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J Lower Genital Tract Disease. London, UK: The authors concluded that topical application of nifedipine and a placebo reduced pain in women with vulvodynia. The tampon test was selected as primary end point using a modified intention-to-treat analysis. Kategori tersembunyi: The post-operative follow-up period was 6 months to 10 years.

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Dari Wikipedia bahasa Indonesia, ensiklopedia bebas. Ini adalah versi stabil , diperiksa pada tanggal 29 November Ada 2 perubahan tertunda menunggu peninjauan. The Little Book of Sex. Ulysses Press. Pearson Education, hlm. Posisi seksual dan persetubuhan. Twenty-seven of 29 women reported a significant benefit, and 9 who had completed the program were pain-free.

All women appreciated the integrated approach, and even those who were not completely pain-free found that they were able to manage their condition satisfactorily. The authors concluded that further evaluation of this program is warranted to assess whether it would be helpful for other women with this problem.

Beco et al noted that perineodynia e. The second aim was to study the clinical value of the afore-mentioned clinical signs in the diagnosis of PCS. In this retrospective analysis, the studied sample comprised 74 female patients who underwent a bilateral PND between and The second aim was achieved by means of a statistical comparison between the patient's group before the operation and a control group of 82 women without any of the following signs i.

The authors concluded that the findings of this study suggested that bilateral PND can treat perineodynia, anal and urinary incontinence. They stated that there is a need for further studies to confirm these preliminary results. The protocol included 5 treatment sessions with caudal epidural, pudendal nerve block, and vestibular infiltration of local anesthetic agents.

There were significant improvements in vestibular pain as determined by the vulvalgesiometer, McGill pain questionnaire, self-report, and the Female Sexual Functioning Inventory. The authors concluded that serial multi-level nerve blocks administered for the treatment of VVS is a conceptually neurophysiologically based modality that may be effective and merits a placebo-controlled study.

Moreover, perineal pain caused by pudendal nerve entrapment is a rare entity. When patients have failed guided nerve blocks with corticosteroids, TCAs, anti-convulsants, and PT, surgical decompression of pudendal nerve is an option. However, it should be noted that the type of evidence supporting the recommendations was not specifically stated; the guideline was based largely on expert opinion.

It stated that most of the available evidence for the treatment of vulvodynia is based on clinical experience, descriptive studies, or reports of expert committees. There are few randomized controlled trials RCTs of vulvodynia treatments. Vulvodynia is a complex disorder that is difficult to treat, and rapid resolution is unusual even with proper treatment.

Decrease in pain may take weeks to months and may not be complete. No single treatment is successful in all women. In a "white paper" on the definition, diagnosis, and management of vulvodynia, Bachmann et al stated that all currently used interventions e. There are no standardized, evidence-based treatment guidelines or algorithms since clinical trials have not been performed to allow evidence-based guidelines.

Excisional vestibular surgery is an approach advocated in some centers for localized vulvodynia when other treatments have failed. The panel concurred on the need for evidence-based, "stepped care" guidelines for clinical management of vulvodynia. This "white paper" also recommended more investigation on alternative therapies e.

Therapeutic interventions should be systematically evaluated in prospective RCTs, especially multi-center trials, when possible. Furthermore, the author noted that the evidence rating on the use of biofeedback for vulvodynia is "B" inconsistent or limited-quality patient-oriented evidence. Surgery is reserved for individuals with severe symptoms.

The use of other dye laser protocols remains controversial. High muscle tone or spasm and instability within the pelvic floor musculature can be identified and relieved with specific exercises. The author also noted that interferon is considered about as effective as placebo and is not in standard use.

Furthermore, laser in any wave length is not of value in the treatment of vulvodynia. In a prospective, non-controlled, pilot study, McDonald and Rapkin examined the effectiveness of a novel treatment using caudal epidural, pudendal nerve block, and vulvar infiltration of local anesthetic agents for the treatment of generalized vulvodynia.

A total of 32 women with vulvodynia met inclusion criteria and 26 women completed the study. The protocol included 5 treatment sessions with multi-level local anesthetic nerve blockade and a follow-up contact or visit 2 to 3 months later. There were significant improvements in vulvar pain as determined by both the sensory and affective components of the MPQ and in depression as assessed by the BDI.

However, there were no changes in sexual functioning on the FSFI. The authors concluded that serial multi-level nerve block administered for the treatment of vulvodynia is a neurophysiologically based modality that may be effective, and merits a placebo-controlled study.

Leo and Dewani noted that anti-depressants have often been recommended as a potential treatment for the management of vulvodynia. However, review of the evidence supporting this recommendation has not been systematically assessed. These researchers evaluated the effectiveness of anti-depressant pharmacotherapy in the treatment of vulvodynia.

An assessment of the methodological quality of published reports addressing the utility of anti-depressants in the treatment of vulvodynia was undertaken. Several secondary outcomes generated in the existing literature were also examined. A comprehensive search of the available literature was conducted. The search yielded 13 published reports, i. The vast majority of studies utilized tricyclic antidepressants TCAs.

Evidence supporting the benefits of TCAs studied to date was limited, i. There were no systematic investigations into the comparative effectiveness of different anti-depressant classes in the treatment of vulvodynia. The authors concluded that there is insufficient evidence to support the recommendation of anti-depressant pharmacotherapy in the treatment of vulvodynia. Although some vulvodynia-afflicted patients derive symptom relief from anti-depressants, additional research is needed to identify those characteristics that would predict those patients for whom anti-depressants are more likely to be effective.

Spoelstra et al stated that anti-convulsant therapy has occasionally been recommended to treat vulvodynia. However, convincing evidence to support this therapeutic option is lacking. These investigators reviewed studies published on the effectiveness of anti-convulsants for the treatment of vulvodynia. E valuation of the methodological quality of relevant publications was the main outcome measure.

Medline, PubMed and Cochrane were used to identify studies published in English between January and February Searches were performed between December and February A total of 8 relevant studies were identified: Gabapentin formed the main focus Lamotrigine was used in 1 study These results seem promising, but the majority of studies have several methodological weaknesses regarding sample size and design.

The authors concluded that insufficient evidence was available to recommend anti-convulsants for the treatment of vulvodynia. They stated that further studies are necessary with double-blind, randomized-controlled designs to investigate the effectiveness of anti-convulsant therapy for vulvodynia.

Leo evaluated the effectiveness of anti-convulsant pharmacotherapy in the treatment of vulvodynia. An assessment of the methodological quality of published reports addressing the utility of anti-convulsants in the treatment of vulvodynia was undertaken.

The search yielded 9 published reports, i. A number of methodological shortcomings were identified in several of the reports with respect to study design, including small sample sizes, lack of placebo or other comparison groups, inadequate outcome measures, among others. The vast majority of studies employed gabapentin. Evidence supporting the benefit of anti-convulsants studied to date was limited, i.

There were no systematic investigations into the comparative effectiveness of different anti-convulsant agents in the treatment of vulvodynia. The authors concluded that although some vulvodynia-afflicted patients derive symptom relief from anti-convulsants, there is, as yet, insufficient evidence to support the recommendation of anti-convulsant pharmacotherapy in the treatment of vulvodynia.

They stated that additional investigations, employing RCTs, are warranted. Kestranek et al described radiofrequency therapy, a new and hopeful possibility in the treatment of refractory severe vulvodynia. These investigators reported on the successful use of the pulsed radiofrequency treatment in a patient with intractable chronic vulvodynia. The authors stated that to their knowledge, this was the first report of a successful use of pulsed radiofrequency in the treatment of chronic vulvodynia.

They concluded that if the effectiveness of pulsed radiofrequency is confirmed by more studies, it would be a welcome addition to the treatment modalities used to treat this sometimes truly intractable condition. A Committee Opinion from the American College of Obstetricians and Gynecologists on vuvodynia ACOG, stated that commonly prescribed topical medications include a variety of local anesthetics which can be applied immediately before intercourse or in extended use , estrogen cream, and tricyclic antidepressants compounded into topical form.

These researchers observed a decrease in pain scores on the visual analog scale VAS from initially 8 to 9 to presently 0 to 2. Injection sites were: Head's zones and trigger points of the lower abdomen, regional hypo-gastric ganglia, bilateral maxillary sinus, and scars of the lower jaw.

No major adverse events were observed. Injections to remote sites improved symptoms more strongly than local or regional therapy. After a 3-year follow-up the patient was free of symptoms. The authors concluded that therapy with local anesthetics can be a useful additional therapy in complicated cases of vulvodynia.

Moreover, they stated that further studies on the underlying mechanism of injections into remote foci and the effectiveness of tumescent local anesthesia in chronic pain syndromes should be performed. De Andres et al reported on the case of a year old woman with 3 years of dysesthetic vulvodynia who had tried conventional and interventional medical treatment with inadequate relief.

She was offered peripheral subcutaneous vulvar field stimulation and underwent implantation of 2 vulvar subcutaneous electrodes. At 15 days after treatment and during 1-year follow-up, the patient scored 1 out of 15 on Friedrich scale, 1 out of 10 on the VAS, and 1 out of 10 on the tampon test. The patient no longer required oral medication.

The authors concluded that stimulation with subcutaneous electrodes provided relief from vulvodynia to a patient in whom all previous therapeutic approaches had failed. The findings of this single-case study need to be validated by well-designed studies. Corbett and colleagues identified trends in compounding pharmacies with a focus on women's health and, more specifically, the types and combinations of medications used in the treatment of vulvodynia.

This survey was conducted with non-chain pharmacies that compound medications. Each pharmacy was asked to complete a item online survey assessing general practice and common compounding indications, focusing on women's health. The authors concluded that vulvo-vaginal symptoms are a common indication for compounding medications in women's health.

Moreover, they stated that further research in understanding the rationale for using compounded medications, even when standard treatments are available for some of these symptoms e. Keppel Hesselink et al stated that the prevalence of idiopathic vulvodynia and proctodynia is high. Pain management with anti-depressants and anti-epileptics may induce undesirable side effects.

Therefore, topical baclofen cream and palmitoylethanolamide might be new therapeutic options. These researchers reported on the case of a year old woman with intractable chronic vulvar and anal pain who had to abstain from sexual intercourse and could neither cycle nor sit for more than 5 mins. The patient did not respond to standard treatments. The authors concluded that topical baclofen and palmitoylethanolamide can be a viable treatment option in chronic vulvodynia and proctodynia.

In a pilot study, Corsini-Munt et al tested the feasibility and potential effectiveness of a novel cognitive-behavioral couple therapy CBCT for couples coping with PVD. The primary outcome measure was women's pain intensity during intercourse as measured on a numerical rating scale. Secondary outcomes included sexual functioning and satisfaction for both partners.

Exploratory outcomes included pain-related cognitions; psychological outcomes; and treatment satisfaction, feasibility, and reliability. One couple separated before the end of therapy. Paired t-test comparisons involving the remaining 8 couples demonstrated significant improvements in women's pain and sexuality outcomes for both women and partners.

Exploratory analyses indicated improvements in pain-related cognitions, as well as anxiety and depression symptoms, for both members of the couple. Therapists' reported high treatment reliability and participating couples' high participation rates and reported treatment satisfaction indicate adequate feasibility.

The authors concluded that treatment outcomes, along with treatment satisfaction ratings, confirmed the preliminary success of CBCT in reducing pain and psychosexual burden for women with PVD and their partners. Due to poorly understood pathophysiology and lack of efficient treatment frustration is vastly spread among affected women and their physicians.

Behavioral, medical and surgical interventions are widely used, but hardly any of them show significance compared to placebo effect. The authors stated that a multi-disciplinary treatment is considered to be the new state of the art treatment; however evidence for such a model is hard to find. In a randomized, wait-list, controlled pilot study, Schlaeger and colleagues determined the feasibility and potential effects of using a standardized acupuncture protocol for the treatment of women with vulvodynia.

The primary outcome was vulvar pain, and sexual function was the secondary outcome. A total of 36 women with vulvodynia met inclusion criteria. They were randomly assigned either to the acupuncture group or to the wait-list control group. The 18 subjects assigned to the acupuncture group received acupuncture 2 times per week for 5 weeks for a total of 10 sessions.

Reports of vulvar pain and dyspareunia were significantly reduced, whereas changes in the aggregate FSFI scores suggested significant improvement in sexual functioning in those receiving acupuncture versus those who did not. Acupuncture did not significantly increase sexual desire, sexual arousal, lubrication, ability to orgasm or sexual satisfaction in women with vulvodynia.

The authors concluded that this was the first randomized controlled pilot study to examine the use of acupuncture for the treatment of vulvodynia. The acupuncture protocol was feasible and in this small sample appeared to reduce vulvar pain and dyspareunia with an increase in overall sexual function for women with vulvodynia. They stated that this study should be replicated in a larger double-blinded RCT.

It is expensive and typically not covered by insurance when used for this indication. BTX-A has been injected directly into the vestibule for localized provoked vulvodynia and has been used for trigger point injections into muscles of the pelvic floor …. There is minimal evidence that topical corticosteroids alone, anti-inflammatory agents, montelukast, topical testosterone, antibiotics, retinoid compounds or topical nitroglycerin, lamotrigine are effective.

Goldstein and colleagues updated the scientific evidence published in , from the 3rd International Consultation on Sexual Medicine, pertaining to the assessment and treatment of women's sexual pain. An expert committee, as part of the 4rth 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 women's genital pain.

These investigators recommend the following treatments for the management of vulvodynia: They also support the use of multi-disciplinary treatment approaches for the management of vulvodynia; however, more studies are needed to determine which components are most important. They recommend waiting for more empirical evidence before recommending alternative therapeutic options, anti-inflammatory agents, hormonal agents, and anti-convulsant medications.

Although they do not recommend lidocaine, topical corticosteroids, or anti-depressant medication for the management of vulvodynia, they suggest that capsaicin, botulinum toxin, and interferon be considered 2nd-line avenues and that their recommendation be revisited once further research is conducted.

Weinberger and colleagues noted that female sexual dysfunction FSD is a highly prevalent condition. Nevertheless, the scientific literature has only recently begun to accumulate evidence for treatment modalities that address the underlying etiologies of FSD. In a systematic review, these investigators evaluated what treatments are effective across the various symptom complexes of FSD.

Utilizing meta-analysis of observational studies in epidemiology guidelines, these researchers conducted a systematic review of PubMed, Embase, clinicaltrials. A total of 11 search strings, encompassing the terms "female sexual dysfunction" and "treatment" in combination with "vulvovaginal atrophy", "vaginismus", "vaginal atrophy", "vulvodynia", "vestibulitis", "hypoactive sexual desire", "arousal disorder", "sexual pain disorder", "genitourinary syndrome of menopause" and "orgasmic disorder" were utilized.

A total of relevant articles were retrieved, and original studies met inclusion criteria. These researches assessed peer-reviewed literature; a total of 42 treatment modalities were utilized, including 26 different classes of medications. Although outcome measures varied, the most substantial improvement across multiple studies was noted with various hormonal regimens.

The most common treatments included hormonal therapy 25 studies , phosphodiesterase type-5 inhibitors 9 studies , botulinum toxin A 5 studies , and flibanserin 5 studies. The psychotherapeutic approach was detailed in 36 articles while 3 studies utilized homeopathic treatments. Numerous treatments showed efficacy in a single-case series, including the promising results associated with the micro-ablative carbon-dioxide laser.

Despite the marked improvement in specific FSD domains, neither pharmacologic treatments nor psychotherapeutic interventions demonstrated consistent disease resolution. The wide variability of treatment and outcome measures across the literature attested to the complexity of FSD and the need for a treatment algorithm that addresses all 4 domains of FSD.

In a pilot study, Murina and colleagues evaluated the safety and effectiveness of the application of micro-ablative fractional CO2 laser to the vulvar vestibule in the management of patients with vulvar pain from vestibulodynia or genitourinary syndrome of menopause. Inclusion criteria were the existence of vestibular atrophic changes and the absence of moderate or severe pelvic floor hypertonic dysfunction.

A VAS of pain and the Marinoff score of dyspareunia were chosen to evaluate improvement. Data were collected at baseline, at weeks 4, 8, and 12, and 4 months after the final treatment. For VAS and dyspareunia scoring and for the overall vestibular health index scoring, statistically significant improvement was noted after 3 sessions of vestibular fractional CO2 laser treatment.

Improvement gradually increased throughout the study period and was maintained through the 4-month follow-up visit. There was no statistically significant difference in outcomes between the 2 study groups. No adverse events AEs from fractional CO2 laser treatment were noted. Overall, The authors concluded that this preliminary case series showed encouraging results using fractional CO2 laser treatment of the vestibule in women with vestibulodynia and genitourinary syndrome of menopause.

The ganglion impar is the fused terminus of the sympathetic chain. In a retrospective, single-center study, Cardaillac and colleagues evaluated the effects of ropivacaine Impar node infiltration in patients suffering from rebel vulvodynia. Horner's syndrome ptosis , miosis , and anhidrosis ipsilateral to damaged sympathetic nerve fibers.

H-reflex electrical equivalent of the monosynaptic stretch reflex elicited by selectively stimulating the Ia fibers of the posterior tibial or median nerve. Huntington disease fatal autosomal dominant neurodegenerative disorder characterized by chorea and progressive dementia ; due to a trinucleotide CAG-repeat mutation on chromosome 4.

These sites are all supplied by small penetrating arteries that are subject to high sheer stress and have no collaterals, making them vulnerable to the effects of increased blood pressure. Jefferson fracture burst fracture of the anterior and posterior arches of C1 due to axial loading; typically stable.

Korsakoff syndrome chronic phase of thiamine deficiency characterized by impairment in establishing new memories and retrieving previous memories, occurring most commonly in alcoholics. Lambert-Eaton Myasthenic syndrome autoimmune disorder of neuromuscular transmission characterized by antibodies directed against the voltage-gated calcium channels on the presynaptic motor nerve terminal leading to impaired release of acetylcholine and causing proximal muscle weakness, hyporeflexia, and autonomic changes e.

Lennox-Gastaut syndrome syndrome of mental retardation, generalized epilepsy with mixed seizures , especially tonic , myoclonic and atypical absence , and a characteristic pattern of slow, generalized spike-and-wave activity on the electroencephalogram. Lewy body dementia see diffuse Lewy body disease.

Loftstrand Crutch type of crutch with an attached holder for the forearm that provides extra support. Marcus-Gunn pupil see afferent pupillary defect. Meissner corpuscles dermal mechanoreceptors that subserve light touch sensation. MELAS Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes mitochondrial disorder characterized by hearing loss, episodic vomiting, and recurrent cerebral insults resembling strokes and causing hemiparesis , hemianopia , or cortical blindness.

Merkel cells disk-shaped receptor endings in the skin believed to be involved with the sensation of fine touch. Mesulam syndrome eponym for primary progressive aphasia. Millard-Gubler syndrome ipsilateral lateral rectus palsy, ipsilateral peripheral facial palsy, and contralateral hemiplegia due to a ventral pontine lesion affecting the abducens and facial nerve fascicles and corticospinal tract.

Mollaret meningitis benign recurrent aseptic meningitis mononeuropathy multiplex mononeuritis multiplex condition associated with various systemic disorders e. Monroe-Kellie doctrine doctrine stating that the total cranial volume tends to remain constant. An increase in the volume of any of its three components brain, blood, or CSF or the addition of a space-occupying lesion e.

Moro reflex normal neonatal reflex consisting of symmetric abduction followed by adduction of both arms, elicited by gently allowing the back of the head to drop; present during the first months of life. Motor neurons nerve cells that direct movement motor neuron disease dysfunction of alpha motor neurons ; motor neuronopathy.

Negri body viral inclusion in hippocampal, neocortical, or Purkinje cell neurons that is the diagnostic hallmark of rabies encephalitis. Nothnagel Syndrome ipsilateral oculomotor palsy and contralateral ataxia due to a midbrain tegmental lesion affecting the III nerve fascicle and superior cerebellar peduncle. Ondine's curse central alveolar hypoventilation condition in which the respiratory center in the brain is unable to stimulate breathing in response to an increased amount of carbon dioxide in the blood; typically worsens during sleep.

Pacinian corpuscle largest of the skin receptors located deep in the dermis and responsible for sensation of vibration and deep pressure. Many methods of eliciting the plantar reflex have been described, including the following: Unlike in athetosis , the movements are not present when the eyes are open because visual feedback provides the necessary information to know where the limb is in space.

Ramsy-Hunt syndrome facial paralysis, hyperacusis , loss of taste, and vesicles on the eardrum, external auditory meatus, or palate due to herpes zoster infection of the geniculate ganglion. Raymond syndrome ipsilateral lateral rectus palsy and contralateral hemiplegia sparing the face due to a ventral pontine lesion affecting the abducens nerve fascicles and corticospinal tract but sparing the facial nerve.

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This procedure corresponds to the explorative phase of the standard pelvic examination, supplemented with the patient's report on the feelings it provokes and the processing and integration of these feelings. Br J Dermatol. Inclusion criteria were the existence of vestibular atrophic changes and the absence of moderate or severe pelvic floor hypertonic dysfunction. Benedikt Syndrome ipsilateral oculomotor palsy and contralateral hemichoreoathetosis due to lesion of the ventral midbrain tegmentum affecting the IIII nerve fascicles and the red nucleus. Higher pre-treatment pain intensity predicted poorer outcomes at the 2. Leo RJ, Dewani S.

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  1. Fluoroscopy revealed atypical needle tip positioning and radiolucent dye distribution, presumably due to radiation-induced fibrosis in the target region.
  2. The psychotherapeutic approach was detailed in 36 articles while 3 studies utilized homeopathic treatments.
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  5. This effect was not apparent in other outcome measurements.
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  8. The incision may need to approach the peri-urethral area and extend from the openings of Skene's ducts to the perineum.

Perineoplasty compared with vestibuloplasty for severe vulvar vestibulitis. Application of a modality requiring constant provider attendance to one or more areas; low-level laser; each 15 minutes.


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