Study Shows Vulvodynia May Be Overlooked in Patients

New research sheds light on vulvodynia, showing that the disorder is underdiagnosed and inadequately treated. Since the chronic pain associated with vulvodynia can make it difficult to sit or participate in sexual activity, the disorder greatly impacts quality of life for women afflicted with it. The research is published online as part of the American Journal of Obstetrics and Gynecology.

Dr Barbara D. Reed, professor of family medicine at the University of Michigan Medical School, and colleagues conducted a population-based longitudinal study of adult women (N=2,269) in a four county area in southeastern Michigan. Participants were recruited via random telephone dialing surveys; participation involved a telephone interview, an online or written survey to be completed shortly after study initiation, and a series of follow-up interviews. Current cases of vulvodynia were based on previously validated survey-based diagnostic criteria. Almost one quarter (21.4%) of the participants were 65 years of age or older, and a majority were white (73.5%). The current findings represent data collected from the baseline survey.

The researchers found a 9.2% unweighted prevalence of vulvodynia (weighted prevalence was 8.1%). In addition, the researchers found that another 17.9% of the women reported symptoms suggestive of past vulvodynia. The prevalence of vulvodynia appeared to decrease after the age of 70; after adjusting for the decrease in number of women who were having intercourse, however, the researchers no longer found a decrease in prevalence associated with older age. Reed and colleagues also noted that vulvodynia and pain symptoms persisted among women during menopause even when they are taking hormone therapy.

In comparing those women with vulvodynia and those without the disorder, Reed et al. noticed some trends regarding prevalence. Specifically, the odds of having vulvodynia were statistically increased in younger women, in married women, in those who were employed, in those who had had intercourse in the past 6 months, and in those who were not black. After an adjustment analysis, the risk of vulvodynia remained significant for women who were married, those who were having intercourse in the past 6 months, and women who were not black.

The researchers also looked at pain profiles among women who had been diagnosed with vulvodynia. While a majority of the women only reported provoked pain (64.8%), almost one-quarter (20.3%) of the women reported unprovoked pain (20.3%) and about 15% noted a mixed pain profile. Women most frequent described their pain as “irritating,” “burning,” and “raw;” slightly over a quarter of the women also described their pain as “itchy.”

Based on their findings, the problem of underdiagnosis may be a result of women not reporting their symptoms to their physicians. In fact, Reed et al. found that only 48.6% of the women had sought treatment for their symptoms. Of those who met criteria for vulvodynia and presented to clinicians, almost one third were given one of several incorrect diagnoses, including estrogen deficiency or yeast infection, and only 5.7% (or 2.0% of all women screening positive for vulvodynia) received a diagnosis of vulvodynia or vestibulitis.

“With this knowledge, we better understand how common this disorder is, and who is likely to be affected,” Reed explained in a press statement. “Knowing this should make it easier for medical providers to expect to see women with this problem, and will therefore make the diagnosis earlier so that treatment can proceed.”

Addtional Information

 Measuring Treatment Outcomes in Women With Vulvodynia

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References:

References:
Reed BD, Harlow SD, Sen A, et al. Prevalence and demographic characteristics of vulvodynia in a population-based sample. AJOG. 2011; August 22 [Epub].
McLeod L. Chronic vulvar pain a reality for more than 100,000 women in southeast Michigan. University of Michigan Health System Press Release. September 14, 2011.