PREVALENCE AND ETIOLOGICAL PREDICTORS OF VULVODYNIA

描述(改编自申请者的描述)：外阴疼痛是一种 原因不明的外阴瘙痒、灼热和/或疼痛综合征，导致严重的 身体和心理上的痛苦。在以下情况下，这是一种排斥诊断 外阴不适会在几个月后变得慢性，任何 其他可补救的原因，如感染或皮炎，也被排除。两个人 外阴疼痛的主要亚型--广泛性外阴感觉障碍和 前庭痛--经常被错误归类。很少有描述性的或病因的 已经进行了流行病学研究。因此，流行率和 普通人群中的发病率未知，也没有可预防的接触 已经被确认了。最近由美国国立卫生研究院主办的共识会议强调 需要确定外阴疼痛的患病率并进行以人群为基础的调查 用于确定可改变的风险因素的观察性研究。 申请人进行了一项以人口为基础的流行率调查 400名女性获得了70%的应答率，并发现18%的女性 报告了持续三年的外阴慢性症状的一生病史 几个月或更长时间。在所有接受调查的女性中，约8%的人目前 经历这些症状。此外，申请人还进行了一项试点 31例外阴功能障碍或外阴疼痛的病例对照研究 前庭痛，或在过去五年内两者的组合，以及 将她们与31名年龄相近的健康女性进行比较 人口。平均而言，病例报告体检的可能性要高出三倍。 治疗或外科手术对可能影响 会阴疼痛，或更频繁地使用避孕套和使用滑石粉 在生殖器区域，这可能会导致粘膜磨损和炎症。 申请人现在建议调查16,000名年龄在20-59岁之间的妇女 以估计一般人群外阴疼痛的年龄别患病率。从… 这份样本，申请者将鉴定出400例外阴疼痛，经核实 通过两步筛选过程，与400个样本进行频率匹配 居住控制的年龄和县。结构化面试将评估广泛的 与创伤有关的暴露范围。80例患者和80例患者的亚样本 控制组将接受临床检查，以确认是否存在或 无外阴痛，还将提供阴道冲洗和外阴拭子 细胞因子鉴定和微生物培养的标本 有机体。申请人假设各种类型的外阴创伤可能 先于女性所经历的自发性和诱发性外阴疼痛 外阴疼痛和外阴疼痛可能是一种特定类型复合体的变体 与感觉障碍相一致的区域性疼痛综合征，如 机械性超感痛症。

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.