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Vulvodynia is a chronic pain condition in which women experience extreme discomfort and pain during sexual intercourse. Although widely misdiagnosed and under-diagnosed, many women suffer from vulvodynia, with prevalence rates estimated as high as 16% within the United States (U.S.) However, very little is known as to what causes this chronic pain condition, resulting in inconsistent and varied treatment protocols. In turn, women with vulvodynia often report experiencing multidimensional levels of distress, particularly psychological, sexual, and relational in nature. It is also evident that vulvodynia can negatively impact women’s gender identity, especially the working definition of womanhood. The purpose of this qualitative study was to utilize Interpretative Phenomenological Analysis to develop greater understanding and insight as to the ways in which the lived experience of vulvodynia impacted four heterosexual women’s gender identity. Results of this study revealed the following four superordinate themes and seven subordinate themes: 1) critical time periods (i) initial adjustment to vulvodynia after first sexual intercourse was the most difficult time period, (ii) diagnosis was a turning point, and (iii) acceptance of vulvodynia and development of healthy coping strategies; 2) alienation and isolation (iv) feeling inherently different from other women and (v) feeling misunderstood, dismissed, and not believed by others, especially by medical professionals; 3) positive impacts upon life (vi) finding my voice and (vii) reclaiming and renewed appreciation for my body and my physical self; and 4) personalized definitions of womanhood based on individuals’ lived experiences and social contexts. In conclusion, implications for healthcare providers and future directions of research are offered.

Bakgrund: Provocerad vulvodyni är ett smärttillstånd som innebär smärta vid provokation av vaginan, exempelvis beröring eller penetration. Fysioterapi är förstahandsvalet vid behandling. Det saknas forskning kring vilken fysisk aktivitetsnivå (FA) de drabbade kvinnorna har och vilken tilltro de har till sin förmåga att vara fysiskt aktiva. Syfte: Undersöka och kartlägga underlivssmärta, FA och tilltro till sin förmåga att vara fysiskt aktiv hos en grupp med provocerad vulvodyni och jämföra resultatet med en kontrollgrupp. Även undersöka om det finns något samband mellan kvinnor med provocerad vulvodynis skattade underlivssmärta och FA samt FA och tilltro till sin förmåga att vara fysiskt aktiv. Metod: Tvärsnittsstudie med icke-experimentell design. Deltagarna var kvinnor mellan 18–40 år. De med provocerad vulvodyni inkluderades i undersökningsgruppen (n=29) och de utan inkluderades i kontrollgruppen (n=32). Deltagarna rekryterades via enkätutskick i fem facebookgrupper. Resultat: Undersökningsgruppen ägnade mindre tid åt vardagsmotion jämfört med kontrollgruppen, men det var ingen signifikant skillnad avseende fysisk träning samt den sammanlagda fysiska aktiviteten en vanlig vecka, skattat med Socialstyrelsens indikatorfrågor för fysisk aktivitet. Undersökningsgruppen hade en lägre tilltro till sin förmåga att vara fysiskt aktiv skattat enligt Swedish Exersice Self-Efficacy Scale jämfört med kontrollgruppen. I undersökningsgruppen fanns ett signifikant samband mellan FA och tilltro till sin förmåga att vara fysiskt aktiv men inte mellan skattad underlivssmärta och FA. Slutsats: Resultatet antyder att kliniska insatser bör fokusera på att undersöka och stärka kvinnornas tilltro till sin förmåga att vara fysiskt aktiv i syfte att öka deras FA. Vidare forskning behövs på ämnet. / Background: Provoked vulvodynia (PV) is a condition involving pain upon provocation of the vagina, for example touch or penetration. Physiotherapy is the first choice for treatment.There is a lack of research on the physical activity level (PA) of the affected women and their self-efficacy of being physically active (SE-PA). Aim: To investigate vulva pain, PA and SE-PA in a group with PV and compare the results with a control group. Also investigate whether there is any relationship between women with PV estimated vulva pain and PA as well as PA and SE-PA. Method: Cross-sectional study with non-experimental design. The participants were women between 18–40 years old. Those with PV were included in the study group (n=29) and those without were included in the control group (n=32). The participants were recruited by posting a survey in five Facebook groups. Results: The study group spent less time on everyday exercise compared to the control group, but there was no significant difference regarding physical exercise and total amount of physical activities during a normal week, estimated with the National Board of Health and Welfare's indicator questions for physical activity. The study group had a lower SE-PA asassessed according to the Swedish Exercise Self-Efficacy Scale, compared to the controlgroup. In the study group, there was a significant relationship between PA and SE-PA, but not between estimated vulva pain and PA. Conclusion: The result suggests that clinical interventions should focus on investigating and strengthening women's SE-PA in order to increase their PA. Further research is needed.

Orientadores: Paulo César Giraldo, Rose Luce Gomes do Amaral / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T19:21:36Z (GMT). No. of bitstreams: 1 Yoshida_LauraPagotto_M.pdf: 3666243 bytes, checksum: be3b6471fc51fe29366a20aeb4370f79 (MD5) Previous issue date: 2012 / Resumo: Quadros vulvovaginais dolorosos crônicos causados por vulvodínia são queixas comuns nos consultórios ginecológicos, com prevalência de 9 a 16% nas mulheres americanas sexualmente ativas. Além de dor na relação sexual, a mulher com vulvodínia se apresenta ansiosa, depressiva e com alteração significativa em sua função sexual. Objetivo: Avaliar o tratamento fisioterápico com estimulação elétrica do tipo corrente interferencial (CI) em mulheres com vulvodínia localizada provocada (VLP). Desenho do estudo: Ensaio clínico randomizado cego simples com 32 mulheres com queixa de dor vulvovaginal ao coito há, pelo menos 6 meses, alocadas em dois grupos: tratamento versus controle-placebo. O primeiro recebeu 8 sessões de estimulação elétrica com CI (Endophasys NMS-0501 - KLD Biosistemas Equipamentos Eletrônicos Ltda., método bipolar, 4000Hz, amplitude de modulação de frequência de 100Hz, por 20 minutos) e o segundo recebeu os mesmos procedimentos, sem passagem de corrente elétrica. Os parâmetros analisados pré e pós-tratamento foram: dor subjetiva na relação sexual vaginal (escala visual analógica), frequência mensal de relações sexuais vaginais, dor no toque vulvar em exame físico (teste do cotonete, de 0 a 10) e função sexual feminina (questionário Índice de Função Sexual Feminina - FSFI). Os dados foram analisados usando testes Qui-quadrado de Pearson, Exato de Fisher e Mann-Whitney. O início e final do tratamento foram comparados pelo teste de Wilcoxon (amostras relacionadas) e de McNemar (efeito da intervenção), considerando nível de significância estatística de 5%. O software utilizado foi o SAS (Release 9.1, SAS Institute,Cary, NC, USA, 2002-2003) e o SPSS Statistics (Release 17.0). Resultados: Os grupos foram homogêneos em relação à idade, índice de massa corpórea (IMC), cor da pele, escolaridade, uso de anticoncepcional oral e de preservativo masculino. Os escores totais do FSFI na avaliação inicial entre os grupos tratamento e controle foram 19,01±4,85 e 18,13±8,27, e após a intervenção 27,35±3,64 e 21,25±6,74 (p=0,0001 e p=0,0125), respectivamente. A dor subjetiva na relação sexual vaginal diminuiu significativamente em ambos os grupos (de 7,69±1,13 para 4±2,41; p=0,0002, no grupo tratamento e 8,19±1,27 para 4,92±2,46; p=0,0010, no grupo controle). O número de relações sexuais vaginais mensais aumentou de 4,94±3,71 para 6,21±3,03 (p=0,0234) no primeiro e de 4±4,56 para 4,38±3,25 (ns) no segundo grupo. A análise da sensibilidade ao toque na região vulvar apresentou diminuição significativa da dor apenas no grupo tratamento, de 7,44±1,54 para 3,21±2,39 (p=0,0002), versus de 6,50±1,96 para 4,54±3,45 (ns), no grupo controle. Conclusão: O tratamento da VLP com CI promoveu melhora na função sexual das mulheres estudadas, aumento na frequência de relações vaginais mensais e diminuição da sensibilidade da dor vulvovaginal ao toque / Abstract: Vulvovaginal chronic pains caused by vulvodynia are common complaints in gynaecological clinics with a prevalence of 9-16% in sexually active American women. In addition to complaining of pain during intercourse, the woman with vulvodynia appears anxious, depressed and with significant changes in their sexual function. Objective: To evaluate physical therapy with electrical stimulation with interferential current (IC) in women with localized provoked vulvodynia (LPV). Materials and Methods: Single blind randomized clinical trial with 32 women with vulvovaginal pain during vaginal intercourse for at least six months, divided into two groups: treatment versus placebo-controlled. The first group received eight sessions of electrical stimulation with IC (Endophasys NMS-0501 - KLD Electronic Equipment Biosystems Ltda., Bipolar method, 4000Hz, amplitude modulation frequency of 100Hz for 20 minutes) and the second received the same procedures, without passing electric current. The parameters analysed before and after treatment were: subjective pain in vaginal intercourse (visual analogue scale), monthly frequency of vaginal intercourse, vulvar sensibility at touch during physical exam (cotton-swab test, 0-10) and sexual function (Female Sexual Function Index - FSFI). Data were analysed using chi-square test, Fisher exact and Mann-Whitney test. The beginning and end of treatment were compared using the Wilcoxon test (related samples) and McNemar (intervention effect), with statistical significance level of 5%. The software used was SAS (Release 9.1, SAS Institute, Cary, NC, USA, 2002- 2003) and SPSS (Release 17.0). Results: The groups were homogeneous regarding to age, body mass index, skin colour, schooling, use of oral contraceptives and condoms. The total scores of the FSFI of the treatment and control groups improved from 19.01±4.85 to 27.35±3.64 (p=0,0001) and from 18.13±8.27 to 21.25±6.74 (p=0.0125), respectively. The subjective pain during intercourse vaginal improved significantly in both groups (7.69±1.13 to 4±2.41; p=0.0002 in the treatment group and 8.19±1.27 to 4.92±2.46; p=0.0010 in the control group). The number of vaginal intercourse increased from 4.94±3.71 to 6.21±3.03 (p=0.0234) in the treatment group and 4±4.56 to 4.38±3.25 (ns) in the placebo group. The analysis of the sensibility to touch in the vulvar region significantly decreased only in the treatment group (7.44±1.54 to 3.21±2.39; p=0.0002, versus 6.50±1,96 to 4.54±3.45; (ns) in the control group). Conclusion: The treatment of LPV with IC promoted improvement in sexual function of women studied, increase in the monthly frequency of vaginal intercourse and a decrease in pain intensity at vulvar touch / Mestrado / Fisiopatologia Ginecológica / Mestra em Ciências da Saúde

In this study I want to explore and give voice to the lived embodied experiences of women affected by vulvodynia in Italy. Through an autoethnography and two qualitative interviews, I will try to investigate if their embodied experiences question or not the normative construction of female body in Italian context.

Problem: Vulvodynia, an unexplained vulvar pain, is a medical condition affecting women of all ages, races, and ethnicities and causes pain levels ranging from very mild discomfort to extreme suffering. Purpose: The purpose of this study was to explore women’s knowledge toward seeking care for vulvodynia and to explore the different types of treatments prescribed after diagnosis. The secondary purpose of this review was to describe the treatments most effective in reducing pain caused by vulvodynia. Methods: A review of the literature was conducted using articles from 2001 to 2021 that focused on diagnosis of vulvodynia and the relief of pain with various types of treatment options for women diagnosed with vulvodynia. Multiple databases were used, and world-wide research was compiled for context on diagnosis of vulvodynia and treatment options that worked best to reduce pain. From the literature review, 14 articles met the inclusion criteria and were used to compare diagnosis of vulvodynia and the different treatment methods to relieve pain. Results: All studies suggest women did not seek immediate care or have a timely diagnosis for vulvodynia because of speculation by health care providers that vulvodynia is a pseudoscience. Women avoided seeking early diagnosis due to embarrassment discussing the condition and fear of skepticism about the level of pain associated with vulvodynia. The studies showed topical ointments and complementary treatments were the most prescribed agents. Effectiveness ranged from no pain relief to complete relief, but the conclusions were relatively similar in all the results. A multidisciplinary approach to vulvodynia, with mental health professionals and gynecologic providers had the best outcomes in relieving pain and optimizing treatment. Conclusion: Knowledge about vulvodynia is very limited due to under diagnosis and embarrassment of admitting that something is wrong. Most of the research conducted was a general overview of cases and is focused on diagnosis of the condition. Benefits of therapy differ from woman to woman and complete pain relief, or remission is elusive in many instances. CAM therapies in combination with medications for individuals with vulvodynia to alleviate pain can be useful and finding multiple methods that can be used together for pain relief is of value for further research.

Female sexual pain is a common problem affecting women worldwide yet remains a poorly researched area of women’s sexual health. Dyspareunia and vaginismus are two types of sexual pain disorder each having psychological and physical health consequences for women and their partners. Part 1: A literature review of the qualitative research literature exploring women’s experiences of sexual pain disorders and their treatment was conducted adopting a narrative synthesis approach. Searches of psychological and medical electronic databases highlighted the paucity of research exploring women’s experiences of sexual pain disorders. Ten studies met the inclusion criteria for the review. The type of qualitative method and quality varied. Findings highlighted the complexity of women’s experiences of sexual pain. Positive experiences of treatment identified alternative benefits of treatment in addition to the traditional outcome of vaginal penetration and penetration without pain. Existing literature has focussed on dyspareunia, and further research is needed on vaginismus. Part 2: The research study used an Interpretative Phenomenological Analysis (IPA) of women’s experiences of vaginismus. Three women were interviewed about their experiences of vaginismus and the treatment they received. Interview transcripts were analysed using IPA. The findings identified the complexity of experiencing vaginismus, the struggle the women faced when trying to make sense of their vaginismus and the wider impact of these experiences on their identity. The findings highlight the value of psychological therapy with this client group and of the need to raise awareness amongst primary care professionals whom women with vaginismus are likely to consult in the first instance. Part 3: A critical appraisal of the research process is presented with focus on the experience of conducting qualitative research as a trainee clinical psychologist. A discussion of the findings is presented in the context of critical reflections on both the strengths and limitations of the study.

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Previous studies have suggested that protective responses in the pelvic floor muscles (PFMs), described in terms of hypertonicity and over-reactivity, are associated with and may worsen the symptoms of provoked vestibulodynia (PVD, i.e., chronic vulvar pain). A recent study reported that, upon manual palpation of the PFM, hypertonicity was consistently found in the superficial but not the deep PFM layers. The goals of this study were to compare superficial and deep PFM resting tone, protective response magnitude and onset timing to moderate perceived vulvar pain between women with and without PVD. Eleven women with PVD and eleven control women Tcompleted a gynecological examination and standardized PFM electromyography (EMG) testing. Three trials of sTurface EMG activity of the PFM were recorded while a pressure-pain stimulus (PPS) was applied to the vulvar vestibule. Increasing pressure was applied to achieve a perceived pain intensity rating of 6/10 using an 11-point numerical rating scale presented visually. The women with PVD had higher resting EMG activity in their superficial PFMs (p=0.04) as compared to the control group, while no difference was found at the level of the deep PFMs (p=0.12). Participants in both groups demonstrated contractile responses to the PPS in both the superficial and the deep PFM, and these responses were significantly higher (p=0.0001) in the superficial (50.06 vs 38.69 % maximal voluntary electrical activation [MVE]) as compared to the deep (24.88 vs 22.52 %MVE) PFM layers. Women with PVD had significantly higher PFM responses at the superficial layer as compared to the control women (p<0.0005). The onset of the superficial and deep EMG PFM responses followed the PPS application in both groups. No differences were found between the deep and superficial PFM onset latency to the timing of the PPS application.The results of this study suggest that women with PVD have superficial PFMs that are more responsive to vulvar pain than those in non-affected women. The findings also suggest that superficial PFM over-reactivity, rather than deep PFM over-reactivity, is part of the PFM dysfunction reported in women with PVD. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2008-09-26 15:46:22.84

Provoked Vestibulodynia (PVD) is a common form of chronic genital pain, affecting approximately 12% of premenopausal women. Even though knowledge of vulvodynia has been present in the medical field for many years, it was previously thought to be of psychogenic origin and has never been thoroughly investigated for the purpose of pain classification. When investigating any pain condition, one of the most important distinctions to make is whether or not the pain is neuropathic. Even though this possibility has never been investigated in women with PVD, some have claimed that PVD pain contains elements of neuropathy, even treating this pain with medication created for neuropathic pain conditions. The purpose of this study was to use standardized measures and determine whether PVD may have a neuropathic component. Women with PVD completed an online survey assessing various pain and psychosocial variables. Their responses were compared with those of pain-free controls and women experiencing an established neuropathic pain condition, post-herpetic neuralgia (PHN). Women with PVD scored above established cut-offs on measures of neuropathic pain (NP). Further, for some NP measures there was no difference in scores between PVD and PHN women. Women with PVD also had similar psychosocial profiles as those with PHN, although women with PHN reported poorer health-related quality of life. Interestingly, the number of NP symptoms did not predict pain/psychosocial disturbance, or vary as a function of pain duration or intensity. Overall, these results lend support to the argument that PVD is a chronic pain condition. Further, these results indicate that women with PVD likely experience some form of NP. These results add to the understanding and classification of PVD, justifying further investigation, for example, via psychophysical testing and functional magnetic resonance imaging. / Thesis (Master, Psychology) -- Queen's University, 2011-09-21 16:25:34.216