Susan Kellogg-Spadt

Impact of vulvovaginal health on postmenopausal women: A review of surveys on symptoms of vulvovaginal atrophy

Several recent, large-scale studies have provided valuable insights into patient perspectives on postmenopausal vulvovaginal health. Symptoms of vulvovaginal atrophy, which include dryness, irritation, itching, dysuria, and dyspareunia, can adversely affect interpersonal relationships, quality of life, and sexual function. While approximately half of postmenopausal women report these symptoms, far fewer seek treatment, often because they are uninformed about hypoestrogenic postmenopausal vulvovaginal changes and the availability of safe, effective, and well-tolerated treatments, particularly local vaginal estrogen therapy. Because women hesitate to seek help for symptoms, a proactive approach to conversations about vulvovaginal discomfort would improve diagnosis and treatment.

Continuing Medical Education: Urogenital Complaints and Female Sexual Dysfunction (Part 1) (CME)

INTRODUCTION Sexual dysfunction and dyspareunia are common complaints in women with urological disorders. AIM To provide a comprehensive review of sexual dysfunction related to common hypersensitive/hyperactive urogenital disorders including interstitial cystitis/painful bladder syndrome (IC/PBS), overactive bladder (OAB) with and without incontinence, and high-tone pelvic floor muscle dysfunction and the appropriate treatment strategies. METHODS A medical literature search using several related terms including sexual dysfunction, dyspareunia, IC/PBS, OAB, urinary incontinence pelvic floor dysfunction, and levator ani muscle spasm. MAIN OUTCOME MEASURES Review of the medical literature to identify relation between sexual dysfunction and common urological disorders in women and to describe appropriate treatment strategies to improve the womens quality of life. RESULTS A thorough review of sexual dysfunction in urological disorders and their related treatments modalities including: behavioral, pharmacological, and nonpharmacological therapies. CONCLUSIONS Sexual dysfunction is a common, underestimated, and untreated complaint in women with urologic disorders. Identifying sexual complaints and treating the underlying etiologies can result in significant improvement in a womans quality of life. This process requires a focused, multidisciplinary approach tailored to meet the needs of women with urogenital complaints.

ORIGINAL RESEARCH—SEXUAL PAIN DISORDERS: Interstitial Cystitis/Painful Bladder Syndrome as a Cause of Sexual Pain in Women: A Diagnosis to Consider

INTRODUCTION Sexual pain, or dyspareunia, is a common symptom among women. Dyspareunia presents in many ways, and arises from a range of causes. Interstitial cystitis/painful bladder syndrome (IC/PBS) is one potential cause that may frequently be overlooked by clinicians. Interstitial cystitis is increasingly recognized as more common than was once thought. However, it can be difficult to identify, as the symptoms of IC/PBS (urinary urgency and frequency, dyspareunia, nocturia, and pelvic pain) overlap with other urogynecologic conditions. AIM This article will review the association between dyspareunia and IC/PBS, and will provide an approach to the diagnosis and treatment of IC/PBS in women with sexual pain. METHODS AND MAIN OUTCOME MEASURES Review of the medical literature and expert medical opinion. RESULTS Many women with IC/PBS experience dyspareunia, often in conjunction with chronic pelvic pain. When IC/PBS is suspected, there are simple measures to aid in the diagnosis of this condition, and treatments are readily available. CONCLUSIONS When a woman presents with the symptoms of urinary urgency and frequency, dyspareunia, nocturia, and/or pelvic pain, IC/PBS should be part of the diagnostic evaluation.

Vulvodynia: Definition, Prevalence, Impact, and Pathophysiological Factors

INTRODUCTION Vulvodynia constitutes a highly prevalent form of chronic genital pain in women, and current information regarding its definition, prevalence, impact, and pathophysiologic factors involved is needed. AIM To update the scientific evidence published in 2010 from the Third International Consultation of Sexual Medicine pertaining to the definition, prevalence, impact, and pathophysiologic factors of womens sexual pain. METHODS An expert committee, as part of the Fourth International Consultation of Sexual Medicine, comprised of researchers and clinicians from biological and social science disciplines, reviewed the scientific evidence on the definition, prevalence, impact, and pathophysiologic factors related to chronic genital pain. MAIN OUTCOME MEASURES A review of the definition, prevalence, impact, and pathophysiological factors involved in vulvodynia. RESULTS Vulvodynia is a prevalent and highly impactful genital pain condition. Numerous factors have been implicated in its development and maintenance. CONCLUSION What is becoming increasingly apparent is that it likely represents the end point of different factors that can differ from patient to patient. Longitudinal research is needed to shed light on risk factors involved in the expression of vulvodynia, as well as in potential subgroups of affected patients, in order to develop an empirically supported treatment algorithm.

Retrospective chart review of vaginal diazepam suppository use in high-tone pelvic floor dysfunction

To study intravaginal diazepam suppositories as adjunctive treatment for high-tone pelvic floor dysfunction (HTPFD) and sexual pain. A retrospective chart review was conducted on 26 patients who received diazepam suppositories as adjuvant therapy to pelvic physical therapy and intramuscular trigger point injections for bladder pain, sexual pain, and levator hypertonus. Pelvic floor muscular tone and pain were assessed by palpation and perineometry; sexual pain was objectively rated by Female Sexual Function Index (FSFI) and the Visual Analog Scale for Pain (VAS-P). Twenty-five out of 26 patients reported subjective improvement with suppository use; six out of seven sexually active patients resumed intercourse. Sexual pain as assessed on FSFI and serial VAS-P improved with diazepam (by 1.44 on 10-point scale, p = 0.14). PFM tone improved during resting (p < 0.001), squeezing (p = 0.014), and relaxation (p = 0.003) phases. Vaginal diazepam suppositories gave a clinically significant improvement in the treatment of HTPFD compared with the usual treatment regimen alone.

Vulvodynia: Assessment and Treatment.

INTRODUCTION Vulvodynia constitutes a highly prevalent form of sexual pain in women, and current information regarding its assessment and treatment is needed. AIM To update the scientific evidence published in 2010, from the Third International Consultation on Sexual Medicine, pertaining to the assessment and treatment of womens sexual pain. METHODS An expert committee, as part of the Fourth International Consultation on Sexual Medicine, was comprised of researchers and clinicians from biological and social science disciplines for the review of the scientific evidence on the assessment and treatment of womens genital pain. MAIN OUTCOME MEASURES A review of assessment and treatment strategies involved in vulvodynia. RESULTS We recommend the following treatments for the management of vulvodynia: psychological interventions, pelvic floor physical therapy, and vestibulectomy (for provoked vestibulodynia). We also support the use of multidisciplinary treatment approaches for the management of vulvodynia; however, more studies are needed to determine which components are most important. We recommend waiting for more empirical evidence before recommending alternative treatment options, anti-inflammatory agents, hormonal agents, and anticonvulsant medications. Although we do not recommend lidocaine, topical corticosteroids, or antidepressant medication for the management of vulvodynia, we suggest that capsaicin, botulinum toxin, and interferon be considered second-line avenues and that their recommendation be revisited once further research is conducted. CONCLUSION A comprehensive assessment is needed to understand the pain experience of women presenting with vulvodynia. In addition, treatment typically progresses from less invasive to more invasive, and several treatment options are worth pursuing.

ORIGINAL RESEARCH—SEXUAL PAIN DISORDERSORIGINAL RESEARCH—SEXUAL PAIN DISORDERS: Interstitial Cystitis/Painful Bladder Syndrome as a Cause of Sexual Pain in Women: A Diagnosis to Consider

INTRODUCTION Sexual pain, or dyspareunia, is a common symptom among women. Dyspareunia presents in many ways, and arises from a range of causes. Interstitial cystitis/painful bladder syndrome (IC/PBS) is one potential cause that may frequently be overlooked by clinicians. Interstitial cystitis is increasingly recognized as more common than was once thought. However, it can be difficult to identify, as the symptoms of IC/PBS (urinary urgency and frequency, dyspareunia, nocturia, and pelvic pain) overlap with other urogynecologic conditions. AIM This article will review the association between dyspareunia and IC/PBS, and will provide an approach to the diagnosis and treatment of IC/PBS in women with sexual pain. METHODS AND MAIN OUTCOME MEASURES Review of the medical literature and expert medical opinion. RESULTS Many women with IC/PBS experience dyspareunia, often in conjunction with chronic pelvic pain. When IC/PBS is suspected, there are simple measures to aid in the diagnosis of this condition, and treatments are readily available. CONCLUSIONS When a woman presents with the symptoms of urinary urgency and frequency, dyspareunia, nocturia, and/or pelvic pain, IC/PBS should be part of the diagnostic evaluation.

Urogynecological causes of pain and the effect of pain on sexual function in women.

Abstract Female Sexual Dysfunction (FSD) is a complex biopsychosocial phenomenon. Screening, identifying and managing urogenital and sexual symptoms often result in significant improvement in women’s quality of life. Providers must proactively question patients about possible presence of FSD. When a sexual problem is present, identify the type of FSD, counsel patients on the appropriate approaches to treatment. No single therapeutic approach is effective in treating all types of FSD.

Treatments for Hypoactive Sexual Desire Disorder (HSDD) and the Pursuit of Sexual Health for Women amidst Inglorious Rhetoric

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