The immediate goal of this K23 proposal is to strengthen the candidate's research skills and knowledge and to use these skills to explore quality of life (QOL) in a sample of women undergoing surgical excision for vulvar intraepithelial neoplasia (VIN). The ultimate goal of this application is to prepare the candidate to lead a multi-disciplinary research team that studies the clinical, psychological, and social problems women face in the aftermath of physically altering vulvar disease. Currently very little is known about the QOL of women who undergo vulvar excision for VIN. The standard treatment, surgical excision of the affected area, physically alters the genitalia and potentially impairs QOL, particularly sexual function as a QOL domain. This treatment often impairs QOL to a greater degree than the disease. Given the dramatic increases in the prevalence of VIN, particularly in young women, and the potentially mutilating affects of the treatment it is critical to understand how overall QOL and QOL domains are affected. A prospective repeated measures design will be used to describe changes in overall QOL and sexual function, depressive symptoms, and relationship adjustment as indicators of the psychological, physical, and social functioning domains of QOL. The influence of these QOL domains and excision size on overall QOL will be explored, moving knowledge from the descriptive to explanatory level. This study is a critical first step needed to design effective interventions to improve clinical outcomes in this understudied population. This program of research, which is consistent with the mission of the NINR, focuses on the needs of women and seeks to understand and ease the symptoms associated with disease/treatments, and identify approaches and strategies to achieve and sustain good health. A multi-disciplinary career development plan is proposed to enhance the candidate's present skills through focused and relevant didactic experiences, clinical apprenticeships, conferences, journal clubs, and research experiences. The candidate will develop expertise related to i) interdisciplinary QOL research, 2) sexual function, 3) physically altering vulvar disease, and 4) advanced research skills needed for independent scientific study. Study findings, along with the skills and knowledge gained as part of the career development plan, will enable the candidate to submit an R-level application as a principle investigator who focuses on multidisciplinary patient-oriented research. ? ? ?
