Women with provoked vestibulodynia (PVD) are more likely to report a history of vulvovaginal candidiasis (VVC) and recurrent VVC (RVVC). This observational Italian study was undertaken to analyze how many women with PVD have an RVVC as a leading trigger and to describe predisposing factors.
The cross-sectional-based study, named VuNet (Vulvodynia Network), was performed among consecutive female patients affected by chronic vulvar pain (symptoms lasting at least 3 months) attending 21 Italian medical centers (public hospital, university clinic, and private outpatient services). A total of 1183 subjects with a diagnosis of chronic vulvar pain were included in the study, presenting leading symptoms such as vulvar pain (90%), vulvar burning (97%), and pain during and after intercourse (96%). 70,8% of women were diagnosed with spontaneous or provoked PVD and 27,3% with generalized vulvodynia. RVVC was complained of by 32% of patients. Family history showed a higher prevalence of diabetes mellitus (mother=8,4%, father=8,6%), compared to the prevalence in the Italian population <65 years (5,3%). Clinical examinations found a hyperactive pelvic floor in 71, 6%. The recurrent/persistent inflammation associated with an aberrant immune allergic reaction to Candida antigens may be a strong co-factor for developing PVD in this cluster of patients.
These data highlight the importance of investigating metabolic vulnerabilities to diabetes, both in the patient and her family; check for a hyperactive pelvic floor, predisposing to introital microabrasions, and encourage appropriate lifestyles, including reducing the consumption of glucose or saccharose, controlling body weight, and performing daily aerobic exercise to reduce peripheral insulin resistance. The ultimate goals are reducing predisposing factors for candidiasis, PVD, and coital pain in this cluster of patients, and tailoring treatment accordingly.
The cross-sectional-based study, named VuNet (Vulvodynia Network), was performed among consecutive female patients affected by chronic vulvar pain (symptoms lasting at least 3 months) attending 21 Italian medical centers (public hospital, university clinic, and private outpatient services). A total of 1183 subjects with a diagnosis of chronic vulvar pain were included in the study, presenting leading symptoms such as vulvar pain (90%), vulvar burning (97%), and pain during and after intercourse (96%). 70,8% of women were diagnosed with spontaneous or provoked PVD and 27,3% with generalized vulvodynia. RVVC was complained of by 32% of patients. Family history showed a higher prevalence of diabetes mellitus (mother=8,4%, father=8,6%), compared to the prevalence in the Italian population <65 years (5,3%). Clinical examinations found a hyperactive pelvic floor in 71, 6%. The recurrent/persistent inflammation associated with an aberrant immune allergic reaction to Candida antigens may be a strong co-factor for developing PVD in this cluster of patients.
These data highlight the importance of investigating metabolic vulnerabilities to diabetes, both in the patient and her family; check for a hyperactive pelvic floor, predisposing to introital microabrasions, and encourage appropriate lifestyles, including reducing the consumption of glucose or saccharose, controlling body weight, and performing daily aerobic exercise to reduce peripheral insulin resistance. The ultimate goals are reducing predisposing factors for candidiasis, PVD, and coital pain in this cluster of patients, and tailoring treatment accordingly.