Inga Sjöberg

Prevalence and incidence of prolonged and severe dyspareunia in women: results from a population study.

Aims: The principle aim of this study was to investigate the prevalence and incidence of prolonged (≥6 months) and severe dyspareunia in a non-patient population of women, and to explore the rate of recovery as well as the inclination to seek medical care. Another aim was to compare the use of oral contraceptives among women who had ever had dyspareunia and those who had not. Methods: A total of 3,017 women aged 20—60 participating in a screening program for cervical cancer answered a questionnaire about possible painful coitus. Results: The prevalence was 9.3% for the whole group and 13% for women aged 20—29 and 6.5% for the women aged 50—60, with a risk ratio of 2.0 (95% CI 1.4—2.8) for the youngest age group compared with the oldest. The incidence risk ratio was 9.3 (95% CI 2.8—30.9) for the youngest age group compared with the oldest. Using age-specific incidence rates, a rising incidence of dyspareunia in young women was demonstrated. Of the women who had ever had prolonged and severe dyspareunia 28% had consulted a physician for their symptoms; 20% recovered after treatment, while 31% recovered spontaneously. No differences were found in the use of oral contraceptives between the women who had had dyspareunia and those who had not. Conclusions: Prolonged and severe dyspareunia is a great health problem among all women and especially young women, for whom a rising incidence of dyspareunia is suggested and discussed. Surprisingly few women have consulted a physician, raising the question of why this is the case and what can be done about it.

Sexual behaviour and papillomavirus exposure in cervical intraepithelial neoplasia: a population-based case-control study.

Sexual history is an established risk determinant for cervical neoplasia. It is not clear if human papillomavirus (HPV) exposure entirely explains the sexual behaviour-related risk or if other sexually transmitted agents may act as cofactors for HPV in carcinogenesis. The aim of this study was to elucidate whether HPV exposure or HPV persistence explains the sexual history-related risk of high-grade cervical intraepithelial neoplasia (CIN) using a population-based case-control study of most of the 254 women referred to colposcopy in the Vasterbotten county in Sweden because of an abnormal cervical smear during October 1993 to December 1995 and 320 age-matched women from the general population. The women were interviewed for sexual history and tested for presence of serum antibodies to HPV-16, -18 and -33 as well as for presence of HPV DNA in cervical brush samples. HPV-16, -18 and -33 seropositivity was specific for the corresponding type of HPV DNA, dependent on the lifetime sexual history and associated with a two- to threefold increased risk of CIN 3. There was no sexual history-related risk of CIN among HPV-seropositive women and adjustment for HPV DNA presence explained the sexual history-related risk of CIN. In conclusion, HPV exposure appeared to explain the sexual history-related risk of high-grade CIN.

Vulvar vestibulitis: medical, psychosexual and psychosocial aspects, a case‐control study

Background. Vulvar vestibulitis is suspected to be increasingly prevalent among young women, but the etiology is still unclear. The aim of this study was to explore the differences in medical, psychosexual and psychosocial factors between women with vulvar vestibulitis and a control group.

Influence of hormonal contraceptives on the immune cells and thickness of human vaginal epithelium.

OBJECTIVE To determine whether use of steroid hormone contraceptives modifies immune defense parameters of the vaginal epithelium in humans. METHODS Vaginal biopsies were collected during the follicular and luteal phases in regularly menstruating women (controls) and in women using combined oral contraceptives, depot-medroxyprogesterone acetate injections, or levonorgestrel implants. Fifteen healthy women (aged 20–34 years) were enrolled in each group. Biopsies were analyzed in a blinded manner. Epithelial thickness was estimated by morphometry. Immune cells were analyzed by immunomorphometry with cell-type-specific monoclonal antibodies. RESULTS The epithelium of controls harbored 241 ± 35 leukocytes (CD45+ cells) per mm2 (mean ± 1 standard error of the mean), and the thickness was 261 ± 16 μm. T lymphocytes (CD3+) dominated, and cytotoxic or suppressor T cells (CD8+) were more frequent than T helper cells (CD4:CD8 ratio: 0.7 ± 0.1). Macrophages (CD68+) constituted the second-largest population, followed by Langerhans cells (CD1a+). B cells, natural killer cells, monocytes, and granulocytes were generally absent. There were no significant differences between the follicular and luteal phases. The epithelium was significantly thicker in all three groups that used hormonal contraceptive (333 ± 9 μm) compared with controls, and it exhibited superficial hyperplasia. The frequency of intraepithelial leukocytes (CD45+) was increased in depot-medroxyprogesterone acetate (P < .001) and levonorgestrel implant users (P < .04). In depot-medroxyprogesterone acetate users, this was explained by an increased frequency of the CD8+ T lymphocyte subset. CONCLUSION Hormonal contraceptives induce hyperplasia of the vaginal epithelium. The significant changes in the intraepithelial leukocyte population in depot-medroxyprogesterone acetate and levonorgestrel implant users most probably reflect altered local immune capacity.

Vulvar vestibulitis: a multi‐factorial condition

Objective To study differences in somatic symptoms and personality dimensions between women with vulvar vestibulitis and a non‐symptomatic control group.

Morphometric characteristics of the vaginal epithelium during the menstrual cycle.

Vaginal biopsies were obtained in 5 healthy women every third day during the menstrual cycle. The specimens were examined with morphometric technique and the mean nuclear size was correlated to values of estradiol and progesterone and caryopycnotic index. Cyclical changes of the histological appearance of the epithelium could be demonstrated. During estrogen influence a proliferation and maturation of the vaginal mucosa was seen whereas addition of progesterone was associated with a shedding of the superficial cell layers and a steady state of the basal part of the epithelium. At ovulation the epithelium reached maximal thickness and maturity. The histological architecture at this time may resemble a human-papilloma-virus (HPV)-infected mucosa. The difficulties in distinguishing an HPV-infected epithelium from normal are discussed.

Acupuncture for the treatment of vulvar vestibulitis: A pilot study

Background. The study was conducted to obtain a preliminary indication of the effectiveness of acupuncture in the treatment of vulvar vestibulitis but also to obtain information how well the women tolerate the treatment.

Menstrual Variation of Estrogen Receptor Content in Vaginal Tissue

Estrogen receptor content in vaginal tissue was quantified in 12 healthy female volunteers during the menstrual cycle. Epithelial biopsies were obtained at cycle days 10 and 21 and investigated by a monoclonal enzyme immunoassay. Measurable amounts of estrogen receptors were found in all women at both sampling occasions. In women with an ovulatory menstrual cycle, a significant fall in V-receptor content was recorded during the luteal phase. Structural and functional changes in the vaginal epithelium during the menstrual cycle may be important for the diagnosis and susceptibility to certain viral infections.

The vagina Morphological, functional and ecological aspects

The vagina is one organ of the body which has not been studied exhaustively. Moreover, most of the studies found in the contemporary literature have been performed on women affected by a variety of ...

Endotoxin in vaginal fluid of women with bacterial vaginosis.

The concentration of endotoxin in vaginal fluid was measured in 19 women with bacterial vaginosis and in nine controls with normal vaginal flora. The vaginal fluid of the women with bacterial vaginosis contained significantly greater amounts of endotoxin: 0.308 ± 0.396 versus 0.008 ± 0.002 endotoxin units/mg vaginal fluid. Endotoxin in vaginal fluid may contribute to the activation of the prostaglandin system, which could provoke premature labor.