited Here...

5.Goetsch MF. Vulvar vestibulitis: prevalence and historic features in a general gynecologic practice population. Am J Obstet Gynecol 1991;164:1609-14.

Cited Here... | PubMed

6.Harlow BL, Stewart EG. A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of

vulvodynia? J Am Med Womens Assoc 2003;58:82-8.

Cited Here... | PubMed

7.Reed BD, Crawford S, Couper M, Cave C, Haefner HK. Pain at the vulvar vestibule: a web-based survey. J Low Genit Tract Dis 2004;8:48-57.

Cited Here... | View Full Text | PubMed | CrossRef

8.Reed BD, Haefner HK, Harlow SD, Gorenflo DW, Sen A. Reliability and validity of self-reported symptoms for predicting vulvodynia. Obstet

Gynecol 2006;108:906-13.

Cited Here... | View Full Text | PubMed

9.Harlow BL, Wise LA, Stewart EG. Prevalence and predictors of chronic lower genital tract discomfort. Am J Obstet Gynecol 2001;185:545-50.

Cited Here... | View Full Text | PubMed | CrossRef

10.Reed BD, Caron AM, Gorenflo DW, Haefner HK. Treatment of vulvodynia with tricyclic antidepressants: efficacy and associated factors. J Low Genit Tract Dis 2006;10:245-51.

Cited Here... | View Full Text | PubMed | CrossRef

11.Bazin S, Bouchard C, Brisson J, Morin C, Meisels A, Fortier M. Vulvar vestibulitis syndrome: an exploratory case-control study. Obstet Gynecol 1994;83:47-50.

Cited Here... | View Full Text | PubMed

12.Bohm-Starke N, Johannesson U, Hilliges M, Rylander E, Torebjork E. Decreased mechanical pain threshold in the vestibular mucosa of women using oral contraceptives: a contributing factor in vulvar vestibulitis? J Reprod Med 2004;49:888-92.

Cited Here... | PubMed

13.Bouchard C, Brisson J, Fortier M, Morin C, Blanchette C. Use of oral contraceptive pills and vulvar vestibulitis: a case-control study. Am J

Epidemiol 2002;156:254-61.

Cited Here...

14.Johannesson U, Blomgren B, Hilliges M, Rylander E, Bohm-Starke N. The vulval vestibular mucosa-morphological effects of oral contraceptives and menstrual cycle. Br J Dermatol 2007;157:487-93.

Cited Here... | View Full Text | PubMed | CrossRef

15.Sjoberg I, Nylander Lundqvist EN. Vulvar vestibulitis in the north of Sweden. An epidemiologic case-control study. J Reprod Med 1997;42:166-8.

Cited Here... | PubMed

Obstetrics & Gynecology August 2008 - Volume 112 - Issue 2, Part 1 doi: 10.1097/AOG.0b013e318180965b Original Research Vulvodynia Incidence and Remission Rates Among Adult Women: A 2-Year Follow-up Study

**Aida Blanchett** il Sab 17 Mar 2012, 02:12

Economic Burden and Quality of Life of Vulvodynia in the United States.

Xie Y., Shi L., Xiong X., Wu E., Dade C.

Abstract.
Objective To explore the economic burden and quality of life of vulvodynia in the United States.
Methods We conducted a web-based survey from 2009 to 2010. Patients who responded to the advertisement of National Vulvodynia Association completed the survey every month recording their own costs and their employers' payments related to vulvodynia in the past month. A total of 302 patients entered data for at least one month and among them, 97 patients had completed data for six months.

We used multiple imputation to generate values for unobserved cost components. For insurance payments, we also extracted the average insurance payments for direct health care service related to vulvodynia from a commercial insurance database. The total costs were disaggregated into direct health care costs, direct non-health care costs and indirect costs. We also assessed patients' quality of life by using Euro QOL 5 dimensions (EQ-5D) in a follow-up survey.
Results The total costs in six months were $8862.40 per patient, of which $6043.34 (68.19%) was direct health care costs, $553.81 (6.25%) was direct non-health care costs and $2265.25 (25.56%) was indirect costs.

Based on the reported prevalence range of 3% to 7% in the U.S., our analysis yielded an annual national burden ranging from $31 billion to $72 billion in the United States. Yet the estimate should be viewed with caution as our study sample was a non-probability sample. The average EQ-5D score was 0.74±0.19 among vulvodynia patients.
Conclusion Vulvodynia is associated with a huge economic burden to both individuals and the society. It is also related to a relatively low quality of life.

http://www.ncbi.nlm.nih.gov/pubmed/22356119

**Aida Blanchett** il Sab 17 Mar 2012, 02:14

J Sex Med. 2012 Feb 21. doi: 10.1111/j.1743-6109.2011.02641.x. [Epub ahead of print]Provoked Vestibulodynia-Women's Experience of Participating in a Multidisciplinary Vulvodynia Program.

Sadownik LA, Seal BN, Brotto LA.
Source

Department
of Obstetrics & Gynecology, University of British Columbia,
Vancouver, Canada Department of Psychology, University of
the Fraser Valley, Abbotsford, Canada.

Abstract

Introduction.
Provoked Vestibulodynia (PVD) is the most common cause of pain with
intercourse that affects reproductively aged women. The treatment
outcome literature suggests that existing treatments, when administered
individually, may have only limited benefits for improving pain, and
that multidisciplinary approaches may be more effective for reducing
pain and pain-associated distress. A program that offers education,
group cognitive behavioral therapy, pelvic floor physiotherapy, and
medical appointments was developed and implemented at our hospital site.
Aim. To explore the experiences of women who participated in the
Multidisciplinary Vulvodynia
Program (MVP) in order to identify the perceived benefits of this
program. Methods. Qualitative retrospective study. A semi-structured
interview format was used to interview graduates of the MVP. Nineteen
women, mean age 30.8 (20-54 years), participated in a one-on-one
in-depth interview with a trained interviewer. The key question asked
was "What has been the impact of the MVP on your life?" Interviews were
audio-recorded, transcribed, and qualitatively analyzed for major
themes. Main Outcome Measure. Content analysis of interview
transcripts. Results. Five main themes emerged and included: increased
knowledge, gained tools/skills, perceived improved mood/psychological
well-being, a sense of validation and support, and an enhanced sense of
empowerment. Conclusion. Overall, a multidisciplinary vulvodynia
program was perceived as being beneficial for women with PVD. Sadownik
LA, Seal BN, and Brotto LA. Provoked vestibulodynia-Women's experience
of participating in a multidisciplinary vulvodynia program. J Sex Med **;**:**-**.
© 2012 International Society for Sexual Medicine.

**Aida Blanchett** il Sab 21 Apr 2012, 02:17

Copio breve estratto da un articolo scientifico datato 27 April 2007 sul sito OurGyn a firma del dr. Andrew Goldstein. Interessa la parte che lui stesso ha evidenziato in grassetto:

In addition to a proliferation of nerve endings in the vestibule, there is a proliferation of mast cells in the vestibule. Mast cells are the white blood cells that are responsible for allergic and inflammatory reactions. 3) Up to 50% of women with VVS have a defect in one of 2 genes (IL1-RA, IL-1 beta) that are responsible for limiting inflammatory conditions in the body. If we put these (and other) pieces of information together, a new hypothesis is emerging. (Actually, we must give credit to Dr. Stanley Marinoff who first published this hypothesis in 1986- long before there was data to support it.)

VVS may be initiated by an allergic reaction to a chemical irritant in the vulvar vestibule. This irritation – possibly to topical antifungals, other medications, or chemicals- causes mast cells to migrate to the vestibule. If the irritation persists, activation of mast cells leads to an uncontrolled proliferation of nociceptors in the mucosa.

This hypothesis explains why up to 80% of women with VVS complain of an acute onset of symptoms that includes burning and itching, which then
progress to severe pain on touch. The pain on touch often then persists even after the initial symptoms of itching and burning disappear. Of course, further studies are ongoing to assess the validity of this hypothesis.
Fonte

Perciò insisto e persisto nel sottolineare che il fattore chimico non è assolutamente da sottovalutare e l'uso di detergenti e di lubrificanti con componenti chimiche dannose va evitato nel modo più assoluto.

Usare solo acqua per risciacquarsi.

**Aida Blanchett** il Sab 21 Apr 2012, 02:24

A Search for Helicobacter pylori in Localized Vulvodynia
Adam Gevaa, Edmond Sabof, Josef Levyb, Monique Blumenthale, Ella Ophird, e, Hana Gevac, Jacob Bornsteind, e aWomen’s Health Center and bGastroenterology Unit, Lin Clinic, cDepartment of Quality Assurance, Rambam Medical Center, and dRappaport Faculty of Medicine, Hatechnion University, Haifa, and eDepartment of Obstetrics and Gynecology, Western Galilee Hospital, Nahariya, Israel;
fDepartment of Pathology, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, R.I., USA Address of Corresponding Author Gynecol Obstet Invest 2008;66:152-156 (DOI: 10.1159/000135712)
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.
Copyright © 2008 S. Karger AG, Basel

Fonte

**Aida Blanchett** il Sab 21 Apr 2012, 02:37

Int J Gynecol Pathol. 2008 Jan;27(1):136-41.
Involvement of heparanase in the pathogenesis of localized vulvodynia.
Bornstein J, Cohen Y, Zarfati D, Sela S, Ophir E.
Source
Department of Obstetrics and Gynecology, Research Laboratory and Department of Pathology, Western Galilee Hospital, Nahariya, Israel. [email protected]
Abstract
Recently, we have shown that vestibular hyperinnervation and the presence of 8 or more mast cells in a 10 x 10 microscopic field can be used as diagnostic criteria in localized vulvodynia (vulvar vestibulitis). We have also documented that degranulation of mast cells occurs in these cases. The present study further examines the characteristics of vestibular hyperinnervation and mast cell function in localized vulvodynia to elucidate if the 2 processes-hyperinnervation and mast cell increase and degranulation-are related. We examined vestibular tissue from 7 women aged 18 to 48 with severe localized vulvodynia and from 7 healthy control women. Parallel sections were stained by Giemsa and then immunostained for CD117 and heparanase. Nerve fibers that expressed protein gene product 9.5 were examined. Tissues from women with localized vulvodynia documented a significant increase in vestibular mast cells, subepithelial heparanase activity, and intraepithelial hyperinnervation compared with healthy women. This is the first documentation of heparanase activity in localized vulvodynia. Heparanase, which is degranulated from mast cells, is capable of degrading the vestibular stroma and epithelial basement membrane, thus permitting stromal proliferation and intraepithelial extension of nerve fibers, as seen in the present study. The hyperinnervation has been thought to cause the vestibular hyperesthesia distinctive of localized vulvodynia.
PMID: 18156988 [PubMed - indexed for MEDLINE]
Fonte

Cosa è l' eparanasi?

L'eparanasi è un enzima che agisce sulla superficie delle cellule e all'interno della matrice cellulare, con effetti degradanti.

Idrolizza le catene di eparansolfato (HS) dei proteoglicani.

L’eparanasi è un enzima implicato nel ricambio di molte molecole dei tessuti connettivi tra cui le cellule della parete dei vasi sanguigni. Negli ultimi anni è molto studiato in ambito oncologico come possibile bersaglio di nuovi farmaci anti-tumorali per ridurre la capacità di dare metastasi. Relativamente recente è l’interesse per questa molecola in àmbito diabetologico. Ricercatori dell’Università di Haifa, in Israele, hanno rilevato un aumento considerevole (circa 10 volte) di eparanasi nei campioni di urine e di plasma di soggetti con diabete tipo-2. In queste persone, gli elevati livelli di zucchero e di insulina stimolerebbero le cellule del rene a produrre eparanasi. Questo fatto, a sua volta, danneggerebbe i vasi sanguigni innescando la catena di effetti che porta alle complicanze del diabete.

Fonte: Shafat I et al. PLoS One. 2011 Feb 22;6(2):e17312.

Tra l'altro è il responsabile (come è facile intuire) dell'invecchiamento cutaneo (rughe, etc).

**Aida Blanchett** il Sab 12 Gen 2013, 01:10

Richiamo la bibliografia presente nel sito del dr. Glazer:

http://www.vulvodynia.com/bibliog.htm
http://www.vulvodynia.com/bibliog2.htm
http://www.vulvodynia.com/bibliog3.htm
http://www.vulvodynia.com/bibliog4.htm

**Aida Blanchett** il Lun 18 Mag 2015, 16:57

Articoli scientifici più recenti ricerca scientifica sulla Vulvodinia • Associazione VulvodiniaPuntoInfo ONLUS

(grazie a MyVulvodynia.com)

The incidence rates of vulvodynia differ by age, ethnicity, and marital status. Onset is more likely among women with previous symptoms of vulvodynia or those with intermediate symptoms not meeting criteria for vulvodynia and among those with pre-existing sleep, psychological, and comorbid pain disorders. This suggests vulvodynia is an episodic condition with a potentially identifiable prodromal phase.

Fonte:
http://journals.lww.com/greenjournal/Citation/2014/02000/Factors_Associated_With_Vulvodynia_Incidence.2.aspx

Remission of vulvar pain among women with primary vulvodynia.

Our study underscores the heterogeneity of vulvodynia and provides evidence that primary vulvodynia may have a less wavering course and, as such, a potentially different underlying mechanism than that of secondary vulvodynia.

Fonte http://www.ncbi.nlm.nih.gov/pubmed/24859843

Vulvodynia-An Evidence-Based Literature Review and Proposed Treatment Algorithm.

The optimal therapy for vulvar pain syndrome remains elusive, with low percentages of therapeutic success, using either local or systemic pharmacological approaches. Surgery involving invasive and often irreversible therapeutic procedures has resulted in success for certain subtypes of vulvodynia. We present a multidisciplinary approach whereby pain treatment units may provide an intermediate level of care between standard medical and surgical treatments.
© 2015 World Institute of Pain.
Fonte http://www.ncbi.nlm.nih.gov/pubmed/25581081

Bibliografia Medico-Scientifica • Vulvodinia.info