Prevalence

OBJECTIVE:

To describe the characteristics of women presenting with vulvodynia or vulvar vestibulitis and to evaluate their clinical responses to a variety of treatment modalities, including the tricyclic antidepressants, gabapentin, topical anesthetics, and physical therapy/biofeedback.

METHODS:

A computerized vulvar database was used to identify patients with a primary diagnosis of vulvodynia (3 3 months of chronic, unprovoked vulvar pain occurring in the absence of infection or vaginal disease) or vulvar vestibulitis (3 3 months of provoked pain localized to the vestibule and vestibular point tenderness on exam) see at the vulvar clinic between 1998 and 2003. Patient characteristics, including demographic information and important clinical information (e.g., history of Candida), as well as treatment types and outcomes were ascertained for each patient. Group, as well stratified, analyses were done using Stata Version 7.0 (Stata Corporation, College Station, Texas).

RESULTS:

Of the 297 women who presented to the vulvar clinic, 66 (22%) were given the diagnosis of vulvodynia (32/66 or 48%) or vestibulitis (34/66 or 52%). In general, the population of women with vulvar pain was Caucasian, privately insured and non-smokers. Vulvodynia patients tended to be older (mean 48 years versus 30 years among vestibulitis patients) and to have suffered from vulvar pain for longer durations of time (mean 94 months versus 32 months for vestibulitis patients). Nearly 50% of both vulvodynia and vestibulitis patients gave a history of vaginal infections, most commonly candidiasis. In terms of clinical response, vestibulitis patients tended tobe more likely to experience complete or partial resolution of their symptoms on monotherapy (most commonly the tricyclic antidepressants), while vulvodynia patients required combination therapy (87% versus 75%).

CONCLUSIONS:

In this referral population, vulvar pain syndromes were not infrequently encountered. Complete or partial response to monotherapy appeared to occur more frequently among women with vestibulitis compared to those with vulvodynia.

Key Words:

Supported in part by National Institutes of Health grant K23 HD 1307 from the National Institute of Child Health and Human Development