Self-Reported Vulvar Pain Characteristics and Their Association with Clinically Confirmed Vestibulodynia

Abstract

Objective: We evaluated a series of questions pertaining to vulvar pain symptoms to determine their association with a localized vulvodynia (vestibulodynia) diagnosis in women from the general population. Methods: A sample of 12,435 women completed a self-administered screening questionnaire for the presence of specific types and characteristics of vulvar pain lasting 3 months or longer. Sensitivity, specificity, and predictive values were calculated for each cross-classification of vulvar pain type and characteristic, using as the gold standard 121 subjects with a clinically confirmed vestibulodynia diagnosis. Results: Relative to women with clinically confirmed vestibulodynia, 83% reported >10 episodes of pain on contact at the time of tampon insertion, intercourse, or pelvic examination, and 83% also reported pain on contact that limited or prevented sexual intercourse. These strong associations with a vestibulodynia diagnosis were not observed with respect to women who reported vulvar pain symptoms of burning or knifelike pain, or vulvar pain characteristics of continuous versus intermittent pain, or provoked versus spontaneous pain. Conclusions: Our findings suggest that a small number of symptoms may be suitable for identifying a large proportion of women suffering from vestibulodynia which may be ideal for the development of an effective screening test in the future. However, we also recognize that a large proportion of women experiencing vulvar pain symptoms will not meet the diagnostic criteria for vestibulodynia. Thus, implementing such a screening procedure as part of a routine examination or testing would require a subsequent pelvic examination to confirm a vestibulodynia diagnosis and to rule out other known explanations for vulvar pain.

Urogenital Symptoms and Pain History as Precursors of Vulvodynia: A Longitudinal Study

“…Based on previous validation studies, the probability of misclassification among a small proportion of participants based on concurrent infection or dermatologic disorders is thought to be small. 1,12 In addition, although the cohort of women assessed in this series of surveys was not selected from a clinic-based population or from those with genitourinary symptoms, participation in the Women's Health Registry, from which the women in this study were enrolled, is voluntary and may not represent the population at large. Intermediate phenotypes include those reporting pain with intercourse but no vulvar pain or a history of vulvar pain not lasting ‡ 3 months.…”

“…1 Its prevalence has been reported to be between 3.1% and 15%. [2][3][4][5] Limited data are available on the incidence of vulvodynia in the general population 6,7 and on the relationship between prior experiences with vulvar symptoms and onset of vulvodynia.…”

“…1,6,[8][9][10][11] However, the cross-sectional study design does not allow differentiation between those symptoms that are precursors to vs. comorbid with vulvodynia. Few prospective data are available.…”

Presenting Symptoms Among Black and White Women with Provoked Vulvodynia

“…In addition, these data did not include differences in intensity of the quality of the pain (e.g., hot vs. burning) or affective descriptors (e.g., unbearable); and the descriptors, selected from questionnaires developed by others, 20,21 were not part of the screening criteria used to predict vulvodynia, which may have affected the findings. Menopausal status also may have influenced symptom presentation, as more white women were menopausal (27% vs. 13%).…”

The Vaginal Microbiome: New Findings Bring New Opportunities

“…Vulvovaginal pain is a rarely discussed but not infrequent problem [Harlow et al., ]. The most common condition is referred to as vestibulodynia, which is defined as pain upon vaginal penetration that persists for at least 6 months in the absence of a detectable infectious, neurological, or endocrinological cause.…”