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Reproductive Sciences (Thousand Oaks,... Oct 2013Vulvar and vaginal atrophy (VVA) is a chronic, progressive medical condition prevalent among postmenopausal women, which produces symptoms such as dyspareunia, vaginal... (Review)
Review
Vulvar and vaginal atrophy (VVA) is a chronic, progressive medical condition prevalent among postmenopausal women, which produces symptoms such as dyspareunia, vaginal dryness, and vaginal irritation. Currently, the only prescription options are systemic and vaginal estrogen therapies that may be limited by concerns about long-term safety and breast cancer risk. Ospemifene is a tissue-selective estrogen agonist/antagonist (a selective estrogen receptor modulator) recently approved by the US Food and Drug Administration for treatment of dyspareunia, a symptom of VVA, due to menopause. Ospemifene, the first nonestrogen oral treatment for this indication, may provide an alternative to treatment with estrogen. Animal models with ospemifene suggest an inhibitory effect on growth of malignant breast tissue, but animal data cannot necessarily be extrapolated to humans. Clinical trials, including 3 long-term studies assessing the overall safety of ospemifene, support that ospemifene is generally well tolerated, with beneficial effects on the vagina, neutral effects on the breast, and minimal effects on the endometrium.
Topics: Animals; Breast; Dyspareunia; Female; Humans; Postmenopause; Selective Estrogen Receptor Modulators; Tamoxifen; Vagina; Vulva
PubMed: 23945733
DOI: 10.1177/1933719113497290 -
Cureus Sep 2022Research evaluating optimal repair techniques for the reduction of postpartum dyspareunia following obstetric laceration is severely limited. Prevailing guidelines from... (Review)
Review
Research evaluating optimal repair techniques for the reduction of postpartum dyspareunia following obstetric laceration is severely limited. Prevailing guidelines from the American College of Obstetricians and Gynecologists (ACOG) are reliant on data from just nine clinical trials conducted from 1980 to 2012. While the literature on this topic is still limited today, this review aims to synthesize data from past and present studies to ensure that standing clinical recommendations are supported by current literature. A review was conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Medical Literature Analysis and Retrieval System Online (MEDLINE), Cochrane Library, and Google Scholar were searched. Included articles (1) compared continuous with interrupted repair techniques for subjects with episiotomies and/or second-degree tears, (2) were available in full length, and (3) reported dyspareunia as an outcome variable. Excluded articles were those (1) inclusive of first-, third-, or fourth-degree tears; (2) comparing suture material rather than technique; and (3) not available in English. A meta-analysis was conducted for both acute dyspareunia (<3 months) and chronic dyspareunia (>3 months) utilizing Meta-Essentials Microsoft Excel (Microsoft Corp., Redmond, WA) workbook. Bias was evaluated via Egger regression and Begg and Mazumdar rank correlation tests. Twelve articles met inclusion and exclusion guidelines, seven for acute dyspareunia and eight for chronic dyspareunia. All publications were randomized controlled trials and were inclusive of a total of 4,081 patients. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random effect model. Analysis revealed no statistically significant difference between continuous and interrupted suture groups for acute dyspareunia (RR: 0.98; 95% CI: 0.89-1.08) or chronic dyspareunia (RR: 0.96; 95% CI: 0.83-1.12). Egger regression test (p-value=0.534) and Begg and Mazumdar rank correlation test (p-value=0.570) indicated minimal publication bias. Compiled data does not indicate a preferential suture technique for the reduction of postpartum dyspareunia. These findings are congruent with the ACOG guidelines; therefore, there is no supporting evidence for ACOG's recommendation of continuous suturing to be overturned.
PubMed: 36259006
DOI: 10.7759/cureus.29070 -
European Review For Medical and... Sep 2016Vaginal atrophy is a chronic, progressive medical condition that affects fifty percent of postmenopausal women, causing symptoms like dyspareunia, vaginal dryness, and... (Review)
Review
OBJECTIVE
Vaginal atrophy is a chronic, progressive medical condition that affects fifty percent of postmenopausal women, causing symptoms like dyspareunia, vaginal dryness, and vaginal irritation. Until recently, the only prescription options were systemic and vaginal estrogen therapies that might be limited by concerns about long-term safety and breast cancer risk. The objective is to analyze the literature about ospemifene, a tissue-selective estrogen receptor modulator (SERM) recently approved for the treatment of vulvovaginal atrophy and dyspareunia and to compare its effects with those of the other SERMs to assess its safety.
MATERIALS AND METHODS
Review. Medline search.
RESULTS
Ospemifene treats vaginal atrophy, and, if compared with other SERMS, it has no or not significant effects on endometrium and thromboembolism. Experimental and animal models suggest an inhibitory effect on the growth of malignant breast tissue. The available clinical data support ospemifene breast safety.
CONCLUSIONS
Ospemifene relieves moderate to severe symptoms of vulvovaginal atrophy, like dryness, irritation and soreness around the genital area, and painful sexual intercourse, in menopausal women. It is well tolerated, and it has neutral effects on endometrium and coagulation. Clinical trials and even long-term studies on breast cancer effects support ospemifene overall safety.
Topics: Animals; Atrophy; Dyspareunia; Female; Humans; Models, Animal; Postmenopause; Tamoxifen; Vagina; Vulva
PubMed: 27735020
DOI: No ID Found -
American Journal of Medical Genetics.... Dec 2021Vulvodynia is debilitating vulvar pain accompanied by dyspareunia (pain with sexual intercourse). Ehlers-Danlos syndromes (EDS) and hypermobility spectrum disorders...
Vulvodynia is debilitating vulvar pain accompanied by dyspareunia (pain with sexual intercourse). Ehlers-Danlos syndromes (EDS) and hypermobility spectrum disorders (HSD) may represent a predisposing factor for vulvodynia given a high rate of dyspareunia in these conditions. We conducted an online survey of women with EDS or HSD to assess rates of dyspareunia and estimate rates of vulvodynia, report rates of comorbid conditions common to EDS or HSD and vulvodynia, and examine rates of conditions contributing to dyspareunia in women with EDS or HSD. Women with EDS or HSD (N = 1,146) recruited via social media were 38.2 ± 11.5 years old, primarily White (94.4%), and resided in the United States (78.5%). 63.7% of participants reported dyspareunia and 50% screened positive for vulvodynia. The rate of comorbid conditions common to EDS or HSD and vulvodynia were: irritable bowel syndrome, 6.5%; fibromyalgia, 40.0%; temporomandibular joint dysfunction, 56.4%; migraine, 6.7%; interstitial cystitis, 1.7%; and mast cell activation syndrome, 10.2%. Participants reporting dyspareunia also reported ovarian cysts, fibroids, or abdominal or pelvic scars, 47.5%; endometriosis, 26.5%; and genital lacerations, 19.3%. Women with EDS or HSD may have a higher rate of vulvodynia (50.0%) than women in the U.S. population at large (8%) and should be assessed for dyspareunia and vulvodynia.
Topics: Adult; Dyspareunia; Ehlers-Danlos Syndrome; Female; Humans; Joint Instability; Mast Cell Activation Syndrome; Middle Aged; Vulvodynia
PubMed: 34747110
DOI: 10.1002/ajmg.c.31939 -
Women's Health (London, England) Aug 2015Endometriosis is classically defined as the presence of endometrial glands and stroma in outside the uterine cavity. As the definition suggests that confirming the... (Review)
Review
Endometriosis is classically defined as the presence of endometrial glands and stroma in outside the uterine cavity. As the definition suggests that confirming the ectopic endometrial stroma and glands in ectopic location histopathologically should be necessary for the diagnosis of endometriosis. Therefore, this situation leads to the need for surgery like laparoscopy for diagnosis. However, this surgical diagnostic approach will not be reliable for all patients with suspected endometriosis. It seems to be an important problem that there is still no reliable clinically diagnostic method or pathognomonic clinical finding, which may allow accurate diagnosis of endometriosis without the need for surgery or histopathologic evaluation. While these clinical features are not pathognomonic for the endometriosis, they should be used as markers for creating high-risk population for endometriosis. Clinical features and the available diagnostic methods, their advantages and limitations for the endometriosis will be discussed in this article. The different options for clinical assessment, laboratory tests and imaging techniques will be summarized and the advantages and disadvantages of these methods will be evaluated. We will also discuss the gold standard definitive diagnostic options with their problematic aspects.
Topics: Diagnostic Imaging; Dysmenorrhea; Dyspareunia; Endometriosis; Female; Humans; Ovarian Cysts; Ovarian Diseases; Pelvic Pain
PubMed: 26389666
DOI: 10.2217/whe.15.44 -
European Urology Open Science Nov 2022Even though surgery generally improves sexual function and alleviates dyspareunia related to pelvic organ prolapse (POP), knowledge of the long-term effects is scarce.
BACKGROUND
Even though surgery generally improves sexual function and alleviates dyspareunia related to pelvic organ prolapse (POP), knowledge of the long-term effects is scarce.
OBJECTIVE
To describe changes in sexual activity and dyspareunia rates after POP surgery and to identify potential risk factors for the occurrence of dyspareunia.
DESIGN SETTING AND PARTICIPANTS
This was a prospective longitudinal cohort study of women aged over 18 yr undergoing POP surgery in Finland during 2015. Out of 3515 participants, sexual activity and dyspareunia data were available at baseline, 6 mo, 2 yr, and 5 yr for 79%, 68%, 63%, and 57%, respectively.
INTERVENTION
Native tissue, transvaginal mesh, and abdominal mesh repair.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Rates of sexual activity and dyspareunia were assessed using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) at baseline and at 6 mo, 2 yr, and 5 yr after surgery. As a secondary outcome, risk factors for overall, persisting, and de novo dyspareunia were assessed using logistic regression models.
RESULTS AND LIMITATIONS
The proportion of sexually active women increased from 40.7% to 43% after surgery. Preoperative dyspareunia resolved in >50% of cases during the first 6 mo, irrespective of the surgical approach. De novo dyspareunia rates were low at all time points (1.9-3.1%). Several potential risk factors associated with preoperative and postoperative dyspareunia were identified: younger age, lower preoperative body mass index, lower prolapse stage at baseline, either pelvic pain or dyspareunia at baseline, prior surgery (stress urinary incontinence surgery, posterior colporrhaphy, POP surgery, hysterectomy), and posterior repair.
CONCLUSIONS
Dyspareunia is significantly reduced after POP repair irrespective of the surgical approach. However, multiple factors seem to be associated with persisting and de novo symptoms, which should be considered in preoperative counseling.
PATIENT SUMMARY
Our 5-year follow-up study demonstrates that surgery to repair pelvic organ prolapse (POP) in women improves sexual activity and reduces painful intercourse. Multiple factors, such as preoperative pain, previous POP surgery, and prolapse stage, may be associated with painful intercourse after surgery.
PubMed: 36353662
DOI: 10.1016/j.euros.2022.09.014 -
British Medical Journal (Clinical... May 1984
Topics: Adolescent; Adult; Dyspareunia; Female; Humans; Middle Aged
PubMed: 6426641
DOI: 10.1136/bmj.288.6430.1555 -
American Family Physician Jan 2019
Review
Topics: Adjuvants, Immunologic; Administration, Intravaginal; Dehydroepiandrosterone; Dyspareunia; Female; Humans; Postmenopause; Randomized Controlled Trials as Topic
PubMed: 30633482
DOI: No ID Found -
Obstetrics and Gynecology Mar 2022To identify distinct trajectories of dyspareunia in primiparous women and examine biopsychosocial risk factors of these trajectories.
OBJECTIVE
To identify distinct trajectories of dyspareunia in primiparous women and examine biopsychosocial risk factors of these trajectories.
METHODS
This was a prospective cohort of 582 first-time mothers. Participants completed validated measures of dyspareunia at 20-24 (baseline) and 32-36 weeks of gestation and at 3, 6, 12, and 24 months postpartum. Risk factors were assessed at baseline and 3 months postpartum, with labor and delivery characteristics collected by medical record review. Latent class growth analysis was conducted to identify homogeneous subgroups with distinct trajectories of dyspareunia. Univariable and multivariable binomial logistic regressions examined whether predictors were associated with these trajectories.
RESULTS
Overall, the prevalence of dyspareunia ranged from 31.4% at 3 months postpartum to 11.9% at 24 months. We identified two distinct classes of dyspareunia with 21% of women in the class with moderate dyspareunia and 79% in the class with minimal dyspareunia, with pain decreasing in both groups until 12 months postpartum and little change thereafter. Biomedical factors-prior chronic pain (including preexisting dyspareunia), labor epidural analgesia, induction, episiotomy, perineal laceration, mode of delivery, breastfeeding, and whether the woman had a new pregnancy during the postpartum period-did not significantly predict dyspareunia class. Greater fatigue (odds ratio [OR] 1.30; 95% CI 1.05-1.60) and depressive symptoms (OR 1.08; 95% CI 1.02-1.14) in pregnancy and fatigue (OR 1.27; 95% CI 1.04-1.56) and pain catastrophizing (OR 1.10; 95% CI 1.05-1.16) at 3 months postpartum increased the odds for the moderate relative to the minimal pain trajectory in univariable models. In a multivariable model, pain catastrophizing at 3 months postpartum (OR 1.09; 95% CI 1.04-1.15) was associated with the moderate relative to the minimal pain trajectory.
CONCLUSION
We identified two distinct trajectories of dyspareunia across pregnancy and postpartum. One in five nulliparous women experienced moderate dyspareunia. Pain catastrophizing at 3 months postpartum was associated with experiencing moderate relative to minimal levels of dyspareunia.
Topics: Adolescent; Adult; Disease Progression; Dyspareunia; Female; Follow-Up Studies; Humans; Logistic Models; Nova Scotia; Odds Ratio; Parity; Patient Acuity; Pregnancy; Pregnancy Complications; Prevalence; Prognosis; Prospective Studies; Risk Factors; Young Adult
PubMed: 35115480
DOI: 10.1097/AOG.0000000000004662 -
Acta Obstetricia Et Gynecologica... May 2011There has been a trend towards increased use of synthetic meshes and abdominal procedures with decreased use of sacrospinous fixation (SSF). A Medline search was... (Review)
Review
There has been a trend towards increased use of synthetic meshes and abdominal procedures with decreased use of sacrospinous fixation (SSF). A Medline search was performed for the MeSH terms 'sacrospinous ligament', 'sacrospinous fixation', 'sacrospinous ligament suspension' and 'sacrospinous colpopexy'. Published papers from 1996-2010 were selected for analysis. Outcome measures were assessed in terms of efficacy, complications and quality of life after sacrospinous vaginal fixation. Studies on bilateral SSF and fixing uterus to the sacrospinous ligament, use of concomitant anti-incontinence procedures along with SSF were not included in this review. Sacrospinous vaginal fixation provides good long-term objective and subjective outcomes and improves quality of life of women with pelvic organ prolapse. Further, complication rates of SSF are comparable to abdominal sacrocolpopexy and are much less than transvaginal mesh procedures and SSF is a cost-effective procedure. SSF is a time-tested surgical procedure with a reduction in surgical extent and has a definite place in modern pelvic reconstructive surgery.
Topics: Dyspareunia; Fecal Incontinence; Female; Gynecologic Surgical Procedures; Humans; Ligaments, Articular; Pelvic Organ Prolapse; Quality of Life; Randomized Controlled Trials as Topic; Plastic Surgery Procedures; Sacrum; Spine; Surveys and Questionnaires; Treatment Outcome; Urinary Incontinence; Uterine Prolapse
PubMed: 21306342
DOI: 10.1111/j.1600-0412.2011.01084.x