Departments of Obstetrics and Gynecology, Pathology, and Public Health & Preventative Medicine, Oregon Health & Science University, Portland, Oregon.
Obstet Gynecol. 2013 Oct;122(4):787-793. doi: 10.1097/AOG.0b013e3182a5f25f.
To assess whether premenopausal and postmenopausal vestibulodynia have different histologic features.
We conducted a retrospective analysis of vestibulectomy specimens from 21 women with postmenopausal vestibulodynia and compared them with 88 premenopausal patients (42 primary, 46 secondary). Women with primary vestibulodynia experienced pain at first introital touch and women with secondary vestibulodynia experienced pain after an interval of painless intercourse. Clinical records established the type of vestibulodynia, duration of symptoms, and hormone status. Tissues were stained for inflammation, nerves, mast cells, estrogen receptor α, and progesterone receptor. Histologic findings in the postmenopausal patients were compared with primary and secondary premenopausal patients using proportional odds logistic regression and analysis of variance.
Seventy-one percent (15/21) of postmenopausal women reported vestibular dyspareunia related to a drop in estrogen either with menopause (13/21) or previously, postpartum (2/21). Eighty-six percent (18/21) of postmenopausal patients were using local or systemic estrogen but pain persisted. Compared with premenopausal primary and secondary vestibular biopsies, postmenopausal tissues had more lymphocytes (unadjusted odds ratio [OR] 9.0, 95% confidence interval [CI] 2.8-33.3; adjusted OR for parity and duration of symptoms 9.1, 95% CI 2.6-31.9; unadjusted OR 6.2, 95% CI 1.9-20.0; adjusted OR 6.6, 95% CI 2.0-21.9, respectively) and mast cells (mean 36 compared with 28 and 36 compared with 26, respectively). There was significantly less neural hyperplasia and progesterone receptor expression in postmenopausal biopsies compared with primary cases but less progesterone receptor and similar neural hyperplasia compared with premenopausal secondary cases. Estrogen receptor α did not vary among groups.
Premenopausal and postmenopausal vestibulodynia share histologic features of neurogenic inflammation but differ strikingly in degree. When estrogen supplement does not alleviate symptoms of postmenopausal dyspareunia, vestibulodynia should be considered.
: II.
评估绝经前和绝经后外阴痛是否具有不同的组织学特征。
我们对 21 例绝经后外阴痛患者的外阴切除术标本进行了回顾性分析，并将其与 88 例绝经前患者（42 例原发性，46 例继发性）进行了比较。原发性外阴痛患者在初次阴道触诊时感到疼痛，而继发性外阴痛患者在无痛性交后间隔一段时间感到疼痛。临床记录确定了外阴痛的类型、症状持续时间和激素状态。组织标本行炎症、神经、肥大细胞、雌激素受体 α 和孕激素受体染色。采用比例优势比逻辑回归和方差分析比较绝经后患者与原发性和继发性绝经前患者的组织学发现。
71%（15/21）的绝经后妇女报告与雌激素下降相关的外阴性交痛，与绝经（13/21）或先前产后（2/21）有关。86%（18/21）的绝经后患者正在使用局部或全身雌激素，但疼痛持续存在。与绝经前原发性和继发性外阴活检相比，绝经后组织中的淋巴细胞更多（未调整的优势比[OR] 9.0，95%置信区间[CI] 2.8-33.3；调整后的产次和症状持续时间的 OR 9.1，95%CI 2.6-31.9；未调整的 OR 6.2，95%CI 1.9-20.0；调整后的 OR 6.6，95%CI 2.0-21.9）和肥大细胞（平均 36 与 28 和 36 与 26 相比）。绝经后活检的神经增生和孕激素受体表达明显低于原发性病例，但与绝经前继发性病例的孕激素受体减少而神经增生相似。雌激素受体α在各组之间没有差异。
绝经前和绝经后外阴痛具有神经源性炎症的组织学特征，但程度明显不同。当雌激素补充不能缓解绝经后性交痛的症状时，应考虑外阴痛。
II 级。
