| 1. |
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| 2. |
- Blomgren, Bo, et al.
(författare)
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A computerised, unbiased method for epithelial measurement
- 2004
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Ingår i: Micron. - Amsterdam : Elsevier. - 0968-4328 .- 1878-4291. ; 35, s. 319-329
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo develop and evaluate a standardised method for unbiased measurements of epithelial thickness taking the variability of the dermal papillae in consideration.MethodsA computer-assisted measurement program suitable for haematoxylin and eosin routine stained specimens has been developed.ResultsThe developed program was designed to measure four different distance parameters, taking the number, height and width of dermal papillae into account. The measurement program gave very accurate results compared with manual measurements. The measurement results can be presented as tables or star graphs, and the results can be further processed by multivariate analysis.ConclusionThe computer-assisted measurement program is considered to be a valuable and reliable tool for measurements of epithelial thickness, irrespectively of the variability of the epithelial morphology. Since length, size and number of the papillae may change with certain pathological conditions, age and also under hormonal influence, this method can be a helpful diagnostic tool.
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| 3. |
- Bohm-Starke, Nina, et al.
(författare)
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Decreased mechanical pain threshold in the vestibular mucosa of women using oral contraceptives : a contributing factor in vulvar vestibulitis?
- 2004
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Ingår i: Journal of reproductive medicine. - Chicago : The Journal. - 0024-7758 .- 1943-3565. ; 49:11, s. 888-892
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Tidskriftsartikel (refereegranskat)abstract
- Objective:To analyze possible differences in somatosensory perception in the vestibular mucosa in healthy women associated with the use of oral contraceptives.Study design:Quantitative sensory tests were performed on the vestibular mucosa in 39 healthy women. Twenty women were using oral contraceptives containing 30-40 µg ethinyl estradiol combined with various progestins; 19 women with regular menstrual periods not using oral contraceptives served as controls. The testing included mechanical and heat pain thresholds and detection thresholds of warmth and cold in the anterior and posterior part of the vestibule.Results:Significant lower mechanical pain thresholds were observed in both areas tested in women using oral contraceptives. The most sensitive area was the posterior vestibule in the group using oral contraceptives with a mechanical pain threshold of 72±10 (±SEM) mN as compared to 161±3 mN (p<0.01), in the controls. The result of the thermotest showed no significant differences between the groups.Conclusion:Oral contraceptives may induce increased sensitivity in the vestibular mucosa in healthy women and might be one contributing factor in the development of vulvar vestibulitis.
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| 4. |
- Bohm-Starke, Nina, et al.
(författare)
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Development of a core outcome set for treatment studies for provoked vestibulodynia.
- 2024
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Ingår i: Journal of Sexual Medicine. - : Oxford University Press. - 1743-6095 .- 1743-6109. ; 21:6, s. 556-565
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There is an inconsistency in treatment outcomes used in clinical trials for provoked vestibulodynia (PVD), which makes it impossible to compare the effects of different interventions.AIM: In this study, we completed the first step in creating a core outcome set (COS), defining what outcomes should be measured in clinical trials for PVD.METHODS: Identification of outcomes used in studies was done by extracting data from clinical trials in a recently published systematic review and via review of clinical trials for PVD registered on ClinicalTrials.gov. The COS process consisted of 2 rounds of Delphi surveys and a consensus meeting, during which the final COS was decided through a modified nominal group technique.OUTCOMES: Consensus on what outcomes to include in a COS for PVD.RESULTS: Forty scientific articles and 92 study protocols were reviewed for outcomes. Of those, 36 articles and 25 protocols were eligible, resulting in 402 outcomes, which were then categorized into 63 unique outcomes. Participants consisted of patients, relatives/partners of patients, health care professionals, and researchers. Out of 463 who registered for participation, 319 and 213 responded to the first and second surveys, respectively. The consensus meeting consisted of 18 members and resulted in 6 outcomes for the COS to be measured in all treatment trials regardless of intervention: insertional pain (nonsexual), insertional pain (sexual), provoked vulvar pain by pressure/contact, pain-related interference on one's life, pain interference on sexual life, and sexual function.CLINICAL IMPLICATIONS: Critical outcomes to be measured in clinical trials will allow for accurate comparison of outcomes across treatment interventions and provide solid treatment recommendations.STRENGTHS AND LIMITATIONS: The major strengths of the study are the adherence to methodological recommendations and the intentional focus on aspects of diversity of participating stakeholders (eg, status such as patients with lived experience and researchers, inclusiveness with respect to sexual identity), the latter of which will allow for broader application and relevance of the COS. Among the limitations of the study are the low rate of participants outside North America and Europe and the lower response rate (about 50%) for the second Delphi survey.CONCLUSION: In this international project, patients, health care professionals, and researchers have decided what critical outcomes are to be used in future clinical trials for PVD. Before the COS can be fully implemented, there is also a need to decide on how and preferably when the outcomes should be measured.
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| 5. |
- Bohm-Starke, Nina, et al.
(författare)
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Treatment of provoked vulvodynia : A systematic review
- 2022
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Ingår i: Journal of Sexual Medicine. - : Elsevier. - 1743-6095 .- 1743-6109. ; 19:5, s. 789-808
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Forskningsöversikt (refereegranskat)abstract
- Background: Treatment recommendations for provoked vulvodynia (PVD) are based on clinical experiences and there is a need for systematically summarizing the controlled trials in this field.Aim: To provide an overview of randomized controlled trials and non-randomized studies of intervention for PVD, and to assess the certainty of the scientific evidence, in order to advance treatment guidelines.Data Sources: The search was conducted in CINAHL (EBSCO), Cochrane Library, Embase (Embase.com), Ovid MEDLINE, PsycINFO (EBSCO) and Scopus. Databases were searched from January 1, 1990 to January 29, 2021.Study Eligibility Criteria: Population: Premenopausal women with PVD. Interventions: Pharmacological, surgical, psychosocial and physiotherapy, either alone or as combined/team-based interventions. Control: No treatment, waiting-list, placebo or other defined treatment. Outcomes: Pain during intercourse, pain upon pressure or touch of the vaginal opening, sexual function/satisfaction, quality of life, psychological distress, adverse events and complications. Study design: Randomized controlled trials and non-randomized studies of interventions with a control group.Study Appraisal and Synthesis Methods: 2 reviewers independently screened citations for eligibility and assessed relevant studies for risk of bias using established tools. The results from each intervention were summarized. Studies were synthesized using a narrative approach, as meta-analyses were not considered appropriate. For each outcome, we assessed the certainty of evidence using grading of recommendations assessment, development, and evaluation (GRADE).Results: Most results of the evaluated studies in this systematic review were found to have very low certainty of evidence, which means that we are unable to draw any conclusions about effects of the interventions. Multimodal physiotherapy compared with lidocaine treatment was the only intervention with some evidential support (low certainty of evidence for significant treatment effects favoring physiotherapy). It was not possible to perform meta-analyses due to a heterogeneity in interventions and comparisons. In addition, there was a heterogeneity in outcome measures, which underlines the need to establish joint core outcome sets.Clinical Implications: Our result underscores the need of stringent trials and defined core outcome sets for PVD.Strength and Limitations: Standard procedures for systematic reviews and the Population Intervention Comparison Outcome model for clinical questions were used. The strict eligibility criteria resulted in limited number of studies which might have resulted in a loss of important information.Conclusion: This systematic review underlines the need for more methodologically stringent trials on interventions for PVD, particularly for multimodal treatments approaches. For future research, there is a demand for joint core outcome sets.
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| 6. |
- Bohm-Starke, Nina
(författare)
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Vulvar vestibulitis syndrome : pathophysiology of the vestibular mucosa
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objective: The main purpose of the study was to survey possible pathophysiological changes of the vestibular mucosa in women with vulvar vestibulitis syndrome with regard to the clinical findings of superficial dyspareunia and mucosal erythema. Methods: Biopsies analysed with immunohistochemistry were used to study the morphology, distribution and neuropeptide content of the peripheral nerves, and the microvascularisation of the vestibular mucosa. The somatosensory function of the vestibular nerves was analysed with quantitative sensory testing (QST). Immunohistochemistry and Western dot-blot analyses were used to study the expression of the inflammatory markers COX 2 and NOS in vestibular tissue specimens. The superficial blood flow in the vestibular mucosa was registered with laser Doppler perfusion imaging (LDPI) and correlated to mucosal erythema. The constrictive ability of the vestibular arterioles was studied with LDPI before and after submucosal injection of noradrenaline. Results: Increased number of intraepithelial free nerve endings were found in women with vestibulitis. These nerve fibres were immunopositive for calcitonin gene-related peptide, a neoropeptide with vasodilative capacity. QST revealed lower thresholds for thermal perception and painful stimulation by von Frey filaments, and heat and distension of the vaginal introitus, in patients than in control subjects. Cold-evoked pain was more common among the patients whereas vibration was not painful in either patients or controls. The expression of the inflammatory markers COX 2 and iNOS was not elevated in the vestibular mucosa in women with VVS. A significant increase in superficial blood flow was registered in the erythematous posterior parts of the vestibular mucosa in the patients. However, there was no significant correlation between perfusion values and degree of erythema in the same individual. Microvascular density and the ability of vestibular arterioles to constrict did not differ between patients and controls. Conclusions: There are structural and functional abnormalities of the peripheral sensory nerves in the vestibular mucosa in women with VVS. The somatosensory abnormalities, with decreased pain thresholds for mechanical and thermal stimuli, give psychophysical evidence of peripheral sensitisation and/or increased number of nociceptors in the vestibular mucosa. There is no evidence of an active inflammation in the mucosa. The increased blood flow, most probably caused by neurogenic vasodilatation contributes to, but does not fully explain, the erythema. Atrophic changes in the surface epithelium should also be considered in the evaluation of an erythema.
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| 7. |
- Fugl-Meyer, Kerstin S., et al.
(författare)
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Standard Operating Procedures for Female Genital Sexual Pain
- 2013
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Ingår i: Journal of Sexual Medicine. - : Oxford University Press (OUP). - 1743-6095 .- 1743-6109. ; 10:1, s. 83-93
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Tidskriftsartikel (refereegranskat)abstract
- Introduction. Female genital sexual pain (GSP) is a common, distressing complaint in women of all ages that is underrecognized and undertreated. Definitions and terminology for female GSP are currently being debated. While some authors have suggested that GSP is not per se a sexual dysfunction, but rather a localized genial pain syndrome, others adhere to using clearly sexually related terms such as dyspareunia and vaginismus. Aim. The aims of this brief review are to present definitions of the different types of female GSP. Their etiology, incidence, prevalence, and comorbidity with somatic and psychological disorders are highlighted, and different somatic and psychological assessment and treatment modalities are discussed. Methods. The Standard Operating Procedures (SOP) committee was composed of a chair and five additional experts. No corporate funding or remuneration was received. The authors agreed to survey relevant databases, journal articles and utilize their own clinical experience. Consensus was guided by systematic discussions by e-mail communications. Main Outcome/Results. There is a clear lack of epidemiological data defining female GSP disorders and a lack of evidence supporting therapeutic interventions. However, this international expert group will recommend guidelines for management of female GSP. Conclusions. GSP disorders are complex. It is recommended that their evaluation and treatment are performed through comprehensive somato-psychological multidisciplinary approach. Fugl-Meyer KS, Bohm-Starke N, Damsted Petersen C, Fugl-Meyer A, Parish S, and Giraldi A. Standard operating procedures for female genital sexual pain.
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| 8. |
- Fuxe, Vendela, et al.
(författare)
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Delivery mode and severe maternal and neonatal morbidity among singleton term breech births : A population-based cohort study
- 2022
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Ingår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - : Elsevier. - 0301-2115 .- 1872-7654. ; 272, s. 166-172
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to examine the association between delivery mode and severe maternal and neonatal morbidity in singleton term breech births.& nbsp;Study design: This nationwide population-based cohort study includes 41 319 singleton term and post-term breech births (37 + 0-42 + 6 gestational weeks) in Sweden from 1998 to 2016. Data was retrieved from the Swedish Medical Birth Register. The primary outcomes were two separate composite outcomes, maternal and neonatal severe morbidity. Secondary outcomes were separate severe maternal and neonatal morbidity outcomes. Hospitalization and out-patient visits during childhood were also analyzed in ages 0-5 years. Logistic regression was used to estimate unadjusted and adjusted odds ratios (aOR) with 95% confidence intervals (CI) of severe maternal and neonatal morbidity in women with vaginal breech birth or intrapartum cesarean section. Women with a prelabor breech cesarean section was used as the reference group.& nbsp;Results: No difference between vaginal delivery and prelabor cesarean section was seen regarding maternal morbidity. Intrapartum cesarean section was associated with elevated odds for maternal morbidity (aOR 1.27, 95% CI 1.10-1.47) compared with prelabor cesarean section. A similar result was observed for vaginal delivery and intrapartum cesarean section combined (aOR 1.29, 95% CI 1.11-1.50). Vaginal delivery was associated with higher odds for composite neonatal morbidity (aOR 1.85, CI 1.54-2.21) and most separate outcomes, as well as increased number of hospital nights and out-patient visits during first year of life, compared with prelabor cesarean section.& nbsp;Conclusions: Prelabor cesarean section in breech births improved short-term neonatal health without increasing risks for severe maternal short-term complications.
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| 9. |
- Haraldson, Philip, et al.
(författare)
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Botulinum Toxin A as a Treatment for Provoked Vestibulodynia A Randomized Controlled Trial
- 2020
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Ingår i: Obstetrics and Gynecology. - : LIPPINCOTT WILLIAMS & WILKINS. - 0029-7844 .- 1873-233X. ; 136:3, s. 524-532
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate pain reduction after two injections of 50 units botulinum toxin A compared with placebo for provoked vestibulodynia. METHODS: We conducted a double-blinded, placebo-controlled randomized trial of 50 units botulinum toxin A or placebo injected in the bulbocavernosus muscles twice, 3 months apart, in women with provoked vestibulodynia. Primary outcome was self-reported dyspareunia or pain at tampon use on a visual analog scale (VAS, 0-100). Secondary outcomes were pain at weekly tampon insertion (VAS score), reduction of pelvic floor hypertonicity (measured with a vaginal manometer), adverse events, and sexual function and distress. A sample size of 38 participants for each group was calculated to achieve a statistical power of 80% based on an effect size of 20 VAS units (0-100) (mean score range 56-76 +/- 31 SD). RESULTS: Between May 2016 and June 2018, 124 women with provoked vestibulodynia were assessed, and 88 were randomized to botulinum toxin A (BTA group, n=44) or placebo (placebo group, n=44). Primary outcome showed a lower but statistically nonsignificant pain rating by 7 VAS units (95% CI -15.0 to 0.4) in the BTA group compared with the placebo group. Secondary results showed a significant decrease in pain at weekly tampon insertion by 11 VAS units (95% CI -16.6 to 6.0) with botulinum toxin A injection. The vaginal manometer measured lower maximum contraction strength by 7 mm Hg (95% CI -12.7 to -2.4) and lower 10-second endurance strength by 4 mm Hg (95% CI -7.72 to -1.16) in the BTA group compared with the placebo group. No changes were observed for sexual function and distress, but there was a significant increase in women attempting vaginal intercourse in the BTA group (0.27, 95% CI 0.06-0.48). No severe adverse events were reported. CONCLUSION: Twice-repeated injections of 50 units of botulinum toxin A in women with provoked vestibulodynia did not reduce dyspareunia or pain at tampon use, but secondary outcomes suggested positive effects of the treatment.
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| 10. |
- Haraldson, Philip, et al.
(författare)
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Botulinum Toxin A for Provoked Vestibulodynia : 12 Months’ Follow-up of a Randomized Controlled Trial
- 2022
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Ingår i: Journal of Sexual Medicine. - : Elsevier B.V.. - 1743-6095 .- 1743-6109. ; 19:11, s. 1670-1679
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Tidskriftsartikel (refereegranskat)abstract
- Background: Provoked vestibulodynia (PVD) is a common pain disorder afflicting primarily young women, and botulinum toxin A (BTA) has been to a limited extent tested as a treatment. Aim: Evaluate outcome 12 months after injection with BTA as a treatment for PVD. Methods: We conducted a double-blinded, placebo-controlled trial of twice repeated injections of 50 units of BTA or placebo in the bulbocavernosus muscles, 3 months apart, in women with PVD. Treatment outcome after six months’, failed to show any significant difference in pain reduction between the groups, as previously reported. Here, we report treatment outcomes 12 months after the first injections. In addition to injections, participants where instructed to perform pelvic floor exercises during month 6-12. 38 participants/group was calculated to achieve a statistical power of 80% based on an effect size of 20 VAS units (mean score range 56-76±31 SD). Outcomes: Primary outcome was self-reported dyspareunia or pain at tampon use, using a visual analogue scale (VAS) 0-100. Secondary outcomes were vaginal pressure measurements, psychological health, sexual function and distress. Results: From the initial 88 randomized women with PVD, 75 remained at 12 months; 38 in the BTA and 37 in the placebo group. There was no significant difference in primary outcome between the groups. Vaginal pressure in the BTA group had been restored to pre-treatment levels, with no differences between the groups at 12 months. There was an increase in sexual function in the BTA group, with a Female Sexual Function Index of 22.8 (±4.8) compared to the placebo group to 19.7 (±5.0), P=.048. No differences were observed in sexual distress, stress and anxiety. There was an increase in number of women attempting intercourse in the BTA group (74%) compared with placebo (43%), P=.005. Too few patients performed the pelvic floor exercises for this intervention to be analyzed. Clinical Implications: This study highlights BTA as a safe treatment option for patients with PVD. Strengths and limitations: The randomized, double-blinded design and repeated treatments are the major strengths of this study and it is the first study to objectively evaluate muscular effect after BTA injections. The major shortcoming is that few participants performed the pelvic floor exercises, preventing analyses. Conclusion: At 12 months’ follow up, no significant difference in reduction of dyspareunia or pain at tampon use was observed. Women receiving BTA attempted intercourse more often and improved their sexual function compared with women receiving placebo. Haraldson P, Mühlrad H, Heddini U, et al. Botulinum Toxin A for Provoked Vestibulodynia: 12 Months’ Follow-up of a Randomized Controlled Trial. J Sex Med 2022;19:1670–1679.
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