Biomedical subjects

Hope K Haefner

Publications and source records attributed to Hope K Haefner.

26 records · Page 2Linked to original sources

PubMed2003

Sexual activities and attitudes of women with vulvar dysesthesia.

OBJECTIVE: To assess the relationship between sexual activities and attitudes of women with and without vulvar dysesthesia. METHODS: Women with vulvar dysesthesia, 18-60 years old, and ethnically matched women without this disorder were enrolled in this cross-sectional study, completed a 27-page questionnaire, and had a physical examination. We compared sexual activities and attitudes between patients and controls using univariate and multivariable analyses. RESULTS: Between January 21, 2001, and December 12, 2002, we enrolled 63 women with vulvar dysesthesia and 62 controls who reported having a current sexual partner. Women with vulvar dysesthesia were less likely than controls to have had, during the previous month, intercourse (66.7% versus 83.9%, P =.03) and orgasms (57.6% versus 78.7%, P =.02), although the association with intercourse was no longer statistically significant after controlling for age, education, and smoking status (P =.07). Of those having had intercourse in the past month, the frequency of this activity was less among patients (3.0 +/- 2.7 versus 6.2 +/- 4.5 episodes, P <.001). Frequencies of orgasms, fellatio, cunnilingus, and masturbation did not significantly differ between patients and controls. Patients rated sex less important and rated themselves more negatively as sexual people than did controls (P <.001). CONCLUSION: Women with vulvar dysesthesia are similar to those without in many sexual activities but are less likely to have had an orgasm in the past month or to have had intercourse at the same frequency as controls. Although some attitudes were similar, sexual interest and self-concept were decreased among those with this disorder.

Adult↗

PubMed2003

Placental metastasis of maternal melanoma.

Metastasis of maternal malignant tumor to the products of conception is a rare event. Melanoma is the most common maternal malignant tumor to metastasize to the placenta and the fetus. We report the case of a 28-year-old woman with melanoma during pregnancy. At parturition, histologic evaluation of the placenta revealed metastatic melanoma, and multiple organ metastasis developed. The infant was free of disease. Metastasis to products of conception portends a poor prognosis for the mother. To our knowledge, this report is the first of a patient with melanoma metastasis to the placenta to survive more than 7 months after parturition. As caretakers of patients with melanoma, dermatologists are in a position to coordinate and direct the care and follow-up treatment of affected patients.

Adult↗

PubMed2003

Depressive symptoms among women with vulvar dysesthesia.

OBJECTIVE: The purpose of this study was to determine whether vulvar dysesthesia is associated with elevated depressive symptoms. STUDY DESIGN: This was a cross-sectional case-control study of women who underwent treatment of vulvar dysesthesia (n=32) or who were seen for a routine gynecologic examination (n=32). Subjects completed measures of depressive symptoms and pain and a sexual and medical history. Multivariate and univariate analyses were conducted. RESULTS: Analyses that were adjusted for age, education, and medical conditions indicated that vulvar dysesthesia was associated positively with depressive symptoms (P=.002). However, this was attributable to the somatic (P=.002) rather than cognitive-affective symptoms (P=.16) of depression, partially related to the endorsement of sexual disinterest, and mediated by pain reports. CONCLUSION: Vulvar dysesthesia is associated with elevated depressive symptom severity, although not to the extent that indicates probable depressive disorder. In this condition, depressive symptoms are likely to be a measurement artifact, rather than a depressive process. Certain depressive symptoms (eg, sexual disinterest) directly inflate depression estimates in this patient group.

Adult↗

PubMed2003

Vulvar dysesthesia (vulvodynia). A follow-up study.

OBJECTIVE: To assess long-term outcome in women treated for vulvar dysesthesia (vulvodynia). STUDY DESIGN: Cross-sectional survey via mailed questionnaires of women with vulvar dysesthesia treated at the University of Michigan. Questionnaires addressed symptom characteristics and their predictors, pregnancy response and treatments used. Analysis included t tests, nonparametric tests and multivariate analyses to assess associations between the degree of improvement (in the amount of pain experienced) since diagnosis and potential predictors of that outcome. RESULTS: Of 234 questionnaires mailed, 104 were completed. Based on a 7-point pain scale (0-6, with 6 indicating excruciating pain), the level of pain at the time of the survey (1.6 +/- 1.3) was significantly lower than that at the time of diagnosis (4.5 +/- 1.5) (P < .0001). Of the 104 women, 56.8% reported > 50% improvement in their pain since diagnosis, and the pain had worsened in 1.9%. Greater improvement was noted with higher pain levels at baseline and with a shorter time since onset. The majority of women who had been pregnant since developing vulvar pain reported improvement (30%) or no change (40%) in symptoms during and after pregnancy. Treatments (nonrandom) rated as most effective included antidepressants (used for pain control) and anticonvulsant medications, biofeedback and counseling. CONCLUSION: Most women with vulvar dysesthesia reported markedly less pain at follow-up, although few reported a "cure." Pregnancy was not associated with worsening of vulvar symptoms for most women. Controlled clinical trials will be needed to elucidate treatments that are most effective.

Adult↗

PubMed2003

Generalized vulvar dysesthesia vs. vestibulodynia. Are they distinct diagnoses?

OBJECTIVE: To evaluate prospectively whether generalized vulvar dysesthesia and vestibulodynia possess unique characteristics that support the theory of differing etiologies. STUDY DESIGN: Women with vulvar dysesthesia for a minimum of 3 months were enrolled at the University of Michigan in 2 clinics specializing in vulvar disorders. Informed consent was obtained. Participants completed a 27-page questionnaire and had a physical examination. Differentiation of generalized vulvar dysesthesia and vestibulodynia was based on tenderness to light pressure isolated to the introitus vs. pain beyond the introitus, respectively. We compared women with the 2 diagnoses to each other on demographic characteristics, exposures, pain characteristics and physical findings using t test, Mann-Whitney U and chi 2 analysis. RESULTS: Between January 26, 2001, and August 28, 2002, we enrolled 39 women, aged 18-60 years, with tenderness localized to the vestibule (vestibulodynia) and 17 with generalized vulvar dysesthesia. Women in each diagnostic group were similar in demographic and exposure characteristics. The pain characteristics were similar between the 2 groups except that recent pain was rated as worse by those with generalized vulvar dysesthesia. Activities that aggravated or relieved the pain were similar. However, women with generalized vulvar dysesthesia were more likely to state that their pain was aggravated by sitting and by washing the area. Similar results were found when using "continuous" pain rather than vulvar pain location as the outcome variable. CONCLUSION: The characteristics of women with generalized vulvar dysesthesia are similar to those with localized pain, supporting the theory that the 2 disorders may exhibit 2 presentations on a continuum of severity seen in vulvar dysesthesia rather than 2 distinct entities.

Adult↗

PubMed2002

Atypical glandular cells of undetermined significance. Histologic findings and proposed management.

OBJECTIVE: To increase understanding of the clinical significance of atypical glandular cells of undetermined significance (AGUS) on cervical cytology and to suggest a management plan. STUDY DESIGN: All Pap smears classified as AGUS over a period of five years at the University of Michigan Medical Center were reviewed and the diagnosis confirmed. The charts of these patients were reviewed for demographics, significant previous medical history, symptoms, diagnostic studies performed and final histologic diagnoses. RESULTS: In 1993-1998, a total of 208,041 Pap smears were read. Two hundred seven smears from 189 patients were classified as AGUS, for an incidence of 0.1%. There were 136 patients with follow-up information and 114 patients with histologic diagnoses. In 55 of the 114 patients (48%), significant histologic abnormalities were observed, including 11 endometrial cancers, 1 invasive adenocarcinoma of the cervix, 3 adenocarcinomas in situ of the cervix, 18 CIN 3 lesions and 5 CIN 2 lesions. Among 20 patients with Pap smears subclassified as "atypical glandular cells of undetermined significance, favor benign process," there were two CIN 2, five CIN 3 and one adenocarcinoma in situ of the cervix. CONCLUSION: A diagnosis of AGUS requires an aggressive workup because of the high rate of cancer and precancerous lesions. The evaluation, at the very least, should include colposcopy with directed biopsies and endocervical curettage. Postmenopausal patients, those with irregular bleeding and those with high risk characteristics should also undergo endometrial biopsy.

Adenocarcinoma↗

PubMed2002

Vulvar hidradenitis suppurativa. Immunohistochemical evaluation of apocrine and eccrine involvement.

OBJECTIVE: To evaluate the pathology of vulvar hidradenitis suppurativa (HS). STUDY DESIGN: A retrospective review of the histology of resections for vulvar HS was performed, and a battery of immunohistochemical stains was performed. They included markers of apocrine differentiation (GCDFP-15, CD15, lysozyme) and eccrine differentiation (GCDFP-15, S-100, CA-19.9, HMB45). RESULTS: Thirteen cases were available for review. Eccrine glands accounted for the majority of glands in all cases. Apocrine glands were not seen or were present only away from the area of active inflammation in 10 cases. In two cases, glands were totally destroyed in the areas of inflammation. Evidence of follicular obstruction was present in 11 of 13 cases. Severity of inflammation was variable, ranging from minimal, with burned-out disease, to severe. Fibrosis was variable but was greater with less inflammation, suggesting a later stage in disease evolution. Inflammation of the glands was often absent or minimal and seen only with associated poral occlusion. GCDFP-15 stained both apocrine and eccrine glands (only the dark cells). S-100 stained only the secretory (clear) cells of the eccrine glands. CD15 stained apocrine glands. Lysozyme stained apocrine glands, but this was not a consistent finding. CA19-9 gave inconsistent results in eccrine glands. HMB-45 was negative in all cases. CONCLUSION: Cases of vulvar HS showed a majority of eccrine glands in active areas. Apocrine glands, when present, were away from active inflammation. Inflammation and eventual destruction of glands appear to be a secondary part of the disease process. GCDFP-15 is a reliable marker for both apocrine differentiation and the dark cells of eccrine glands. S-100 is a reliable marker for the clear cells of eccrine glands. CD15 also was reliable for apocrine differentiation. Lysozyme showed weak apocrine staining. CA19-9 and HMB-45 were not reliable markers for apocrine or eccrine gland differentiation.

Apocrine Glands↗

PubMed2002

Victimization in patients with vulvar dysesthesia/vestibulodynia. Is there an increased prevalence?

OBJECTIVE: To examine the prevalence of physical or sexual violence victimization among women referred to a specialty clinic for management of vulvar dysesthesia/vestibulodynia as compared to a healthy gynecology clinic population. STUDY DESIGN: The subjects in this case-control study were women who had completed routine questionnaires prior to presentation to the University of Michigan Center for Vulvar Diseases. Study subjects were all given a diagnosis of vulvar dysesthesia/vestibulodynia. Women without complaints of vulvar pain presenting to a gynecology clinic were enrolled as controls. Information was obtained from the control subjects using a questionnaire similar to the history forms completed by the study group. RESULTS: Comparisons were made between 242 patients with vulvar dysesthesia/vestibulodynia presenting to a specialty clinic and 113 controls. Cases were more likely to be Caucasian, to be married and to have a higher household income than controls but reported less drug or alcohol abuse and a lower frequency of sexual intercourse. After controlling for possible confounders, no relationship between sexual assault and the presence of vulvar dysesthesia/vestibulitis was found. CONCLUSION: The prevalence of victimization was not higher in patients with vulvar dysesthesia/vestibulodynia as compared to the control population after controlling for potential confounding variables.

Adult↗