The epidemiology of vulvodynia: An evaluation of prevalence, predictors, and burden of illness

Vulvodynia is a multifactorial chronic pain condition of unknown origin characterized by vulvar burning, stinging, irritation, and rawness. Symptoms vary greatly among patients and may be localized or diffuse, superficial or deep, and constant or intermittent. Pathologic findings are limited to vulvar erythema, and the diagnosis is one of exclusion. It is estimated that up to 28% of the U.S. female population suffers from this condition at some point in their lifetime. Traditionally, vulvodynia research focused on gynecologic clinic populations, producing results that met controversy regarding the epidemiology, etiology, diagnosis, and treatment of the condition. The necessity for population-based, controlled studies is substantiated by the lack of universal agreement regarding these basic issues. This thesis describes three survey studies that explore the epidemiology of vulvodynia and discusses predictors of symptoms and a diagnosis in both care-seeking women and the general population. Specifically, prevalence and national telephone surveys assessed prevalence of vulvar symptoms in an ambulatory care setting (4%) and the general population (9.9% lifetime, 3.8% current), respectively. These studies also identified associations between vulvar symptoms and other chronic conditions, with a history of chronic vulvovaginal infections and depression as the strongest predictors of vulvar pain. A case-control survey of women with a confirmed diagnosis of vulvodynia yielded similar results. A comparison of symptomatic and diagnosed women illustrates commonalities in health history, pain characteristics, and impact of pain on lifestyle, indicating that the symptomatic population identified from the general population is a good representation of women who may suffer from vulvodynia. Multivariate models demonstrate that the strongest predictors of a diagnosis based upon symptoms are a combination of physical and psychological factors, including pain with speculum insertion, abstaining from intercourse, and fearing intercourse because of vulvar pain. It is anticipated that these findings will serve as a basis for developing a screening tool that identifies women who experience chronic vulvar pain that may be indicative of vulvodynia. When considered together, these three survey studies further our understanding of the prevalence of chronic vulvar symptoms and provide insight regarding predictors of both symptoms and a diagnosis of vulvodynia in the general population.