Prevalence of symptoms consistent with a diagnosis of vulvodynia: population-based estimates from 2 geographic regions

Bernard L. Harlow; Christine G. Kunitz; Ruby H. N. Nguyen; Sarah A. Rydell; Rachel M. Turner; Richard F. MacLehose

doi:10.1016/j.ajog.2013.09.033

Sexual Health Sexual Pain

Prevalence of symptoms consistent with a diagnosis of vulvodynia: population-based estimates from 2 geographic regions

Harlow BL, Kunitz CG, Nguyen RH, Rydell SA, Turner RM, MacLehose RF

Published January 2014 American Journal of Obstetrics and Gynecology, 210(1), 40.e1-40.e8

DOI 10.1016/j.ajog.2013.09.033 PMC PMC3885163

RRM Academy Synopsis

By 40, 7 to 8 in 100 women in 2 metro areas report vulvodynia-like pain

By age 40, 7 to 8 out of 100 women reported symptoms consistent with vulvodynia, according to mailed surveys of women aged 18 to 40 in the Boston and Minneapolis/Saint Paul areas. About half of affected Minneapolis/Saint Paul women pursued no treatment. In Minneapolis/Saint Paul, more than half of those who sought treatment received no diagnosis.

Key Findings

Questionnaires came from 5,440 women in the Boston area and 13,681 women in the Minneapolis/Saint Paul area, all aged 18 to 40.
By age 40, 7–8% of women in both areas reported vulvar pain consistent with vulvodynia, within about one percentage point of each other.
Combined across both areas, Hispanic/Latina women were 1.4 times more likely than Caucasian women to develop vulvar pain by age 40 (95% CI 1.1–1.8).
Among women with these symptoms, 48% in Minneapolis/Saint Paul and 30% in Boston pursued no treatment.
Among women who sought treatment, 67.4% in Boston and 39.0% in Minneapolis/Saint Paul received a diagnosis (adjusted proportions).

Interpretation

The study is a retrospective cohort built from mailed questionnaires. Women reported their own symptoms, using questions validated against clinical examination in earlier work. Boston women came from census-based town directories, Minneapolis/Saint Paul women from clinic records, and the authors found cumulative incidence within about one percentage point across the two samples. The women were 18 to 40 years old. In Minneapolis/Saint Paul, 84.8% were White. The authors note that some women classified as having vulvodynia symptoms may not meet a clinical diagnosis without an exam.

RRM Context

Vulvodynia is chronic vulvar pain with no visible abnormality such as infection or skin disease, so diagnosis depends on evaluation. Many affected women sought no care, or sought it and received no diagnosis. Restorative reproductive medicine (RRM) evaluates a symptom to find its cause. Pain that limits intercourse also affects both partners.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

We used validated sensitive and specific questions associated with clinically confirmed diagnoses of unexplained vulvar pain (vulvodynia) to compare the cumulative incidence of vulvar pain and prevalence of care-seeking behavior in Boston metropolitan area (BMA) and in Minneapolis/Saint Paul metropolitan area (MSP) from 2001 through 2005 using census-based data, and 2010 through 2012, using outpatient community-clinic data, respectively.

Study Design

We received self-administered questionnaires from 5440 women in BMA and 13,681 in MSP, 18-40 years of age, describing their history of vulvar burning or pain on contact that persisted >3 months that limited/prevented intercourse.

Results

By age 40 years, 7-8% in BMA and MSP reported vulvar pain consistent with vulvodynia. Women of Hispanic origin compared to whites were 1.4 times more likely to develop vulvar pain symptoms (95% confidence interval, 1.1-1.8). Many women in MSP (48%) and BMA (30%) never sought treatment, and >50% who sought care with known health care access received no diagnosis.

Conclusion

Using identical screening methods, we report high prevalence of vulvar pain in 2 geographic regions, and that access to health care does not increase the likelihood of seeking care for chronic vulvar pain.

Topics

Sexual Health › Sexual Pain › Vulvodynia · General Gynecology › Pelvic Pain › Chronic Pelvic Pain · Cost and Access › Population and Global Health › Workforce and Training Capacity

Bernard L. Harlow, Christine G. Kunitz, Ruby H. N. Nguyen, Sarah A. Rydell, Rachel M. Turner, Richard F. MacLehose

B Harlow, Chris Kunitz, C Kunitz, R Nguyen, S Rydell, R Turner, Rick MacLehose, Dick MacLehose, Rich MacLehose, R MacLehose

DOI 10.1016/j.ajog.2013.09.033 10.1016/j.ajog.2013.09.033 Harlow et al. 2014, Harlow 2014

Prevalence of symptoms consistent with a diagnosis of vulvodynia: population-based estimates from 2 geographic regions

By 40, 7 to 8 in 100 women in 2 metro areas report vulvodynia-like pain

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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