title: Chronic stress in women with localised provoked vulvodynia.
abstract: BACKGROUND
  Localised provoked vulvodynia (former vulvar vestibulitis syndrome) is the most common cause of superficial dyspareunia among young women. In a clinical setting, it is obvious that many women with localised provoked vulvodynia show signs of chronic stress. The objective of this study was to compare chronic stress in a group of women with localised provoked vulvodynia, referred to the vulvar unit at the Division of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden with control women of the same age and educational level, using two independent methods.
  
  
  METHODS
  Forty-three women with localised provoked vulvodynia and 35 healthy control women underwent a gynecological examination, filled in a health questionnaire, and self-collected saliva for analysis of cortisol at awakening and after 15, 30 and 45 min (morning awakening cortisol). Thirty-three patients and 28 controls completed a stress questionnaire.
  
  
  RESULTS
  Morning awakening cortisol was blunted in women with localised provoked vulvodynia (p < 0.05), indicating chronic stress. The stress questionnaire showed more signs of burnout (p < 0.005), and emotional (p < 0.05) and bodily symptoms of stress (p < 0.005) in women with localised provoked vulvodynia compared with control subjects (students t-test).
  
  
  CONCLUSIONS
  More women with localised provoked vulvodynia showed blunted morning awakening cortisol and reported more symptoms of stress compared with healthy control women of the same age.
authors.affiliation: Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden. sophia.ehrstrom@ds.se
authors.forename: Sophia
authors.initials: S
authors.lastname: Ehrström
authors.forename: Dan
authors.initials: D
authors.lastname: Kornfeld
authors.forename: Eva
authors.initials: E
authors.lastname: Rylander
authors.forename: Nina
authors.initials: N
authors.lastname: Bohm-Starke
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000378:metabolism; D010146:Pain / Q000503:physiopathology* / Q000523:psychology*; D012463:Saliva / Q000737:chemistry; D013315:Stress, Psychological / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism; D011795:Surveys and Questionnaires; D014844:Vulva / Q000503:physiopathology*
chemical_list: D006854:Hydrocortisone