A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia?
OBJECTIVE
To estimate the prevalence of unexplained chronic vulvar pain (burning or sharp knife like pain or pain on contact) in an ethnically diverse population-based sample of women.


METHODS
We used town census directories to identify 4915 women age 18 to 64 from 5 ethnically diverse Boston communities and asked them to complete a self-administered questionnaire pertaining to current and past chronic lower genital tract discomfort (response rate 68%). We calculated the cumulative incidence and 95% confidence intervals by demographic and reproductive characteristics. Approximately 16% of respondents reported histories of chronic burning, knife like pain, or pain on contact that lasted for at least 3 months or longer, and nearly 7% were experiencing the problem at the time of the survey. Chronic vulvar pain on contact decreased with increasing age, but the cumulative incidence of chronic burning and knife like pain was similar across all ages. Contrary to earlier clinical assessments, white and African American women reported similar lifetime prevalences. However, Hispanic women were 80% more likely to experience chronic vulvar pain than were white and African American women. Women with histories of chronic vulvar pain were 7 to 8 times more likely to report difficulty and great pain with their first tampon use than were women without such histories. Nearly 40% of women chose not to seek treatment, and of those who did, 60% saw 3 or more doctors, many of whom could not provide a diagnosis.


CONCLUSIONS
Chronic unexplained vulvar pain is a highly prevalent disorder that is often misdiagnosed.
Harlow
Bernard L
BL
Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
Stewart
Elizabeth Gunther
EG
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D017677:Age Distribution; D003430:Cross-Sectional Studies; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology* / Q000208:ethnology / Q000523:psychology; D017699:Pelvic Pain / Q000453:epidemiology; D012494:Sampling Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014844:Vulva; D044465:White People / Q000706:statistics & numerical data; D016387:Women's Health