Chronic Vulvar and Other Gynecologic Pain: Prevalence and Characteristics in a Self-Reported Survey

Abstract

Over 5000 patients who attended ambulatory clinics at a large teaching medical center were mailed a packet containing a questionnaire concerning gynecologic pain, particularly vulvar pain associated with vulvodynia. The questionnaire was a comprehensive health questionnaire including areas on demographics, general health status, comorbid medical conditions, symptoms associated with depression, general quality-of-life, and obstetric and gynecologic health. A consent form and survey on women’s health were also included in the mailing. Over 700 mailings were returned as undeliverable. Of 4872 women who did receive the packet, there were 1772 completed forms returned (36.8% response rate). A large majority (60–84%) of responders were white, with a long-term domestic partner, college-educated, and sexually active. Twenty-one percent of the women said that they had persistent gynecologic pain during the previous 6 months. Of the women who reported gynecologic pain, slightly more than half (52%) reported pain in the vagina, 40% had pain in the adnexal region, 36% had pain in middle or lower abdomen, and 20% had vulvar pain. Overall, 4.2% of the women surveyed reported chronic vulvar pain. Demographic characteristics in women with vulvar pain were similar to women with other gynecologic pain or no pain. However, women with gynecologic pain, including vulvar pain, reported a significantly lower quality of life (P <.001), greater stress, and more depression than did women without pain. Compared with women with other gynecologic pain, women with vulvar pain were more likely to report dyspareunia (84% vs 52%), pain associated with tight clothing (41% vs 10%), and pain when sitting (51% vs 22%). There were no differences in discomfort associated with speculum insertion or exercise in these subgroups of women with gynecologic pain. Vaginal infections were 2.35 times more common in the group with vulvar pain and 2.11 more common in women with other gynecologic pain compared with the group without chronic gynecologic pain. Menopausal status, hysterectomy history, and use of hormone therapy or oral contraceptives were similar in the women who reported vulvar pain compared with those with no pain. However, when women with other gynecologic pain were compared with women who had no gynecologic pain, they were significantly more likely to be premenopausal, to use oral contraceptives, and significantly less likely to have had a hysterectomy or to use hormone therapy. When all variables assessed in this study were subjected to logistic regression analysis, comorbid medial conditions, arthritis, stress, and a diagnosis of vaginal infection were all significantly associated with vulvar pain. Menopausal status did not emerge as a significant predictor of vulvar pain.