Abnormal vaginal microbioma is associated with severity of localized provoked vulvodynia. Role of aerobic vaginitis and Candida in the pathogenesis of vulvodynia.
Gilbert G G DondersGert BellenKateryna S RubanPublished in: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (2018)
Localized provoked vulvodynia (LPV) causes introital dyspareunia in up to 14% of premenopausal women. Vaginal infections like candidosis may play a initiating role. The aim of this study was to test a possible association of vaginal microbiota alternations such as Candida vaginitis (CV), aerobic vaginitis (AV) and bacterial vaginosis (BV) with severity of vulvodynia and painful intercourse. In an observational study, Q-tip touch test (score 1 (no pain) to 10 (worst possible pain)) was performed on seven vestibular locations in 231 LPV patients presenting in the Vulvovaginal Disease Clinics in Tienen, Leuven and Antwerp, Belgium. Severity of pain upon attempting sexual intercourse was recorded in a similar scale. Both scales were compared to results from fresh wet mount phase contrast microscopy on vaginal fluid smears tested for abnormal vaginal flora (AVF), BV, AV and CV according the standardized microscopy method (Femicare). Fisher's exact test was used. Average age was 31.3 ± 11.6 years, and 58.8% (n = 132) had secondary vestibulodynia. There was an inverse relation between the presence of Candida in the vaginal smears and pain score (p = 0.03). There was no relation of pain score, nor Q-tip score with BV. LPV patients with Q-tip score above 7 at 5 and/or 7 o'clock or at 1 and/or 11 o'clock had more often AV than women with lower pain scores (30 vs 14.5%, p = 0.01, and 39 vs 14.7%, p < 0.005, respectively). Detailed study of the vaginal microflora in patients demonstrates that the most severe patients suffer more from AV and less from Candida. These abnormalities need to be actively looked for and corrected before considering surgery or other therapies.
Keyphrases
- chronic pain
- end stage renal disease
- pain management
- neuropathic pain
- ejection fraction
- newly diagnosed
- candida albicans
- minimally invasive
- prognostic factors
- high resolution
- single molecule
- lipopolysaccharide induced
- type diabetes
- mental health
- spinal cord injury
- magnetic resonance
- magnetic resonance imaging
- men who have sex with men
- biofilm formation
- spinal cord
- high throughput
- postoperative pain
- computed tomography
- inflammatory response
- pseudomonas aeruginosa
- staphylococcus aureus
- mass spectrometry
- early breast cancer