Vulvodynia Is Not Associated with Concurrent Candidal Vaginitis

Abstract

Objective: The study purpose was to determine the prevalence of candida-positive vulvovaginal genital cultures among women with vulvodynia. Methods: This study was a retrospective analysis of data collected from 2017 to 2020. Eligible patients receiving care from an academic women's health practice in central Texas that employed value-based care pathways and who had a genital culture diagnostic test collected were included. Data were extracted from the electronic health record. Descriptive statistics, t -tests, and Fisher's exact test were used to complete the data analysis. Results: A total of 242 women met inclusion criteria and were included in the study. Of these, 64 (26.4%) had been diagnosed with vulvodynia and 178 (73.6%) had not. Of the 242 women, nearly one-third had confirmed yeast infections (29%) and 27 women (11%) met pathway criteria for polymerase chain reaction testing. There was no difference in the number of women with confirmed yeast infections during the study period among patients with or without a diagnosis of vulvodynia (75% vs. 70%, p = 0.718). Notably, among participants with vulvodynia, body mass index (BMI) was lower, and anxiety was more likely ( t = 2.65, df = 120, p = 0.009; 78% vs. 55%, p = 0.002). Conclusions: The findings in this study showed no association between vulvodynia and yeast infection, a divergence from prior studies. In addition, vulvodynia was associated with low BMI and anxiety. Further research is needed to better understand the association between vulvovaginal candida infections and vulvodynia. Including women within and across more diverse races and ethnicities would improve generalizability.

Relationship Between Childhood Sexual Abuse, Obesity, and Vulvodynia in Adulthood

“…[21][22][23] On the other hand, while some data have shown vulvodynia to be associated with a number of different mediators of inflammation, including mast cells, 28 natural killer cells, release of specific cytokines, and fungal and viral infections, other studies have drawn contradictory conclusions. 20,24,25 In their 2016 systemic review, Chalmers et al 26 outlined this conflict and concluded that the current data on the inflammatory profile of women with vulvodynia are inconsistent and sometimes poor in methodology. Although our study established that obesity is not related to an increased risk of vulvodynia, much remains to be explored in this field.…”

“…Although obesity-induced inflammation is mechanistically complicated, it has been established that the activation of immune cells and release of cytokines create both a local and systemic response to increased adiposity 21–23 . On the other hand, while some data have shown vulvodynia to be associated with a number of different mediators of inflammation, including mast cells, 28 natural killer cells, release of specific cytokines, and fungal and viral infections, other studies have drawn contradictory conclusions 20,24,25 . In their 2016 systemic review, Chalmers et al 26 outlined this conflict and concluded that the current data on the inflammatory profile of women with vulvodynia are inconsistent and sometimes poor in methodology.…”

“…Nguyen et al 19 found that women who were underweight or obese were less likely to have remission of their vulvodynia, with obese women 76% less likely than their counterparts with normal BMI to report remission. Whitney et al 20 investigated the association between vulvodynia and Candida vaginitis and found that women with low BMIs were more likely to have vulvodynia. Obesity is known to be a proinflammatory state, 21–23 and although the evidence is mixed, 24–26 some data have shown inflammatory factors to be implicated in vulvodynia pathophysiology 3,6,27,28 .…”

Managing Vulvodynia with Central Sensitization: Challenges and Strategies

“…If these treatments were not effective, the second step involved the use of tricyclic antidepressants, such as amitriptyline, which have been shown to decrease pain in patients with a neuropathic component. The third step involved minimally invasive neuromodulation, with or without botulinum toxin, and was generally prescribed to patients with generalized spontaneous vulvodynia (GSV) and central sensitization [12,[17][18][19][20].…”