Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I

Vesna Harni; Damir Babic; Suzana Ljubojevic-Hadzavdic; Dubravko Barisic

doi:doi:10.11648/j.jgo.20221006.12

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Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I

Vesna Harni, Damir Babic, Suzana Ljubojevic-Hadzavdic, Dubravko Barisic

Published in Journal of Gynecology and Obstetrics (Volume 10, Issue 6)

Received: 16 October 2022 Accepted: 3 November 2022 Published: 10 November 2022

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Abstract

This study aimed to investigate the presence, type, and arrangement of nonspecific lesions considering the different histologies of the three vulvar rings in women with chronic vulvar discomfort to obtain reference data for the diagnostic procedure and a better understanding of women with chronic vulvar distress. The distribution of nonspecific lesions in the vulva based on vulvar rings was monitored as a secondary outcome measure within the framework of the prospective experimental study using diagnostic interventions called DATRIV, which included a total of 328 consecutive participants. Four patient groups were distinguished according to their medical history, structured International Society for the Study of Vulvovaginal Disease vulvodynia questionnaire results, and clinical examination, including inspection and cotton swab test. Asymptomatic participants were classified into normal vulva (N = 82) and impaired vulvar skin (N = 82) groups. Patients with chronic vulvar discomfort were categorized into groups of patients with primary, idiopathic vulvar distress/vulvodynia (N=82), and secondary complaints caused by vulvar dermatosis (N=82). Three rings vulvoscopy form data were used to collect clinical data, which were analyzed using StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). This study was approved by the Institutional Review Board of Polyclinic Harni, and all patients provided written informed consent. Nonspecific changes in the outer vulvar ring were significantly more common in patients with vulvar dermatosis (70.7%). The opposite pattern of lesion incidence was observed, with a considerably higher frequency of nonspecific findings in the inner vulvar ring in patients with vulvodynia (98.8%) and impaired vulvar skin (96.3%). The inner vulvar ring in patients with vulvodynia demonstrated a peculiar and characteristic profile with significantly more frequent findings of erythema (92.7%), punctuations (54.9%), ischemia (48.8%), and papillae (25.6%). A high presence of nonspecific lesions in the middle vulvar ring was documented in all participants, with an evident distinction in the appearance and allocation of these findings between patients with vulvodynia and vulvar dermatosis. By establishing the characteristic pattern of the type and distribution of nonspecific lesions in patients with vulvodynia, the Budapest criteria for considering vulvodynia as chronic reflex pain syndrome (CRPS) type 1, formerly sympathetic dystrophy, are met. Due to the specific three rings anatomy of the vulva, revised Budapest criteria are proposed. This study creates a unique opportunity to introduce vulvoscopy in the differential diagnosis of chronic, primary, and secondary vulvar discomfort.

Published in	Journal of Gynecology and Obstetrics (Volume 10, Issue 6)
DOI	10.11648/j.jgo.20221006.12
Page(s)	243-252
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Vulvar Discomfort, Vulvodynia, Vulvar Dermatosis, Three Rings Vulvoscopy, Vulvar Lesions, Chronic Reflex Pain Syndrome (CRPS), Budapest Criteria

References

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[45]	Harden RN, Bruehl, Perez RSGM, Birklein F, Marinus J, Maihofner C. et al. Validation of proposed diagnostic criteria (the "Budapest Criteria") for Complex Regional Pain Syndrome. Pain 2010; 150 (2): 268–274. DOI: 10.1016/j.pain.2010.04.030.

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APA Style

Vesna Harni, Damir Babic, Suzana Ljubojevic-Hadzavdic, Dubravko Barisic. (2022). Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I. Journal of Gynecology and Obstetrics, 10(6), 243-252. https://doi.org/10.11648/j.jgo.20221006.12

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ACS Style

Vesna Harni; Damir Babic; Suzana Ljubojevic-Hadzavdic; Dubravko Barisic. Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I. J. Gynecol. Obstet. 2022, 10(6), 243-252. doi: 10.11648/j.jgo.20221006.12

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AMA Style

Vesna Harni, Damir Babic, Suzana Ljubojevic-Hadzavdic, Dubravko Barisic. Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I. J Gynecol Obstet. 2022;10(6):243-252. doi: 10.11648/j.jgo.20221006.12

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@article{10.11648/j.jgo.20221006.12,
  author = {Vesna Harni and Damir Babic and Suzana Ljubojevic-Hadzavdic and Dubravko Barisic},
  title = {Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I},
  journal = {Journal of Gynecology and Obstetrics},
  volume = {10},
  number = {6},
  pages = {243-252},
  doi = {10.11648/j.jgo.20221006.12},
  url = {https://doi.org/10.11648/j.jgo.20221006.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20221006.12},
  abstract = {This study aimed to investigate the presence, type, and arrangement of nonspecific lesions considering the different histologies of the three vulvar rings in women with chronic vulvar discomfort to obtain reference data for the diagnostic procedure and a better understanding of women with chronic vulvar distress. The distribution of nonspecific lesions in the vulva based on vulvar rings was monitored as a secondary outcome measure within the framework of the prospective experimental study using diagnostic interventions called DATRIV, which included a total of 328 consecutive participants. Four patient groups were distinguished according to their medical history, structured International Society for the Study of Vulvovaginal Disease vulvodynia questionnaire results, and clinical examination, including inspection and cotton swab test. Asymptomatic participants were classified into normal vulva (N = 82) and impaired vulvar skin (N = 82) groups. Patients with chronic vulvar discomfort were categorized into groups of patients with primary, idiopathic vulvar distress/vulvodynia (N=82), and secondary complaints caused by vulvar dermatosis (N=82). Three rings vulvoscopy form data were used to collect clinical data, which were analyzed using StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). This study was approved by the Institutional Review Board of Polyclinic Harni, and all patients provided written informed consent. Nonspecific changes in the outer vulvar ring were significantly more common in patients with vulvar dermatosis (70.7%). The opposite pattern of lesion incidence was observed, with a considerably higher frequency of nonspecific findings in the inner vulvar ring in patients with vulvodynia (98.8%) and impaired vulvar skin (96.3%). The inner vulvar ring in patients with vulvodynia demonstrated a peculiar and characteristic profile with significantly more frequent findings of erythema (92.7%), punctuations (54.9%), ischemia (48.8%), and papillae (25.6%). A high presence of nonspecific lesions in the middle vulvar ring was documented in all participants, with an evident distinction in the appearance and allocation of these findings between patients with vulvodynia and vulvar dermatosis. By establishing the characteristic pattern of the type and distribution of nonspecific lesions in patients with vulvodynia, the Budapest criteria for considering vulvodynia as chronic reflex pain syndrome (CRPS) type 1, formerly sympathetic dystrophy, are met. Due to the specific three rings anatomy of the vulva, revised Budapest criteria are proposed. This study creates a unique opportunity to introduce vulvoscopy in the differential diagnosis of chronic, primary, and secondary vulvar discomfort.},
 year = {2022}
}

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TY  - JOUR
T1  - Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I
AU  - Vesna Harni
AU  - Damir Babic
AU  - Suzana Ljubojevic-Hadzavdic
AU  - Dubravko Barisic
Y1  - 2022/11/10
PY  - 2022
N1  - https://doi.org/10.11648/j.jgo.20221006.12
DO  - 10.11648/j.jgo.20221006.12
T2  - Journal of Gynecology and Obstetrics
JF  - Journal of Gynecology and Obstetrics
JO  - Journal of Gynecology and Obstetrics
SP  - 243
EP  - 252
PB  - Science Publishing Group
SN  - 2376-7820
UR  - https://doi.org/10.11648/j.jgo.20221006.12
AB  - This study aimed to investigate the presence, type, and arrangement of nonspecific lesions considering the different histologies of the three vulvar rings in women with chronic vulvar discomfort to obtain reference data for the diagnostic procedure and a better understanding of women with chronic vulvar distress. The distribution of nonspecific lesions in the vulva based on vulvar rings was monitored as a secondary outcome measure within the framework of the prospective experimental study using diagnostic interventions called DATRIV, which included a total of 328 consecutive participants. Four patient groups were distinguished according to their medical history, structured International Society for the Study of Vulvovaginal Disease vulvodynia questionnaire results, and clinical examination, including inspection and cotton swab test. Asymptomatic participants were classified into normal vulva (N = 82) and impaired vulvar skin (N = 82) groups. Patients with chronic vulvar discomfort were categorized into groups of patients with primary, idiopathic vulvar distress/vulvodynia (N=82), and secondary complaints caused by vulvar dermatosis (N=82). Three rings vulvoscopy form data were used to collect clinical data, which were analyzed using StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). This study was approved by the Institutional Review Board of Polyclinic Harni, and all patients provided written informed consent. Nonspecific changes in the outer vulvar ring were significantly more common in patients with vulvar dermatosis (70.7%). The opposite pattern of lesion incidence was observed, with a considerably higher frequency of nonspecific findings in the inner vulvar ring in patients with vulvodynia (98.8%) and impaired vulvar skin (96.3%). The inner vulvar ring in patients with vulvodynia demonstrated a peculiar and characteristic profile with significantly more frequent findings of erythema (92.7%), punctuations (54.9%), ischemia (48.8%), and papillae (25.6%). A high presence of nonspecific lesions in the middle vulvar ring was documented in all participants, with an evident distinction in the appearance and allocation of these findings between patients with vulvodynia and vulvar dermatosis. By establishing the characteristic pattern of the type and distribution of nonspecific lesions in patients with vulvodynia, the Budapest criteria for considering vulvodynia as chronic reflex pain syndrome (CRPS) type 1, formerly sympathetic dystrophy, are met. Due to the specific three rings anatomy of the vulva, revised Budapest criteria are proposed. This study creates a unique opportunity to introduce vulvoscopy in the differential diagnosis of chronic, primary, and secondary vulvar discomfort.
VL  - 10
IS  - 6
ER  -

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Author Information

Vesna Harni

Department of Obstetrics and Gynaecology, Polyclinic Harni, Zagreb, Croatia
Damir Babic

Department of Pathology and Cytology, University Hospital Center, Zagreb, Croatia
Suzana Ljubojevic-Hadzavdic

Department of Dermatovenereology, University Hospital Center, Zagreb, Croatia
Dubravko Barisic

Department of Obstetrics and Gynaecology, Kardinal Schwarzenberg Klinikum GmbH, Schwarzach im Pongau, Austria

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APA Style

Vesna Harni, Damir Babic, Suzana Ljubojevic-Hadzavdic, Dubravko Barisic. (2022). Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I. Journal of Gynecology and Obstetrics, 10(6), 243-252. https://doi.org/10.11648/j.jgo.20221006.12

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ACS Style

Vesna Harni; Damir Babic; Suzana Ljubojevic-Hadzavdic; Dubravko Barisic. Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I. J. Gynecol. Obstet. 2022, 10(6), 243-252. doi: 10.11648/j.jgo.20221006.12

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AMA Style

Vesna Harni, Damir Babic, Suzana Ljubojevic-Hadzavdic, Dubravko Barisic. Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I. J Gynecol Obstet. 2022;10(6):243-252. doi: 10.11648/j.jgo.20221006.12

Copy | Download

@article{10.11648/j.jgo.20221006.12,
  author = {Vesna Harni and Damir Babic and Suzana Ljubojevic-Hadzavdic and Dubravko Barisic},
  title = {Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I},
  journal = {Journal of Gynecology and Obstetrics},
  volume = {10},
  number = {6},
  pages = {243-252},
  doi = {10.11648/j.jgo.20221006.12},
  url = {https://doi.org/10.11648/j.jgo.20221006.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20221006.12},
  abstract = {This study aimed to investigate the presence, type, and arrangement of nonspecific lesions considering the different histologies of the three vulvar rings in women with chronic vulvar discomfort to obtain reference data for the diagnostic procedure and a better understanding of women with chronic vulvar distress. The distribution of nonspecific lesions in the vulva based on vulvar rings was monitored as a secondary outcome measure within the framework of the prospective experimental study using diagnostic interventions called DATRIV, which included a total of 328 consecutive participants. Four patient groups were distinguished according to their medical history, structured International Society for the Study of Vulvovaginal Disease vulvodynia questionnaire results, and clinical examination, including inspection and cotton swab test. Asymptomatic participants were classified into normal vulva (N = 82) and impaired vulvar skin (N = 82) groups. Patients with chronic vulvar discomfort were categorized into groups of patients with primary, idiopathic vulvar distress/vulvodynia (N=82), and secondary complaints caused by vulvar dermatosis (N=82). Three rings vulvoscopy form data were used to collect clinical data, which were analyzed using StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). This study was approved by the Institutional Review Board of Polyclinic Harni, and all patients provided written informed consent. Nonspecific changes in the outer vulvar ring were significantly more common in patients with vulvar dermatosis (70.7%). The opposite pattern of lesion incidence was observed, with a considerably higher frequency of nonspecific findings in the inner vulvar ring in patients with vulvodynia (98.8%) and impaired vulvar skin (96.3%). The inner vulvar ring in patients with vulvodynia demonstrated a peculiar and characteristic profile with significantly more frequent findings of erythema (92.7%), punctuations (54.9%), ischemia (48.8%), and papillae (25.6%). A high presence of nonspecific lesions in the middle vulvar ring was documented in all participants, with an evident distinction in the appearance and allocation of these findings between patients with vulvodynia and vulvar dermatosis. By establishing the characteristic pattern of the type and distribution of nonspecific lesions in patients with vulvodynia, the Budapest criteria for considering vulvodynia as chronic reflex pain syndrome (CRPS) type 1, formerly sympathetic dystrophy, are met. Due to the specific three rings anatomy of the vulva, revised Budapest criteria are proposed. This study creates a unique opportunity to introduce vulvoscopy in the differential diagnosis of chronic, primary, and secondary vulvar discomfort.},
 year = {2022}
}

Copy | Download

TY  - JOUR
T1  - Nonspecific Lesions in Patients with Chronic Vulvar Discomfort Revealed Vulvodynia as Chronic Reflex Pain Syndrome (CRPS) Type I
AU  - Vesna Harni
AU  - Damir Babic
AU  - Suzana Ljubojevic-Hadzavdic
AU  - Dubravko Barisic
Y1  - 2022/11/10
PY  - 2022
N1  - https://doi.org/10.11648/j.jgo.20221006.12
DO  - 10.11648/j.jgo.20221006.12
T2  - Journal of Gynecology and Obstetrics
JF  - Journal of Gynecology and Obstetrics
JO  - Journal of Gynecology and Obstetrics
SP  - 243
EP  - 252
PB  - Science Publishing Group
SN  - 2376-7820
UR  - https://doi.org/10.11648/j.jgo.20221006.12
AB  - This study aimed to investigate the presence, type, and arrangement of nonspecific lesions considering the different histologies of the three vulvar rings in women with chronic vulvar discomfort to obtain reference data for the diagnostic procedure and a better understanding of women with chronic vulvar distress. The distribution of nonspecific lesions in the vulva based on vulvar rings was monitored as a secondary outcome measure within the framework of the prospective experimental study using diagnostic interventions called DATRIV, which included a total of 328 consecutive participants. Four patient groups were distinguished according to their medical history, structured International Society for the Study of Vulvovaginal Disease vulvodynia questionnaire results, and clinical examination, including inspection and cotton swab test. Asymptomatic participants were classified into normal vulva (N = 82) and impaired vulvar skin (N = 82) groups. Patients with chronic vulvar discomfort were categorized into groups of patients with primary, idiopathic vulvar distress/vulvodynia (N=82), and secondary complaints caused by vulvar dermatosis (N=82). Three rings vulvoscopy form data were used to collect clinical data, which were analyzed using StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). This study was approved by the Institutional Review Board of Polyclinic Harni, and all patients provided written informed consent. Nonspecific changes in the outer vulvar ring were significantly more common in patients with vulvar dermatosis (70.7%). The opposite pattern of lesion incidence was observed, with a considerably higher frequency of nonspecific findings in the inner vulvar ring in patients with vulvodynia (98.8%) and impaired vulvar skin (96.3%). The inner vulvar ring in patients with vulvodynia demonstrated a peculiar and characteristic profile with significantly more frequent findings of erythema (92.7%), punctuations (54.9%), ischemia (48.8%), and papillae (25.6%). A high presence of nonspecific lesions in the middle vulvar ring was documented in all participants, with an evident distinction in the appearance and allocation of these findings between patients with vulvodynia and vulvar dermatosis. By establishing the characteristic pattern of the type and distribution of nonspecific lesions in patients with vulvodynia, the Budapest criteria for considering vulvodynia as chronic reflex pain syndrome (CRPS) type 1, formerly sympathetic dystrophy, are met. Due to the specific three rings anatomy of the vulva, revised Budapest criteria are proposed. This study creates a unique opportunity to introduce vulvoscopy in the differential diagnosis of chronic, primary, and secondary vulvar discomfort.
VL  - 10
IS  - 6
ER  -

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