PREVALENCE AND ETIOLOGICAL PREDICTORS OF VULVODYNIA

描述（改编自申请人的描述）：外阴痛是一种 不明原因的外阴瘙痒、灼热和/或疼痛综合征，导致严重的 身体和心理上的痛苦。当出现这种情况时， 外阴不适在许多个月内变成慢性的， 其他可补救的原因，如感染或皮炎，被排除。两 外阴痛的主要亚型-全身性外阴感觉迟钝， 前庭痛--经常被错误分类。很少描述性或病因学 进行了流行病学研究。因此， 一般人群的发病率未知，没有可预防的暴露 已经被确认。美国国立卫生研究院最近主办的一次共识会议强调， 需要确定外阴痛的患病率，并进行基于人群的 观察性研究，以确定可改变的风险因素。 申请方已在超过100个国家进行了基于人口的流行率调查， 400名妇女，达到70%的答复率，发现18%的妇女， 报告了一个持续三年的慢性外阴症状的终身病史 几个月或更长。在所有接受调查的妇女中，约有8%目前 出现这些症状。此外，申请人进行了试点 对31名诊断为感觉迟钝性外阴痛或 前庭痛，或两者的组合在过去五年内， 将他们与31名年龄相仿的健康女性进行了比较， 人口平均而言，报告医疗事故的可能性是报告医疗事故的三倍。 治疗或外科手术的条件，可能会影响 会阴疼痛，或更频繁地使用避孕套和使用避孕粉 可能导致粘膜磨损和炎症。 申请人现在提议对16 000名20至59岁的妇女进行调查， 一般人群，以估计外阴痛的年龄特异性患病率。从 这个样本，申请人将确定400例外阴痛，验证 通过两步筛选过程，与400个频率匹配的样本 年龄和居住地控制。结构化面试将评估广泛的 与创伤有关的暴露范围。80个病例和80个 对照组将接受临床检查，以确认是否存在或 没有外阴疼痛，还将提供阴道灌洗和外阴拭子 用于细胞因子评估和微生物培养的样本 有机体申请人假设各种类型的外阴创伤可能 在女性经历自发性和诱发性外阴疼痛之前， 外阴痛和外阴痛可能是一种特殊类型的复杂的变体 区域疼痛综合征，与感觉障碍一致，如 机械性异常性疼痛

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.