(106) Hormonally-Mediated Vestibulodynia: A Chart Review

Abstract Introduction The borders of the vestibule are Hart’s line laterally, hymen medially, frenulum clitoris anteriorly, and fourchette posteriorly. Provoked vestibulodynia (PVD) is characterized by severe burning pain in response to pressure localized vestibule. Numerous factors may negatively affect causing PVD such as hormonal changes, infections, trauma, exaggerated immunologic or inflammatory responses, dermatologic conditions, high-tone pelvic floor dysfunction, pudendal neuropathy, sacral radiculopathy. specifically associated with changes pre-menopausal women has been termed hormonally mediated (HMV). Dense labeling androgen receptors noted germinal layer vestibular epithelium mucinous minor glands, implying a critical role testosterone health. Low calculated free caused elevated sex hormone binding globulin (SHBG) using combined contraception thus be harmful resulting HMV. In HMV, vulvoscopy shows diffuse tenderness entire vestibule, ostia glands frequently erythematous (Fig 1) blood testing consistent low testosterone. Objective We describe variation etiologies for HMV emphasize importance measuring total SHBG monitor levels patients Methods This retrospective chart review premenopausal presenting clinic entrance dyspareunia who were diagnosed whose symptoms alleviated treatment. Inclusion criteria follows: females initial values below reference range, findings significant vestibulodynia, follow-up approaching vulvoscopies demonstrating relief from symptoms. Results A 9 met inclusion criteria. mean age was 32 years old, range 22 old 39 old. Presenting complaints addition (n=9) included recurrent irritative bladder voiding without positive urine culture (n=3) (n=4). Vulvoscopic examination including cotton-tipped swab revealed signs hypersensitivity ranging 1 all 7 regions tested. Patients had histories having taken contraceptives (n=6), isotretinoin (n=1), spironolactone (n=1) and/or treatment breast cancer which can decrease All treated systemic compounded estradiol/testosterone cream applied daily On testing, 0.6-0.8 ng/dl, established Guay et al. optimum range. reported significantly decreased other bothersome symptoms, especially Conclusions illustrates variety diagnosis data emphasizes calculating performing establish dyspareunia. Additionally, this demonstrates efficacy local androgen/estradiol therapies ameliorating Disclosure No