Naslov
Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I

Autori
Harni, Vesna ; Damir Babic, Damir ; Suzana, Ljubojevic-Hadzavdic ; Dubravko Barisic

Izvornik
Journal of gynecology and obstetrics (2376-7812) 10 (2022), 6; 243-252

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, stručni

Ključne riječi
Vulvar Discomfort, Vulvodynia, Vulvar Dermatosis, Three Rings Vulvoscopy, Vulvar Lesions, Chronic Reflex Pain Syndrome (CRPS), Budapest Criteria

Sažetak
This study aimed to investigate the presence, type, and arrangement of nonspecific lesions considering the different histologies of the three vulvar rings in women with chronic vulvar discomfort to obtain reference data for the diagnostic procedure and a better understanding of women with chronic vulvar distress. The distribution of nonspecific lesions in the vulva based on vulvar rings was monitored as a secondary outcome measure within the framework of the prospective experimental study using diagnostic interventions called DATRIV, which included a total of 328 consecutive participants. Four patient groups were distinguished according to their medical history, structured International Society for the Study of Vulvovaginal Disease vulvodynia questionnaire results, and clinical examination, including inspection and cotton swab test. Asymptomatic participants were classified into normal vulva (N = 82) and impaired vulvar skin (N = 82) groups. Patients with chronic vulvar discomfort were categorized into groups of patients with primary, idiopathic vulvar distress/vulvodynia (N=82), and secondary complaints caused by vulvar dermatosis (N=82). Three rings vulvoscopy form data were used to collect clinical data, which were analyzed using StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). This study was approved by the Institutional Review Board of Polyclinic Harni, and all patients provided written informed consent. Nonspecific changes in the outer vulvar ring were significantly more common in patients with vulvar dermatosis (70.7%). The opposite pattern of lesion incidence was observed, with a considerably higher frequency of nonspecific findings in the inner vulvar ring in patients with vulvodynia (98.8%) and impaired vulvar skin (96.3%). The inner vulvar ring in patients with vulvodynia demonstrated a peculiar and characteristic profile with significantly more frequent findings of erythema (92.7%), punctuations (54.9%), ischemia (48.8%), and papillae (25.6%). A high presence of nonspecific lesions in the middle vulvar ring was documented in all participants, with an evident distinction in the appearance and allocation of these findings between patients with vulvodynia and vulvar dermatosis. By establishing the characteristic pattern of the type and distribution of nonspecific lesions in patients with vulvodynia, the Budapest criteria for considering vulvodynia as chronic reflex pain syndrome (CRPS) type 1, formerly sympathetic dystrophy, are met. Due to the specific three rings anatomy of the vulva, revised Budapest criteria are proposed. This study creates a unique opportunity to introduce vulvoscopy in the differential diagnosis of chronic, primary, and secondary vulvar discomfort.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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