Vulvodynia: Etiology, therapeutic options and impact on quality of life

Anu Aalto

Vulvodynia: Etiology, therapeutic options and impact on quality of life

Anu Aalto

Tutkimustuotos: Väitöskirja › Collection of Articles

Abstrakti

Vulvodyniaa, kroonista ulkosynnyttimien kiputilaa sairastaa arviolta 8 % naisista. Paikallinen, kosketuksesta provosoituva vulvodynia (LPV) on sen yleisin alatyyppi, erityisesti nuorilla naisilla. Vulvodynian selvää syytä ei tunneta, mutta tulehdus saattaa olla yksi LPV:n laukaiseva tekijä. Vulvodynian hoitomuodoista on olemassa vain rajallisesti tietoa satunnaistetuissa, kontrolloiduissa tutkimusasetelmissa.

Tämän tutkimuksen ensimmäinen tavoite oli kerätä takautuvasti tietoa kaikista vuosina 2003-2013 TAYS:ssa vulvodynian vuoksi hoidetuista potilaista. Näistä 133 kerätystä potilaasta selvitettiin sekä vulvodynian oireiden yhteyttä eri taustatekijöihin että annettujen hoitojen seuranta-ajan jälkeistä tehoa. Myös potilaiden tyytyväisyyttä yliopistosairaalan moniammatillisessa hoitoryhmässä annettuihin hoitoihin selvitettiin. Tästä potilasryhmästä tunnistettiin myös ne LPV-alamuotoa sairastavat potilaat, jotka oli hoidettu vuosina 2003-2016 toisaalta konservatiivisilla hoitokeinoilla ja toisaalta vestibulektomialla (vulvodynian hoidoksi tehty leikkaus, joka tähtää emättimen eteisen kivuliaan limakalvon poistoon). Toisena tutkimuksen tavoitteena oli verrata takautuvasti (36 kk seuranta-ajan mediaani) näiden potilasryhmien kokemaa kipua, elämänlaatua ja annettuja hoitoa. Tutkimuksen kolmantena tavoitteena oli verrata kirurgisesti hoidettujen LPV:ta sairastavien naisten leikkauksessa poistettuja kudosnäytteitä (n=12) vapaaehtoisten verrokkien (n=15) emättimen eteisestä otettuihin näytteisiin. Näytteistä selvitettiin eri estrogeeninkaltaisten reseptoreiden (ERR alatyypit), estrogeenireseptorin (ER), progesteronireseptorin (PR) sekä tulehduksellisten T-solujen (CD3) ilmentymistä. Neljännessä prospektiivisessa, vuosina 2018-2019 emättimen mikrobiomia käsittelevässä työssä verrattiin 30 LPV:ta sairastavan naisen emättimen eteisen näytteitä 20 kontrollien emättimen eteisestä kerättyihin mikrobiominäytteeseen. Mikrobiominäytteet analysoitiin NGS-menetelmällä.

Tutkimuksen päätulokset on koottu seuraavassa. Eri hoitojen yhdistelmä ja alle 30-vuoden ikä ennusti parempaa vulvodynia-potilaiden hoitotulosta. Kirurgisesti hoidettujen LPV-potilaiden kipu ja elämänlaatu olivat leikkauksen jälkeen paremmat kuin ei-kirurgisesti hoidetuilla. Tätä eroa ei kuitenkaan havaittu enää kolmen vuoden seuranta-ajan jälkeen. LPV potilaiden kudosnäytteissä esiintyi enemmän ERRßreseptoreita. Lisäksi emättimen eteisen mikrobiomi erosi merkittävästi terveiden kontrolleiden kudos- ja mikrobiominäytteistä. Näiden löydösten perusteella voidaan päätellä, että hormonaalisilla ja tulehduksellisilla tekijöillä on merkitystä LPV:n etiologiassa.

Alkuperäiskieli	Englanti
Julkaisupaikka	Tampere
Kustantaja	Tampere University
ISBN (elektroninen)	978-952-03-1625-9
ISBN (painettu)	978-952-03-1624-2
Tila	Julkaistu - 2020
OKM-julkaisutyyppi	G5 Artikkeliväitöskirja

Julkaisusarja

Nimi	Tampere University Dissertations - Tampereen yliopiston väitöskirjat
Vuosikerta	278
ISSN (painettu)	2489-9860
ISSN (elektroninen)	2490-0028

Pääsy asiakirjaan

http://urn.fi/URN:ISBN:978-952-03-1625-9

Siteeraa tätä

@book{e31a38e54845409383a3a77c4e58ad41,

title = "Vulvodynia: Etiology, therapeutic options and impact on quality of life",

abstract = "Vulvodynia, a chronic genital and pelvic pain condition, affects approximately 8\% of women. Localized provoked vulvodynia (LPV) is the most common subtype of the condition especially among young women. The etiology of LPV is unknown, although inflammation may play a role. The efficacy of most vulvodynia treatments has not been proven in a randomized, controlled study setting. The aim of the study was to collect and analyze retrospective data on all women diagnosed and treated for vulvodynia at Tampere University Hospital (TAUH) in 2003–2013. Among the 133 patients, symptom correlation with demographic variables, the efficacy of treatments after follow-up, and the patients{\textquoteright} satisfaction with treatments and different professionals were analyzed. Also, a subgroup of vulvodynia patients treated surgically at TAUH in 2003–2016 was identified. Efficacy and quality of life (QoL) were compared between the surgical and non-surgical treatment protocols. In order to evaluate the etiology of LPV the patients{\textquoteright} vestibulectomy samples (n=12) were analyzed by immunohistochemistry and compared to the vulvar samples from healthy controls (n=15). Different subtypes of estrogen-related receptors (ERRs), estrogen receptor (ER), progesterone receptor (PR) and inflammatory T-cells (CD3) were analyzed. Finally, the microbiomes of patients suffering from LPV (n=30) with those in healthy controls (n=20), using swabs collected prospectively from the vulvar vestibulum. To summarize, combining different treatment modalities, and age under 30 years predicted better outcome in terms of pain control in vulvodynia patients. Short-term QoL was better and self-reported pain was lower after surgical treatment. However, this benefit was not maintained after a follow-up period of three years. Furthermore, LPV patients showed differential vulvar expression of ERR{\ss} as well as dissimilarities in the vulvar microbiome when compared with controls, suggesting possible hormonal and inflammation-related factors in the etiology of LPV.",

author = "Anu Aalto",

year = "2020",

language = "English",

isbn = "978-952-03-1624-2",

series = "Tampere University Dissertations - Tampereen yliopiston v{\"a}it{\"o}skirjat",

publisher = "Tampere University",

}

TY - BOOK

T1 - Vulvodynia

T2 - Etiology, therapeutic options and impact on quality of life

AU - Aalto, Anu

PY - 2020

Y1 - 2020

N2 - Vulvodynia, a chronic genital and pelvic pain condition, affects approximately 8% of women. Localized provoked vulvodynia (LPV) is the most common subtype of the condition especially among young women. The etiology of LPV is unknown, although inflammation may play a role. The efficacy of most vulvodynia treatments has not been proven in a randomized, controlled study setting. The aim of the study was to collect and analyze retrospective data on all women diagnosed and treated for vulvodynia at Tampere University Hospital (TAUH) in 2003–2013. Among the 133 patients, symptom correlation with demographic variables, the efficacy of treatments after follow-up, and the patients’ satisfaction with treatments and different professionals were analyzed. Also, a subgroup of vulvodynia patients treated surgically at TAUH in 2003–2016 was identified. Efficacy and quality of life (QoL) were compared between the surgical and non-surgical treatment protocols. In order to evaluate the etiology of LPV the patients’ vestibulectomy samples (n=12) were analyzed by immunohistochemistry and compared to the vulvar samples from healthy controls (n=15). Different subtypes of estrogen-related receptors (ERRs), estrogen receptor (ER), progesterone receptor (PR) and inflammatory T-cells (CD3) were analyzed. Finally, the microbiomes of patients suffering from LPV (n=30) with those in healthy controls (n=20), using swabs collected prospectively from the vulvar vestibulum. To summarize, combining different treatment modalities, and age under 30 years predicted better outcome in terms of pain control in vulvodynia patients. Short-term QoL was better and self-reported pain was lower after surgical treatment. However, this benefit was not maintained after a follow-up period of three years. Furthermore, LPV patients showed differential vulvar expression of ERRß as well as dissimilarities in the vulvar microbiome when compared with controls, suggesting possible hormonal and inflammation-related factors in the etiology of LPV.

AB - Vulvodynia, a chronic genital and pelvic pain condition, affects approximately 8% of women. Localized provoked vulvodynia (LPV) is the most common subtype of the condition especially among young women. The etiology of LPV is unknown, although inflammation may play a role. The efficacy of most vulvodynia treatments has not been proven in a randomized, controlled study setting. The aim of the study was to collect and analyze retrospective data on all women diagnosed and treated for vulvodynia at Tampere University Hospital (TAUH) in 2003–2013. Among the 133 patients, symptom correlation with demographic variables, the efficacy of treatments after follow-up, and the patients’ satisfaction with treatments and different professionals were analyzed. Also, a subgroup of vulvodynia patients treated surgically at TAUH in 2003–2016 was identified. Efficacy and quality of life (QoL) were compared between the surgical and non-surgical treatment protocols. In order to evaluate the etiology of LPV the patients’ vestibulectomy samples (n=12) were analyzed by immunohistochemistry and compared to the vulvar samples from healthy controls (n=15). Different subtypes of estrogen-related receptors (ERRs), estrogen receptor (ER), progesterone receptor (PR) and inflammatory T-cells (CD3) were analyzed. Finally, the microbiomes of patients suffering from LPV (n=30) with those in healthy controls (n=20), using swabs collected prospectively from the vulvar vestibulum. To summarize, combining different treatment modalities, and age under 30 years predicted better outcome in terms of pain control in vulvodynia patients. Short-term QoL was better and self-reported pain was lower after surgical treatment. However, this benefit was not maintained after a follow-up period of three years. Furthermore, LPV patients showed differential vulvar expression of ERRß as well as dissimilarities in the vulvar microbiome when compared with controls, suggesting possible hormonal and inflammation-related factors in the etiology of LPV.

M3 - Doctoral thesis

SN - 978-952-03-1624-2

T3 - Tampere University Dissertations - Tampereen yliopiston väitöskirjat

BT - Vulvodynia

PB - Tampere University

CY - Tampere

ER -

Vulvodynia: Etiology, therapeutic options and impact on quality of life

Abstrakti

Julkaisusarja

Pääsy asiakirjaan

Sormenjälki

Siteeraa tätä