Stewart D E, Reicher A E, Gerulath A H, Boydell K M
Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada.
Obstet Gynecol. 1994 Oct;84(4):587-90.
To determine whether women with vulvodynia differ psychologically from women with other vulvar pathology and whether women with essential vulvodynia differ psychologically from women with vulvodynia in whom a cause has been identified.
Women attending a vulvar clinic were given a package consisting of the Brief Symptom Inventory, the Center for Epidemiologic Studies-Depression Scale, the Barsky Somatosensory Amplification Scale, the Whitely Index for hypochondriasis, and a study questionnaire. A gynecologist and dermatologist then took a careful history and performed a gynecologic examination, colposcopy, biopsies, and laboratory examinations.
Vulvodynia patients (n = 50) were more symptomatic than women with other vulvar pathology (n = 32) on questions about interference with sexual function (mean difference 1.29, 95% confidence interval [CI] 0.36-2.23, P = .01) and number of doctor visits (mean difference 1.0, 95% CI 0.12-2.12, P = .03). Vulvodynia patients also scored higher than other vulvar patients on the Whitely Index (mean difference 0.45, 95% CI 0.04-0.86, P = .04) and on the Brief Symptom Inventory anxiety subscale (mean difference 0.31, 95% CI 0.09-0.51, P = .05) and somatization subscale (mean difference 0.29, 95% CI 0.10-0.46, P = .04). Women with essential vulvodynia (n = 32) were more anxious (mean difference 0.28, 95% CI 0.02-0.54, P = .02) and more suggestible (mean difference 0.62, 95% CI 0.48-1.72, P = .05) than women with vulvodynia with a physical cause (n = 18).
Vulvodynia patients are more psychologically distressed than women with other vulvar pathology, and women with essential vulvodynia are more distressed than vulvodynia patients with an identified physical cause. Optimal management of vulvodynia patients should include attention to anxiety reduction, sexual function, normalization of every-day bodily sensations, reassurance about the absence of serious disease, and coordination of clinical care to ensure the maximum benefit from consultations.
确定外阴痛女性与患有其他外阴病变的女性在心理上是否存在差异，以及原发性外阴痛女性与已查明病因的外阴痛女性在心理上是否存在差异。
为到外阴诊所就诊的女性提供一套资料，包括简明症状量表、流行病学研究中心抑郁量表、巴尔斯基躯体感觉放大量表、怀特利疑病症指数和一份研究问卷。然后，妇科医生和皮肤科医生详细询问病史，并进行妇科检查、阴道镜检查、活检和实验室检查。
在外阴痛患者（n = 50）与患有其他外阴病变的女性（n = 32）中，外阴痛患者在关于性功能干扰问题（平均差异1.29，95%置信区间[CI] 0.36 - 2.23，P = 0.01）和看医生次数（平均差异1.0，95% CI 0.12 - 2.12，P = 0.03）方面症状更明显。外阴痛患者在怀特利指数（平均差异0.45，95% CI 0.04 - 0.86，P = 0.04）、简明症状量表焦虑子量表（平均差异0.31，95% CI 0.09 - 0.51，P = 0.05）和躯体化子量表（平均差异0.29，95% CI 0.10 - 0.46，P = 0.04）上的得分也高于其他外阴病变患者。原发性外阴痛女性（n = 32）比有躯体病因的外阴痛女性（n = 18）更焦虑（平均差异0.28，95% CI 0.02 - 0.54，P = 0.02）且更易受暗示（平均差异0.62，95% CI 0.48 - 1.72，P = 0.05）。
外阴痛患者比患有其他外阴病变的女性心理困扰更大，原发性外阴痛女性比有明确躯体病因的外阴痛患者心理困扰更大。对外阴痛患者的最佳管理应包括关注减轻焦虑、性功能、使日常身体感觉正常化、消除对严重疾病的担忧以及协调临床护理以确保从会诊中获得最大益处。
