Victimization in Patients With Vulvar Dysesthesia/Vestibulodynia: Is There an Increased Prevalence?

Abstract

Chronic vulvar pain frequently has no known cause and is difficult to treat. Because chronic pelvic pain has been shown to be associated with a history of sexual victimization, this study was conducted to investigate the possibility of a similar link between history of sexual abuse and vulvar dysesthesia or vestibulodynia. Study subjects were 243 patients who were referred to the Center for Vulvar Diseases at the University of Michigan Tauban Center between June 1997 and February 2000 for evaluation of vulvar dysesthesia or vestibulodynia. Control subjects were 113 women with no chronic vulvar or pelvic pain recruited from the university's general gynecology clinics between October 2000 and February 2001. Both study subjects and control subjects completed similar questionnaires on demographics and medical and sexual histories. The two groups were similar in age (mean, 36.6 years for the vulvar group and 34.0 years for the control group). They had comparable educational histories, ages at first intercourse, and numbers of lifetime sexual partners. Study subjects were statistically more likely to be white than control subjects (95% vs. 72.6%; P <.001) and more likely to be married (71.2% vs. 47.8%; P <.001). More study subjects than control subjects were heterosexual (98.7% vs. 93.5%; P =.01) and in stable relationships (79.7% vs. 55.8%; P <.0001). Control subjects had sexual intercourse more frequently than women with vulvar pain (weekly or more, 53.4% vs. 37.5%; P =.007), but both groups reported similar numbers of lifetime partners and recent intercourse. Gastrointestinal symptoms were much more common in study subjects (54.3%) than control subjects (30.1%; P =.00002). More control subjects than women with vulvar pain reported having abused drugs or alcohol (13.4% vs. 4.2%; P =.002). In this study a distinction was made between sexual victimization by a family member, called sexual abuse, or a non-family member, called sexual assault. Sexual abuse and assault were reported by 13.1% and 16.4% of women in the vulvar pain group, respectively, and by 22% and 25.2% of women in the control group, respectively. Neither of these differences was statistically significant (P =.051 and P =.052, respectively). Initial analyses of factors associated with a history of sexual assault (lifetime sexual partners, history of drug or alcohol abuse, depression, and sexual abuse by a family member) and vulvar dysesthesia or vestibulodynia (age, age at first intercourse, marital status, education, and income) found a persistent significant relationship between sexual assault and vulvar pain (P <.05) when each variable was controlled for individually. However, multiple logistical regression analysis of all variables found no difference in the rate of sexual abuse or assault and vulvar dysesthesia or vestibulodynia.