Relationship Between Adverse Childhood Experiences and Vulvodynia Pain Scores

Abstract

ABSTRACT Introduction Vulvodynia is a chronic vulvar pain disorder that has a significant impact on physical and mental health. As with other chronic pain disorders, vulvodynia appears to have a link with childhood exposure to physical and sexual abuse and poor family support. Objective To assess the relationship between adverse childhood experiences (ACEs) and vulvodynia pain scores using the standardized McGill Pain Scale. Methods This study is a retrospective review of intake questionnaire data for patients presenting to a multispecialty vulvar diseases clinic. Demographic information, ACEs-related questions and McGill pain scale portions of the intake questionnaire were included. Exclusion criteria included age less than 18, cancer diagnosis, or presenting postoperatively in initial consultation. A control group was randomly selected using 2:1 age-matching from patients within our database without a coexisting diagnosis of vulvodynia. The primary outcome, McGill pain score, was calculated as the sum across all 20 pain elements. Group differences across demographic characteristics, ACE responses, and McGill scores were assessed using simple linear regressions for continuous measures, and logistic regressions for binary measures. Results A total of 1,245 patients, 415 vulvodynia and 830 age-matched controls were analyzed. Patients with vulvodynia differed significantly across self-reported race/ethnicity, marital status, and income level. Overall, patients with a diagnosis of vulvodynia had higher median McGill pain scores compared to controls (22.0 vs 20.0, p<0.001). Among patients with vulvodynia, patients who reported ACEs exposure had higher McGill pain scores compared to patients without disclosed ACEs exposure (26.0 vs 22.0, p<0.001). Similarly, among patients in the control group, patients who reported ACE exposure had higher McGill pain scores compared to those without (24.0 vs 17.0, p<0.001). Conclusions Our findings indicate a relationship between exposure to ACEs and increased pain in patients with vulvodynia and controls. These findings suggest exposure to ACEs alone may contribute to increased perception of pain and result in higher McGill Pain Scores. Disclosure No