Risk of vulvodynia due to immune-related health events throughout the life course

外阴疼痛是慢性特发性（或原因不明）疼痛的外生殖器（外阴），估计 影响了8%的40岁美国女性最高的发病率发生在女性， 生育年龄早，外阴痛的发作可能发生在青春期， 报告说第一次使用时疼痛。虽然外阴痛的原因在很大程度上是未知的，它被认为是 免疫炎症反应机制改变的结果。我们之前的研究支持 这一假设表明，妇女谁发展外阴痛约2倍， 在外阴痛发作之前患有过敏或过敏反应。鉴于许多女性 被诊断为外阴痛的女性在青春期第一次使用外阴时有疼痛的证据， 外阴痛的最大风险可能是他们的免疫系统在产前或 出生，在他们生命的早期，或者两者兼而有之。记录整个生命过程中与健康有关的事件将 允许评估影响免疫功能的条件或治疗，或者是免疫功能的标志物。 免疫系统健康受损我们建议在现有的 1981年至1996年出生的所有瑞典女性队列已经使用瑞典国家统计局收集， 另一项正在进行的举措的登记数据。在这项嵌套研究中，所有患有特定外阴痛的女性 2012年至2016年之间的诊断（ICD代码N76.3）（n=~3500名女性）将包括病例， 病例将与同一出生年份的对照组相匹配，截至该病例发生时， 诊断日期。我们的目的是评估a）孕产妇和新生儿事件的影响，包括 母亲产前使用抗生素治疗绒毛膜炎、B组链球菌感染或早产 胎膜破裂、剖宫产分娩和新生儿住院; B）免疫特异性 从婴儿期直到发病，表现为缺陷、自身免疫和过度活跃的病症 外阴痛或对照组中的可比时间段，和c）青春期的精神疾病 直到外阴痛发作和对照组之间的可比时间段， 年龄在15到35岁之间的女性青春期外阴疼痛的前兆表明需要 采取生命历程的方法来了解致病机制， 外阴痛在整个生命周期内进行研究可以在关键时期识别免疫相关事件。 风险期，其影响可能会导致更仔细的筛查基于病史， 潜在的干预措施，以防止或减轻这种衰弱的条件。

Vulvodynia is chronic idiopathic (or unexplained) pain of the external genitalia (vulva) that is estimated to affect 8% of American women by the age of 40. The highest incidence occurs in women during their early reproductive ages, and the onset of vulvodynia may occur during adolescence with patients reporting pain at first tampon use. While causes of vulvodynia are largely unknown, it is believed to be the result of an altered immune-inflammatory response mechanism. Our previous research supports this hypothesis by showing that women who develop vulvodynia are approximately 2 times more likely to have suffered from allergies or allergic responses prior to vulvodynia onset. Given that many women diagnosed with vulvodynia have evidence of pain with first tampon use during adolescence, women at greatest risk of vulvodynia may have had their immune systems compromised either prenatally or at birth, early in their life course, or both. Documenting health-related events across the life course would allow for the assessment of conditions or treatments that influence immune function, or are markers of compromised immune health. We propose to conduct a nested case-control study within an existing cohort of all Swedish females born between 1981 and 1996 already assembled using Swedish National Registry data for another ongoing initiative. For this nested study, all women with a specific vulvodynia diagnosis (ICD code N76.3) between 2012 and 2016 (n=~3500 women) will comprise cases, and each case will be matched to a control from the same birth year with no history of vulvar pain as of the case’s date of diagnosis. Our aims are to assess the effect of a) Maternal and neonatal events including maternal prenatal antibiotic use for chorioamnionitis, Group B streptococcal infection or premature rupture of membranes, cesarean section deliveries, and neonatal hospitalizations; b) Immune-specific conditions manifesting as deficient, autoimmune, and overactive from infancy up until onset of vulvodynia or a comparable time period among controls, and c) Psychiatric conditions from adolescence up until onset of vulvodynia and a comparable time period among controls, on the risk of vulvodynia in women between the ages of 15 and 35. Precursors to vulvar pain present at adolescence indicate a need to take a life course approach toward understanding the pathogenic mechanisms that underlie vulvodynia. Carrying out research across the lifespan can identify immune related events during critical risk periods, and its impact could lead to more careful screening based on medical histories and potential interventions to prevent or mitigate this debilitating condition.