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Bernard L. Harlow, PhD
Harvard Medical School
Prevalence And Etiological Predictors Of Vulvodynia
Abstract: DESCRIPTION (Adapted from the applicant's description):
Vulvodynia is a syndrome of unexplained vulvar itching, burning,
and/or pain that causes major physical and psychological distress.
It is a diagnosis of exclusion when vulvar discomfort becomes chronic
over many months and the presence of any other remediable cause,
such as infection or dermatitis, is ruled out. The two major subtypes
of vulvodynia -- generalized vulvar dysesthesia and vestibulodynia
-- are often misclassified. Few descriptive or etiologic epidemiological
studies have been performed. Thus, the prevalence and incidence
in the general population is unknown and no preventable exposures
have been identified. A recent NIH sponsored consensus conference
stressed the need to determine the prevalence of vulvodynia and
conduct population-based observational studies to identify modifiable
risk factors. The applicant has conducted a population-based prevalence
survey in more than 400 women that achieved a 70% response rate
and found that 18% of women reported a lifetime history of chronic
vulvar symptoms that lasted three months or longer. Approximately
8% of all women surveyed were currently experiencing these symptoms.
In addition, the applicant conducted a pilot case-control study
of 31 women diagnosed with either dysesthetic vulvodynia or vestibulodynia,
or a combination of the two within the last five years and compared
them to 31 similarly aged healthy women identified from the general
population. Cases were, on average, three times more likely to report
medical treatments or surgical procedures for conditions that may
have influenced perineal pain, or a greater frequency of condom
use and use of talcum powder in the genital area that may have lead
to mucosal abrasion and inflammation. The applicant now proposes
to survey 16,000 women 20-59 years of age from the general population
to estimate the age-specific prevalence of vulvodynia. From this
sample, the applicant will identify 400 cases of vulvodynia, verified
through a two-step screening process, and a sample of 400 frequency
matched age and county of residence controls. Structured interviews
will assess a wide spectrum of exposures related to trauma. A subsample
of 80 cases and 80 controls will receive a clinical examination
to confirm the presence or absense of vulvodynia, and also will
provide a vaginal lavage and vulvar swab specimen for the assessment
of cytokines and the culturing of microbiological organisms. The
applicant hypothesizes that various types of vulvar trauma may precede
the spontaneous and evoked vulvar pain experienced by women with
vulvodynia and that vulvodynia may be a variant of a specific type
of Complex Regional Pain Syndrome that is consistent with sensory
disturbances such as mechanical allodynia.
back to NIH Funding
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