外陰疼痛比之前估計的更常見


  Jan. 12, 2004 --根據一項發表在一月份的Journal of Lower Genital Tract Disease的網路調查結果顯示,外陰疼痛比之前估計的更常見,而且非裔和白人婦女的流行率相似。
  
  密西根大學健康醫療系統的Barbara D. Reed, MD, MSPH表示,我們過去常認為外陰疼痛很少見,事實上流行率比我們認為的要高很多,根據調查顯示,約有3%的婦女報告有慢性疼痛,1.7%現在有疼痛,這意味著美國有幾百萬的婦女有外陰疼痛的困擾。
  
  根據之前的研究估計受外陰疼痛之苦的婦女只有150,000,在May 24, 2002和June 6, 2002期間,使用e-mail隨機抽取樣本調查了994名年齡18歲以上婦女,這是一項Internet-based研究計劃,其中三分之一的受訪者是非裔每國人,這項研究進行到一半的時候,外陰疼痛這個議題才變得明顯。
  
  半數的受訪者曾有過性交困難,288名(27.9%)婦女報告疼痛部位在前庭,31名(3%)婦女報告疼痛持續超過三個月,曾有中等或者輕微疼痛的大多數婦女疼痛已消除,而嚴重疼痛者中的80%現在疼痛仍存在。
  
  Dr. Reed指出,每個婦女疼痛的情形是不同的,有些人的疼痛十分強烈且令人衰弱,由此她們知道出問題了,但是其他一些人,疼痛輕微,她們以為有傷害,當更多的婦女聽說了這個疾病,她們將會坦承自己也有這樣的困擾。
  
  一般認為與白人婦女相比,非洲裔美國婦女極少有外陰疼痛、性交困難和疼痛等問題,之前的研究顯示非洲裔美國婦女不太可能因外陰疼痛尋求醫生治療。
  
  其它有關外陰疼痛的誤解源自醫生對外陰疼痛疾病不熟悉,很多有劇烈疼痛的婦女被誤診為慢性真菌感染或心理問題,有些婦女沒有跟醫生講述外陰疼痛的問題,認為這個部位一定程度的疼痛是正常的。
  
  Dr. Reed 表示,我常見到受外陰疼痛之苦數年的婦女,使用gabapentin, amitriptyline, 或paroxetine等藥物治療常常有效,物理治療也有幫助,大多數人經治療後有很大的緩解,未來的研究應集中在為何有些婦女外陰疼痛自行消失但是有些卻變成慢性。

Vulvodynia More Common Than Pr

By Laurie Barclay, MD
Medscape Medical News

Jan. 12, 2004 — Vulvodynia is more common than previously estimated, and the prevalence is similar for African-American and white women, according to the results of an Internet survey published in the January issue of the Journal of Lower Genital Tract Disease.

"We used to think this was rare," lead author Barbara D. Reed, MD, MSPH, from the University of Michigan Health System in Ann Arbor, says in a news release. "It turns out it's much more prevalent than we thought: 3% of women report chronic pain and 1.7% currently have pain. That's millions of women across the United States."

Based on previous research, estimates of the number of women affected by vulvodynia were as low as 150,000. Between May 24, 2002, and June 6, 2002, e-mail surveys on women's health issues were completed by a random sample of 994 women aged 18 years or older who had enrolled in SurveySpot, an Internet-based research panel. One third of the women surveyed were African American. The focus on vulvar pain was not apparent until midway through the survey.

Half of the women surveyed had experienced dyspareunia at some point during their lifetime, 288 women (27.9%) reported pain at the vestibule, and 31 women (3%) reported pain lasting more than three months. Intensity of pain was rated as moderate or mild by most women in whom pain had resolved, and as severe by 80% of women who were currently experiencing prolonged pain.

"There's a spectrum of pain involved that's different in each woman," Dr. Reed says. "For some women, the pain is quite intense and debilitating — they know something is wrong. For other women, it's mild and they think it's supposed to hurt. As more women hear about this condition, they'll be coming out of the woodwork."

Contrary to popular belief that African-American women rarely have vulvodynia, dyspareunia and pain at the vulvar vestibule were as common in the African-American women as in the white women surveyed. Previous research showed that African-American women were less likely to seek treatment for vulvodynia from their physicians.

Other misconceptions about vulvodynia spring from lack of familarity of many physicians with vulvar pain disorders. Many women with intense pain may be misdiagnosed with chronic yeast infections or psychological conditions. Others may fail to report vulvar pain, believing that some degree of pain in this region is normal.

Pharmacologic treatment with gabapentin, amitriptyline, or paroxetine is often effective, and physical therapy may also be helpful. "Often the women I see have gone years with this pain, yet the majority of women see great relief with treatment," Dr. Reed says.

Future research may focus on why vulvodynia resolves in some women but remains chronic in others.

The University of Michigan Department of Family Medicine helped fund this study.

J Lower Genital Tract Dis. 2004;000:000-000

Reviewed by Gary D. Vogin, MD

    
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