Vulvar Vestibulitis Syndrome (VVS), the most common type of chronic vulvo-vaginal pain, negatively impacts the psychological, physical, and reproductive health of approximately 10% of women at some point in their life. Despite decades of research, the etiology and pathophysiology of VVS remain unknown. Current treatments are largely empiric and guided more by an individual clinician's prior experience and comfort level than objective data on therapeutic efficacy. Recent evidence suggests that the etiology of VVS involves impairment of biological and psychological processes, similar to those of other chronic pain disorders. Although women diagnosed with VVS present with a spectrum of mucosal sensitivity, pelvic muscle dysfunction, and psychological distress, the actual diagnosis of VVS continues to rely on relatively crude measures of mucosal sensitivity (cotton swab palpation and patient report of pain) on clinical exam. A lack of strict criteria for evaluation, and dependence on highly subjective measures by both clinician and patient, suggests that this diagnosis is currently poorly circumscribed. As such, it is likely to encompass a heterogeneous, potentially divergent group of women with the sole common feature of frustration with persistent vulvar pain and dyspareunia. Refinement of therapeutic interventions and insight into the underlying pathophysiology of VVS are critically impaired by lack of methods to reliably and reproducibly assess key features of VVS, as well as by the lack of a classification system based on pathophysiological processes. Our long-term goal is to understand the pathogenesis of VVS, so that optimal treatment strategies can be developed. The primary goal of this proposal is to establish the reliability and reproducibility of our recently developed quantitative assessment tools to determine the spectrum of mucosal and pelvic muscle pain sensitivity (Aims 1-2). We will also assess central dysregulation (via experimental pain sensitivity procedures) and psychological factors to provide a solid evidence-based framework for a comprehensive, multiaxial assessment of VVS as a true pain disorder (Aims 3-4). Our rationale is that advances in treatment and potential for prevention of VVS can only be realized in the context of a conceptual framework informed by comprehensive multiaxial assessment of VVS, similar to that of other pain disorders (e.g., temporomandibular disorder, TMD). The public health relevance of this research is that its successful completion will positively impact the physical, psychological and reproductive health of millions of women.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23HD053631-04
Application #
7676207
Study Section
Pediatrics Subcommittee (CHHD)
Program Officer
Parrott, Estella C
Project Start
2006-09-20
Project End
2011-08-31
Budget Start
2009-09-01
Budget End
2010-08-31
Support Year
4
Fiscal Year
2009
Total Cost
$140,372
Indirect Cost
Name
University of North Carolina Chapel Hill
Department
Obstetrics & Gynecology
Type
Schools of Medicine
DUNS #
608195277
City
Chapel Hill
State
NC
Country
United States
Zip Code
27599
Bair, Eric; Simmons, Elizabeth; Hartung, Jessica et al. (2015) Natural history of comorbid orofacial pain among women with vestibulodynia. Clin J Pain 31:73-8
Lamvu, Georgine; Nguyen, Ruby H N; Burrows, Lara J et al. (2015) The Evidence-based Vulvodynia Assessment Project. A National Registry for the Study of Vulvodynia. J Reprod Med 60:223-35
Corbett, Susan H; Cuddeback, Gary; Lewis, Jasmine et al. (2014) Trends in pharmacy compounding for women's health in North Carolina: focus on vulvodynia. South Med J 107:433-6
Wagner, I Janelle; Damitz, Lynn A; Carey, Erin et al. (2013) Bilateral accessory breast tissue of the vulva: a case report introducing a novel labiaplasty technique. Ann Plast Surg 70:549-52
Carey, Erin; Zedek, Daniel; Lewis, Jasmine et al. (2013) Superimposed methicillin-resistant Staphylococcus aureus infection of vulvar eczematous dermatitis: a case report. J Reprod Med 58:261-3
Zolnoun, Denniz; Bair, Eric; Essick, Greg et al. (2012) Reliability and reproducibility of novel methodology for assessment of pressure pain sensitivity in pelvis. J Pain 13:910-20
Johnson, Elisabeth; Groben, Pamela; Eanes, Alisa et al. (2012) Vulvar skin atrophy induced by topical glucocorticoids. J Midwifery Womens Health 57:296-9
Martin, C E; Johnson, E; Wechter, M E et al. (2011) Catastrophizing: a predictor of persistent pain among women with endometriosis at 1 year. Hum Reprod 26:3078-84
Zhang, Zheng; Zolnoun, Denniz A; Francisco, Eric M et al. (2011) Altered central sensitization in subgroups of women with vulvodynia. Clin J Pain 27:755-63
Eanes, Alisa; Bair, Eric; Martin, Caitlin et al. (2011) Psychosexual correlates of persistent postsurgical pain in patients with vulvodynia. Int J Gynaecol Obstet 113:225-8

Showing the most recent 10 out of 14 publications