SANTA FE, N.M. -- Psychological disturbances probably do not contribute to the development or maintenance of vulvodynia, according to results of a cross-sectional study.
Psychological factors such as sexual and physical abuse, depression, and marital difficulties have been postulated to play a role in the onset and maintenance of vulvodynia for many years. But there have been few controlled studies that have examined the issue, Dr. Barbara D. Reed noted at the International Society for the Study of Vulvovaginal Disease World Congress.
Vulvodynia is a chronic pain disorder of unknown cause characterized by minimal or no physical findings at the location of the pain and tenderness at the vulva when touched with a cotton swab. Pain with sexual intercourse is common, Dr. Reed said.
She and her associates at the University of Michigan, Ann Arbor, gave lengthy questionnaires and a battery of standardized psychological inventories to new patients attending the university's gynecology clinics.
A personal history of sexual abuse was reported by 21% of 31 vulvodynia patients and 26% of 23 asymptomatic controls, a nonstatistical difference. But 63% of the 18 women with chronic pelvic pain but no vulvodynia reported such a history, Dr. Reed reported.
A history of physical abuse was also significantly more common among chronic pelvic pain patients, reported by 42% of the women in this group. In contrast, only 5% of the vulvodynia patients and none of the controls reported a history of physical abuse.
Women in all three groups reported similar levels of marital satisfaction, positive and negative feelings toward their sexual partner in the prior week, and interest in sex.
Patients with vulvodynia scored similarly to controls with respect to family history of depression, a personal history of depression, and current depression. But those with chronic pelvic pain had significantly higher rates on all three measures.
Patients with chronic pelvic pain scored significantly higher than vulvodynia patients on measures of pain disability, affective distress, and somatic preoccupation. Chronic pelvic pain patients also had significantly more physical symptoms in other parts of their body than women with vulvodynia and controls.
Physical Therapy Eases Vulvodynia Symptoms
SANTA FE, N.M. - Referral to a physical therapist who specializes in women's health may be helpful for patients with dysesthetic vulvodynia, Elizabeth H. Hartmann suggested at the International Society for the Study of Vulvovaginal Disease World Congress.
Mrs. Hartmann, a physical therapist in private practice in Naperville, Ill., treated 15 patients with vulvodynia that occurred without local pressure or intercourse using a variety of physical therapy techniques. She usually saw them once a week. The mean number of visits was 16.
The patients had their symptoms for an average of 5.2 years. Current and previous treatments included but were not limited to antidepressants, vulvar surgery, acupuncture, and calcium citrate diets.
Following physical therapy intervention, 13 of the women reported that physical therapy had significantly decreased their vulvodynia symptoms and that their sexual activity had increased. All four patients who had previously quit work because of their pain had returned to work.
A total of 19 physical therapy techniques were used. All patients received internal and external soft tissue mobilization, internal and external therapeutic exercise, and pelvic floor retraining. Biofeedback, interferential electrical stimulation to the pelvis, diet modulation, and visceral mobilization were used in 10 of the women treated. These are techniques that most physical therapists are familiar with, but "with women's health, they are utilized just a bit differently," Mrs. Hartmann noted.
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