Editorial

“Doctor, It Hurts.”

L

Kevin A. Ault, MD

See related article on page 225.

Dr. Ault is from the Department of Obstetrics and Gynecology at Emory University, Atlanta, Georgia; e-mail: [email protected]. Financial Disclosure The author did not report any potential conflicts of interest. © 2014 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins. ISSN: 0029-7844/14

ooking at the table of contents of Obstetrics & Gynecology over the past few months, one would find clinically related research and guidelines concerning preterm delivery in twin gestations, the interpretation of electronic fetal monitoring, and the recommended work-up for abnormal cervical cytology. All of these clinical scenarios would be seen by a practicing obstetrician–gynecologist on a regular basis. Based on the research done by Reed et al in this issue (see page 225), vulvodynia would be on that list of common gynecologic problems.1 Vulvodynia and related pain disorders are poorly understood, poorly recognized, and poorly treated problems. Vulvodynia causes major disruption in our patients’ lives—from mundane activities such has wearing a favorite pair of jeans to important and pleasurable aspects of life such as intimacy with a loving partner. More than half of women with vulvodynia will report low or very low sexual desire.2 “Doctor, it hurts.” is the usual presenting complaint when a woman with vulvodynia comes to our offices. When pain is reported at the initiation of intercourse, vulvodynia is likely the first item in the differential diagnosis. The highlighted study provides new data concerning the incidence of vulvodynia. The authors employ a validated survey administered every 6 months over a period of 30 months. They use a case definition of selfreported vulvar pain for at least 3 months. Based on their findings, there were 4.2 new-onset vulvodynia cases per 100 person-years. At younger ages, new cases of vulvodynia were even higher, and this difference was apparent in all ethnic groups. They also note a number of comorbid conditions that may put women at risk for vulvodynia. These include sleep dysfunction, psychological distress, and chronic pain with associated illnesses. In 2012, Nguyen et al3 reported the results of a survey done in collaboration with the National Vulvodynia Association (www.nva.org), the leading patient advocacy group for our patients with this disease. Women in this survey had suffered vulvodynia for a mean of 3 years and had seen five different physicians. Three quarters of these women had moderate to severe vulvar pain. In 2006, the American College of Obstetricians and Gynecologists issued Committee Opinion No. 345,4 which was adopted from a prior publication of the American Society for Colposcopy and Cervical Pathology (www.asccp.org). There are few randomized trials of various treatments for vulvodynia. However, this committee opinion and related materials from the American Society for Colposcopy and Cervical Pathology provide multiple potential therapeutic options. Multidisciplinary approaches appear to help many women with vulvodynia. In one Dutch study, 80% of women resumed intercourse and 81% reported a decrease in vulvar pain.5 In conclusion, a sizeable percentage of the patients we see suffer from chronic vulvar pain, or vulvodynia. Reed and her colleagues1

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have provided a well-done study to estimate the incidence of this agonizing disease. REFERENCES 1. Reed BD, Legocki LJ, Plegue MA, Sen A, Haefner HK, Harlow SD. Factors associated with vulvodynia incidence. Obstet Gynecol 2014;123:225–31. 2. Piper CK, Legocki LJ, Moravek MB, Levin K, Haefner HK, Wade K, et al. Experiences of symptoms, sexual function, and attitudes toward counseling of women newly diagnosed with vulvodynia. J Lower Genital Tract Dis 2012;16:447–53.

3. Nguyen RH, Ecklund AM, MacLehose RF, Veasley C, Harlow BL. Co-morbid pain conditions and feelings of invalidation and isolation among women with vulvodynia. Psychol Health Med 2012;17:589–98. 4. Vulvodynia. ACOG Committee Opinion No. 345. American College of Obstetricians and Gynecologists. Obstet Gynecol 2006;108;1049–52. 5. Spoelstra SK, Dijkstra JR, van Driel MF, Weijmar Schultz WC. Long term results of an individualized, multifaceted and multidisciplinary therapeutic approach to provoked vestibulodynia. J Sex Med 2011;8: 489–96.

Standards for Different Types of Articles Guidelines for five different types of articles have been adopted by Obstetrics & Gynecology: 1. CONSORT (Consolidated Standards of Reporting Trials) standards for reporting randomized trials 2. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for metaanalyses and systematic reviews of randomized controlled trials 3. MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines for meta-analyses and systematic reviews of observational studies 4. STARD (Standards for Reporting of Diagnostic Accuracy) standards for reporting studies of diagnostic accuracy 5. STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for the reporting of observational studies Investigators who are planning, conducting, or reporting randomized trials, meta-analyses of randomized trials, meta-analyses of observational studies, studies of diagnostic accuracy, or observational studies should be thoroughly familiar with these sets of standards and follow these guidelines in articles submitted for publication. NOW AVAILABLE ONLINE - http://ong.editorialmanager.com

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“Doctor, It Hurts.”

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OBSTETRICS & GYNECOLOGY

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