Oral contraceptive use and risk of vulvodynia: a population‐based longitudinal study

Abstract

Objective To assess whether the risk of vulvodynia is associated with previous use of oral contraceptives (OCs). Design Longitudinal population-based study. Setting Four counties in south-east Michigan, USA. Population A population-based sample of women, aged 18 years and older, enrolled using random-digit dialling. Methods Enrolled women completed surveys that included information on demographic characteristics, health status, current symptoms, past and present OC use, and a validated screen for vulvodynia. The temporal relationship between OC use and subsequent symptoms of vulvodynia was assessed using Cox regression, with OC exposure modelled as a time-varying covariate. Main outcome measure Vulvodynia, as determined by validated screen. Results Women aged <50 years who provided data on OC use, completed all questions required for the vulvodynia screen, and had first sexual intercourse prior to the onset of vulvodynia symptoms were eligible (n = 906). Of these, 71.2% (n = 645) had used OCs. The vulvodynia screen was positive in 8.2% (n = 74) for current vulvodynia and in 20.8% (n = 188) for past vulvodynia. Although crude cross-tabulation suggested that women with current or past vulvodynia were less likely to have been exposed to OCs prior to the onset of pain (60.7%), compared with those without this disorder (69.3%), the Cox regression analysis identified no association between vulvodynia and previous OC use (HR 1.08, 95% CI 0.81–1.43, P = 0.60). This null finding persisted after controlling for ethnicity, marital status, educational level, duration of use, and age at first OC use. Conclusion For women aged <50 years of age, OC use did not increase the risk of subsequent vulvodynia.

Recent advances in understanding provoked vestibulodynia

“…Burrows and Goldstein 58 described a case series of 50 women who developed PVD while on HCs and who were successfully treated with topical estradiol and testosterone. However, these findings were not confirmed in two epidemiologic studies 59, 60 .…”

Female Sexual Pain Disorders: a Review of the Literature on Etiology and Treatment

“…Recent studies have shown at least four possible pathways that may modify risk of developing this disorder: (1) hormonal changes, (2) neurological changes, (3) inflammation, and (4) hypertonic pelvic floor muscles. First, evidence on the role of combined hormonal contraception (CHC) in the development of vulvodynia is inconclusive, as several cross-sectional studies have shown that CHC use significantly increases the risk of developing vulvodynia [35,36], while a recent large population-based study showed that CHC use did not increase the risk of vulvodynia [37]. Nevertheless, it has been demonstrated that CHCs induce morphologic changes in the vestibular mucosa [38] and increase its sensitivity [39].…”

Randomized clinical trial of multimodal physiotherapy treatment compared to overnight lidocaine ointment in women with provoked vestibulodynia: Design and methods

“…change in pain intensity during intercourse. It has been suggested that oral contraceptives could influence vestibular sensitivity [64] and PVD development [9] but conflicting results were found in large epidemiological studies showing a non-significant impact [65] and [66]. It was therefore decided not to exclude women taking oral contraceptives but to verify this potential confounder and if relevant, incorporate it as a covariate in the statistical model.…”