Characteristics of the pain observed in the focal vulvodynia syndrome (VVS)
Characteristics of the pain observed in the focal vulvodynia syndrome (VVS)
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DOI：
10.1016/j.mehy.2011.09.030
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发表时间：
2012-01-01
影响因子：
4.7
通讯作者：
Bellen, Gert
中科院分区：
文献类型：
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作者：
Donders, Gilbert;Bellen, Gert
局灶性外阴痛或外阴前庭炎综合征（VVS）患者的症状和体征在部位和严重程度上是可变的。目前尚不清楚前庭最严重疼痛的位置是否与主诉有关，也许是不同的实体。临床直觉提示，两种不同类型的局灶性外阴痛可能集中在2点（5点和7点）或4点（5点、7点、1点和11点）。30名局灶性外阴痛妇女在147次访视中填写了一份问卷，并由一名独立的研究护士检查其完整性。另一名研究者评价VVS的临床体征，对患者病史或主诉设盲。尝试性接触时经历的疼痛的视觉模拟评分（VAS）用作严重程度的标志。使用Q-tip评估外阴局部疼痛，前庭7个区域的评分为1 - 10分。除了性接触时的疼痛外，47%的患者在插入阴茎时也有疼痛。超过40%的女性遭受超过3年的痛苦，70%的女性由于无法忍受的疼痛而不得不中断性交行为，25%的女性由于这种疼痛而从未有过满意的性生活。在高疼痛评分（VAS）的女性中，感觉深度疼痛，性接触后持续12-24小时的烧灼感以及停止性交的尝试更为突出：VAS >7的女性中有26%在过去一年中没有性生活，而低疼痛评分组中有6%（p = 0.004）。与仅在5点和7点疼痛的患者相比，在1点和11点处患有尿道旁疼痛区的患者在深穿透时更经常疼痛，并且在插入卫生棉条时经历更多的疼痛（p = 0.001）。1点和11点有局灶性疼痛的患者有更深的疼痛感，但在插入卫生棉条时感觉较少。因此，双灶性疾病可能具有与4灶性疾病不同的发病机制。Bartholin腺和Skene腺可能参与了本病的发病。(C)2011爱思唯尔有限公司保留所有权利。
Symptoms and signs of patients with focal vulvodynia or vulvo-vestibulitis syndrome (VVS) are variable in location and severity. It is not known whether the location of the most severe pain in the vestibulum is linked to the complaints and perhaps a different entity. A clinical gut feeling suggests that two distinct varieties of focal vulvodynia may be either focused at 2 points (5 and 7 o' clock) or at 4 points (5, 7, 1 and 11 o' clock).A questionnaire was filled out by 30 women with focal vulvodynia during 147 visits and checked for completeness by an independent study nurse. Another investigator to evaluated the clinical signs of VVS, blinded to the patients history or complaints. The visual analogue score (VAS) of pain experienced upon attempt of sexual contact was used as a marker of severity. Focal vulvar pain was assessed using Q-tip with a score from 1 to 10 on 7 areas of the vestibulum.Besides pain during sexual contact, 47% also had pain on inserting a tampon. More than 40% of women suffer since more than 3 years, 70% had to interrupt the act of sexual intercourse mostly or always due to unbearable pain and 25% never had satisfactory sex due to this pain. Feeling deep pain, burning lasting for 12-24 h after sexual contact, and stopping the attempt of intercourse were more prominent in women with high pain scores (VAS): 26% of women with VAS >7 had no sex during the last year versus 6% in the group with low pain score (p = 0.004). Patients suffering from para-urethral pain zones at 1 and 11 o' clock, have more often pain upon deep penetration, and experienced more pain when inserting tampons than patients with only painful areas at 5 and 7 o' clock (p = 0.001).We conclude that patients with severe disease display a different panel of complaints than women with less pain. Patients with focal pain at 1 and 11 o' clock have more deep pain sensations, but feel less pain during insertion of tampons. Hence disease with bi-focal disease may have a different ethipathogenesis that 4-focal disease. Glands of Bartholin and Skene may be involved in this pathogenenis. (C) 2011 Elsevier Ltd. All rights reserved.