VULVODYNIA - SYSTEMATIC EPIDEMIOLOGIC, ETIOLOGIC OR THERAPEUTIC STUDIES
RELEASE DATE: March 27, 2002
PA NUMBER: PA-02-090 (This PA has been reissued, see PA-06-302)
EXPIRATION DATE: March 1, 2005, unless reissued.
National Institute of Child Health and Human Development (NICHD)
(http://www.nichd.nih.gov)
Office of Research on Women's Health (ORWH)
(http://www4.od.nih.gov/orwh/)
THIS PA CONTAINS THE FOLLOWING INFORMATION
o Purpose of the PA
o Research Objectives
o Mechanism of Support
o Eligible Institutions
o Individuals Eligible to Become Principal Investigators
o Where to Send Inquiries
o Submitting an Application
o Peer Review Process
o Review Criteria
o Award Criteria
o Required Federal Citations
PURPOSE
This PA replaces PA-98-112.
The Center for Population Research (CPR) of the National Institute of Child
Health and Human Development (NICHD) invites new and experienced basic
scientists, epidemiologists, and clinical investigators to submit research
grant applications to further our understanding of the epidemiology,
etiology, prevalence, criteria for accurate diagnosis, underlying
pathophysiology and pain mechanisms, and treatment strategies for vulvodynia.
Research grant applications are encouraged that address preclinical or
clinical, biomedical and/or behavioral research that concentrates on studies
of relevance to vulvodynia. This solicitation is intended to stimulate and
strengthen a multidisciplinary approach to this complex, underresearched area
of women's health and form a framework for assessing future research needs.
The goal is to build a substantive scientific knowledge base related to this
debilitating condition.
RESEARCH OBJECTIVES
Background
Vulvodynia is one of the poorly understood complex focal pain syndromes,
representing a complex, multifactorial clinical syndrome of unexplained
vulvar pain, sexual dysfunction, and psychological disturbance. On April 2-
3, 1997, the NICHD, in collaboration with the Office of Research on Women's
Health, Office of Rare Diseases, and the National Institute of Arthritis,
Musculoskeletal and Skin Diseases, convened the "Vulvodynia Workshop:
Current Knowledge and Future Directions" to explore the state-of-the-science
by reviewing current definitions, etiology, epidemiology, and treatment
modalities. In response to recommendations made at the conclusion of this
workshop, emphasis was placed on stimulating clinically relevant research on
promising biomedical, clinical or behavioral studies that would expand our
knowledge of vulvodynia. The Program Announcement (PA-98-112), "Vulvodynia
Systematic Epidemiologic, Etiologic or Therapeutic Studies," was published on
September 29, 1998. This announcement was followed by another initiative,
Pathophysiology, Epidemiology and Treatment of Vulvodynia (RFA-HD-00-008) in
February 2000. It was anticipated that studies in this under-researched area
would form a foundation for assessing future research needs and complement
our overall commitment to support research important to women's health. As a
result of the workshop, subsequent PA, and RFA, the research community was
made aware of our interest in this area. Notwithstanding this programmatic
emphasis, additional efforts are now needed to strengthen the science base.
This PA represents a continuation of ongoing research efforts to reduce the
burden of this disease and ultimately improve the quality of life for women
affected with this disorder. Moreover, this initiative reflects the NICHD
research agenda for identifying and characterizing the pathophysiologic
factors and potential avenues for treatment related to benign gynecologic
disorders.
Vulvodynia is a clinical condition with several different and poorly defined
antecedents. There is a need to increase knowledge and understanding about
vulvodynia and the biological processes that lead to its development and
long-term sequelae. The factors influencing a patient's decision to seek
care and the criteria by which the clinician selects therapy are not uniform.
Patients frequently experience dyspareunia, persistent vulvar irritation,
burning, and pain. Symptoms also may be associated with the urinary and
gastrointestinal tracts. In addition, diagnostic criteria that define the
categories and subtypes of vulvodynia are neither well defined nor utilized
consistently by many clinicians. While the true prevalence of vulvodynia
remains unknown, there are several common diagnostic subtypes that are
recognized, including: (1) vulvar vestibulitis, (2) dysesthetic vulvodynia,
and (3) vulvar dermatosis and dermatitis. Vulvar vestibulitis, thought to be
the most common subtype, has been found in 15 percent of patients in a
general clinical practice in some studies. While histologic studies suggest
a chronic inflammatory reaction, the causes of the inflammation, as well as
its significance, remain unclear. The role of pelvic floor dysfunction as a
catalyst for the development of vulvar pain syndromes, particularly
dysesthethic vulvodynia, has been proposed in several published studies, but
its true impact is uncertain. Published studies also comment on the
influence of neurophysiological parameters as a potential association that
should be taken into account.
Surgery has been reported to be a successful intervention for selected cases
of vulvar vestibulitis, and is reserved for women with severe and long-
standing symptoms. However, optimum surgical management is still
undetermined and very few well-designed, long-term studies document the
outcome of surgical procedures. In addition, pharmacological and behavioral
therapies would benefit from treatment standardization and prospective
clinical studies.
Despite the use of surgery, pharmaceutical regimens, psychological support,
physical therapy, and pain management techniques such as biofeedback and
behavior modification, there is no consensus on which procedure(s) offers the
most improvement and patient satisfaction. A combination of therapies is
frequently utilized and, while there are several options available for the
treatment of vulvodynia, most of the literature supports the conclusion that
cures for vulvodynia are uncommon and a specific inciting cause can be
diagnosed in a relatively small percentage of patients. Consideration of
these factors must be an integral part of the management of patients with
vulvodynia and this underscores the need to examine this condition in a
multidisciplinary context.
This elusive pain syndrome has many unexplored questions. Therefore, an
overall strategy of augmenting and strengthening a multidisciplinary approach
to this distressing condition, leading to improved diagnosis and therapy, is
warranted. Improvements in pain management, as well as approaches to the
treatment and prevention of vulvodynia, will require insight and increased
knowledge of the underlying etiology and pathophysiological mechanisms.
Research Scope
Several research strategies are deemed important for the potential
development of new leads or approaches. Examples of the scope of research
areas considered responsive to this announcement include, but are not limited
to, the following:
o Elucidation of pathogenic antecedents involved in stimulating the
biological processes that lead to the development and long-term sequelae of
vulvodynia. Evaluation of the role of pathologic vaginal microbial and viral
agents or altered vagina flora in this process.
o Development of chronicity and inclusion/exclusion criteria for refining
the definition for and diagnosis of vulvodynia and its subtypes. Rigorous
definitions will permit uniform study designs leading to comparability at the
national and international levels.
o Development of novel experimental preclinical or clinical studies in
animal models and/or humans to evaluate normal and dysfunctional
neurophysiological parameters and mechanisms. Determination of the role of
neurogenic irritability and/or regional autonomic dysfunction and its
influence on symptoms, muscle instability, tissue injury, and repair in
vulvodynia.
o Documentation of the use and evaluation of the effects of adjunctive
therapy in clinical trials, including behavioral, surgical, and medical
treatment, in women with vulvodynia. Investigation and translation of
promising, innovative, preclinical findings into clinical research
applications, including designing clinical trials of novel therapeutic
interventions.
o Assessment of the natural history of vulvodynia. Creation and validation
of population-based epidemiological studies that assist in defining the
prevalence and resolution of vulvodynia and its subtypes. Feasibility and
effectiveness of risk factor modification for prevention of vulvodynia.
o Initiation and implementation of controlled clinical epidemiological
studies to determine if at-risk groups can be identified for prospective or
interventional studies.
o Assessment of normal tissue structure, muscle integrity, cellular
mechanisms, structural defects, and the factors involved in the transition
between latent injury, symptoms, and tissue rehabilitation in vulvodynia.
Detection of the role of nerve damage, muscular damage, and/or direct tissue
disruption.
o Initiation and implementation of well-controlled multidisciplinary
clinical trials of therapeutic protocols for treating vulvodynia in a well-
defined population.
o Determination of the influence of risk factors such as race, ethnicity,
and co-morbid medical conditions or previous surgery associated with the
occurrence of vulvodynia, treatment outcomes, and complications.
Prospective applicants are encouraged to consider relevant topics other than
those listed here and to discuss their ideas with the program staff listed
under WHERE TO SEND INQUIRIES, below.
MECHANISM OF SUPPORT
This PA will use the NIH Research Project Grant (RO1) award mechanism. As an
applicant, you will be solely responsible for planning, directing, and
executing the proposed project.
This PA uses just-in-time concepts. It also uses the modular as well as the
non-modular budgeting formats (see
http://grants.nih.gov/grants/funding/modular/modular.htm). Specifically, if
you are submitting an application with direct costs in each year of $250,000
or less, use the modular format. Otherwise, follow the instructions for non-
modular research grant applications.
ELIGIBLE INSTITUTIONS
You may submit an application if your institution has any of the following
characteristics:
o For-profit or non-profit organizations
o Public or private institutions, such as universities, colleges, hospitals,
and laboratories
o Units of State and local governments
o Eligible agencies of the Federal government
o Domestic or foreign
INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS
Any individual with the skills, knowledge, and resources necessary to carry
out the proposed research is invited to work with their institution to
develop an application for support. Individuals from underrepresented racial
and ethnic groups as well as individuals with disabilities are always
encouraged to apply for NIH programs.
WHERE TO SEND INQUIRIES
We encourage your inquiries concerning this PA and welcome the opportunity to
answer questions from potential applicants. Inquiries may fall into two
areas: scientific/research and financial or grants management issues:
o Direct your questions about scientific/research issues to:
Estella Parrott, M.D., M.P.H.
Center for Population Research
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 8B01, MSC 7510
Bethesda, MD 20892-7510
Telephone: (301) 496-6515
FAX: (301) 496-0962
Email: ep61h@nih.gov
o Direct your questions about financial or grants management matters to:
Ms. Kathy Hancock
Grants Management Branch
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 8A17, MSC 7510
Bethesda, MD 20892-7510
Telephone: (301) 496-5482
FAX: (301) 402-0915
Email: kathy.hancock@nih.gov
SUBMITTING AN APPLICATION
Applications must be prepared using the PHS 398 research grant application
instructions and forms (rev. 5/2001). The PHS 398 is available at
http://grants.nih.gov/grants/funding/phs398/phs398.html in an interactive
format. For further assistance contact GrantsInfo, Telephone (301) 710-0267,
Email: GrantsInfo@nih.gov.
APPLICATION RECEIPT DATES: Applications submitted in response to this
program announcement will be accepted at the standard application deadlines,
which are available at http://grants.nih.gov/grants/dates.htm. Application
deadlines are also indicated in the PHS 398 application kit.
SPECIFIC INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS: Applications
requesting up to $250,000 per year in direct costs must be submitted in a
modular grant format. The modular grant format simplifies the preparation of
the budget in these applications by limiting the level of budgetary detail.
Applicants request direct costs in $25,000 modules. Section C of the
research grant application instructions for the PHS 398 (rev. 5/2001) at
http://grants.nih.gov/grants/funding/phs398/phs398.html includes step-by-step
guidance for preparing modular grants. Additional information on modular
grants is available at
http://grants.nih.gov/grants/funding/modular/modular.htm.
SPECIFIC INSTRUCTIONS FOR APPLICATIONS REQUESTING $500,000 OR MORE PER YEAR:
Applications requesting $500,000 or more in direct costs for any year must
include a cover letter identifying the NIH staff member within one of NIH
institutes or centers who has agreed to accept assignment of the application.
Applicants requesting more than $500,000 must carry out the following steps:
1) Contact the IC program staff at least six weeks before submitting the
application, i.e., as you are developing plans for the study;
2) Obtain agreement from the IC staff that the IC will accept your
application for consideration for award; and,
3) Identify, in a cover letter sent with the application, the staff member
and IC who agreed to accept assignment of the application.
This policy applies to all investigator-initiated new (type 1), competing
continuation (type 2), competing supplement, or any amended or revised
version of these grant application types. Additional information on this
policy is available in the NIH Guide for Grants and Contracts, October 19,
2001 at http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-004.html.
SENDING AN APPLICATION TO THE NIH: Submit a signed, typewritten original of
the application, including the checklist, and five signed photocopies in one
package to:
Center for Scientific Review
National Institutes of Health
6701 Rockledge Drive, Room 1040, MSC 7710
Bethesda, MD 20892-7710
Bethesda, MD 20817 (for express/courier service)
APPLICATION PROCESSING: Applications must be mailed on or before the receipt
dates described at
http://grants.nih.gov/grants/funding/submissionschedule.htm.
The CSR will not accept any application in response to this PA that is
essentially the same as one currently pending initial review unless the
applicant withdraws the pending application. The CSR will not accept any
application that is essentially the same as one already reviewed. This does
not preclude the submission of a substantial revision of an application
already reviewed, but such application must include an Introduction
addressing the previous critique.
PEER REVIEW PROCESS
Applications submitted for this PA will be assigned on the basis of
established PHS referral guidelines. An appropriate scientific review group
convened in accordance with the standard NIH peer review procedures
(http://www.csr.nih.gov/refrev.htm) will evaluate applications for scientific
and technical merit.
As part of the initial merit review, all applications will:
o Receive a written critique
o Undergo a selection process in which only those applications deemed to have
the highest scientific merit, generally the top half of applications under
review, will be discussed and assigned a priority score
o Receive a second level review by the appropriate national advisory council
or board
REVIEW CRITERIA
The goals of NIH-supported research are to advance our understanding of
biological systems, improve the control of disease, and enhance health. In
the written comments, reviewers will be asked to discuss the following
aspects of your application in order to judge the likelihood that the
proposed research will have a substantial impact on the pursuit of these
goals:
o Significance
o Approach
o Innovation
o Investigator
o Environment
The scientific review group will address and consider each of these criteria
in assigning your application's overall score, weighting them as appropriate
for each application. Your application does not need to be strong in all
categories to be judged likely to have major scientific impact and thus
deserve a high priority score. For example, you may propose to carry out
important work that by its nature is not innovative but is essential to move
a field forward.
(1) SIGNIFICANCE: Does your study address an important problem? If the aims
of your application are achieved, how do they advance scientific knowledge?
What will be the effect of these studies on the concepts or methods that
drive this field?
(2) APPROACH: Are the conceptual framework, design, methods, and analyses
adequately developed, well integrated, and appropriate to the aims of the
project? Do you acknowledge potential problem areas and consider alternative
tactics?
(3) INNOVATION: Does your project employ novel concepts, approaches or
methods? Are the aims original and innovative? Does your project challenge
existing paradigms or develop new methodologies or technologies?
(4) INVESTIGATOR: Are you appropriately trained and well suited to carry out
this work? Is the work proposed appropriate to your experience level as the
principal investigator and to that of other researchers (if any)?
(5) ENVIRONMENT: Does the scientific environment in which your work will be
done contribute to the probability of success? Do the proposed experiments
take advantage of unique features of the scientific environment or employ
useful collaborative arrangements? Is there evidence of institutional
support?
ADDITIONAL REVIEW CRITERIA: In addition to the above criteria, your
application will also be reviewed with respect to the following:
PROTECTIONS: The adequacy of the proposed protection for humans, animals, or
the environment, to the extent they may be adversely affected by the project
proposed in the application.
INCLUSION: The adequacy of plans to include subjects from both genders, as
appropriate, all racial and ethnic groups (and subgroups), and children as
appropriate for the scientific goals of the research. Plans for the
recruitment and retention of subjects will also be evaluated. (See Inclusion
Criteria included in the section on Federal Citations, below)
DATA SHARING: The adequacy of the proposed plan to share data, if
appropriate.
BUDGET: The reasonableness of the proposed budget and the requested period
of support in relation to the proposed research.
AWARD CRITERIA
Applications submitted in response to a PA will compete for available funds
with all other recommended applications. The following will be considered in
making funding decisions:
o Scientific merit of the proposed project as determined by peer review
o Availability of funds
o Relevance to program priorities
REQUIRED FEDERAL CITATIONS
MONITORING PLAN AND DATA SAFETY AND MONITORING BOARD: Research components
involving Phase I and II clinical trials must include provisions for
assessment of patient eligibility and status, rigorous data management,
quality assurance, and auditing procedures. In addition, it is NIH policy
that all clinical trials require data and safety monitoring, with the method
and degree of monitoring being commensurate with the risks (NIH Policy for
Data Safety and Monitoring, NIH Guide for Grants and Contracts, June 12,
1998: http://grants.nih.gov/grants/guide/notice-files/not98-084.html).
INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH: It is the policy of
the NIH that women and members of minority groups and their sub-populations
must be included in all NIH-supported clinical research projects unless a
clear and compelling justification is provided indicating that inclusion is
inappropriate with respect to the health of the subjects or the purpose of
the research. This policy results from the NIH Revitalization Act of 1993
(Section 492B of Public Law 103-43).
All investigators proposing clinical research should read the AMENDMENT "NIH
Guidelines for Inclusion of Women and Minorities as Subjects in Clinical
Research - Amended, October, 2001," published in the NIH Guide for Grants and
Contracts on October 9, 2001 (http://grants.nih.gov/grants/guide/notice-
files/NOT-OD-02-001.html); a complete copy of the updated Guidelines are
available at
http://grants.nih.gov/grants/funding/women_min/guidelines_amended_10_2001.htm.
The amended policy incorporates: the use of an NIH definition of
clinical research; updated racial and ethnic categories in compliance with
the new OMB standards; clarification of language governing NIH-defined Phase
III clinical trials consistent with the new PHS Form 398; and updated roles
and responsibilities of NIH staff and the extramural community. The policy
continues to require for all NIH-defined Phase III clinical trials that: a)
all applications or proposals and/or protocols must provide a description of
plans to conduct analyses, as appropriate, to address differences by
sex/gender and/or racial/ethnic groups, including subgroups if applicable;
and b) investigators must report annual accrual and progress in conducting
analyses, as appropriate, by sex/gender and/or racial/ethnic group
differences.
INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS:
The NIH maintains a policy that children (i.e., individuals under the age of
21) must be included in all human subjects research, conducted or supported
by the NIH, unless there are scientific and ethical reasons not to include
them. This policy applies to all initial (Type 1) applications submitted for
receipt dates after October 1, 1998.
All investigators proposing research involving human subjects should read the
"NIH Policy and Guidelines" on the inclusion of children as participants in
research involving human subjects that is available at
http://grants.nih.gov/grants/funding/children/children.htm.
REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS: NIH
policy requires education on the protection of human subject participants for
all investigators submitting NIH proposals for research involving human
subjects. You will find this policy announcement in the NIH Guide for Grants
and Contracts Announcement, dated June 5, 2000, at
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html.
HUMAN EMBRYONIC STEM CELLS (hESC): Criteria for federal funding of research
on hESCs can be found at http://grants.nih.gov/grants/stem_cells.htm and at
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-005.html. Only
research using hESC lines that are registered in the NIH Human Embryonic Stem
Cell Registry will be eligible for Federal funding (see http://escr.nih.gov).
It is the responsibility of the applicant to provide the official NIH
identifier(s)for the hESC line(s)to be used in the proposed research.
Applications that do not provide this information will be returned without
review.
PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT: The
Office of Management and Budget (OMB) Circular A-110 has been revised to
provide public access to research data through the Freedom of Information Act
(FOIA) under some circumstances. Data that are (1) first produced in a
project that is supported in whole or in part with Federal funds and (2)
cited publicly and officially by a Federal agency in support of an action
that has the force and effect of law (i.e., a regulation) may be accessed
through FOIA. It is important for applicants to understand the basic scope
of this amendment. NIH has provided guidance at
http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm.
Applicants may wish to place data collected under this PA in a public
archive, which can provide protections for the data and manage the
distribution for an indefinite period of time. If so, the application should
include a description of the archiving plan in the study design and include
information about this in the budget justification section of the
application. In addition, applicants should think about how to structure
informed consent statements and other human subjects procedures given the
potential for wider use of data collected under this award.
URLs IN NIH GRANT APPLICATIONS OR APPENDICES: All applications and proposals
for NIH funding must be self-contained within specified page limitations.
Unless otherwise specified in an NIH solicitation, Internet addresses (URLs)
should not be used to provide information necessary to the review because
reviewers are under no obligation to view the Internet sites. Furthermore,
we caution reviewers that their anonymity may be compromised when they
directly access an Internet site.
HEALTHY PEOPLE 2010: The Public Health Service (PHS) is committed to
achieving the health promotion and disease prevention objectives of "Healthy
People 2010," a PHS-led national activity for setting priority areas. This PA
is related to one or more of the priority areas. Potential applicants may
obtain a copy of "Healthy People 2010" at http://www.health.gov/healthypeople.
AUTHORITY AND REGULATIONS: This program is described in the Catalog of
Federal Domestic Assistance No. 93.864, and is not subject to the
intergovernmental review requirements of Executive Order 12372 or Health
Systems Agency review. Awards are made under authorization of Sections 301
and 405 of the Public Health Service Act as amended (42 USC 241 and 284) and
administered under NIH grants policies described at
http://grants.nih.gov/grants/policy/policy.htm and under Federal Regulations
42 CFR 52 and 45 CFR Parts 74 and 92.
The PHS strongly encourages all grant recipients to provide a smoke-free
workplace and discourage the use of all tobacco products. In addition,
Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in
certain facilities (or in some cases, any portion of a facility) in which
regular or routine education, library, day care, health care, or early
childhood development services are provided to children. This is consistent
with the PHS mission to protect and advance the physical and mental health of
the American people.
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