Vulvar dysesthesia (vulvodynia). A follow-up study.
OBJECTIVE
To assess long-term outcome in women treated for vulvar dysesthesia (vulvodynia).


METHODS
Cross-sectional survey via mailed questionnaires of women with vulvar dysesthesia treated at the University of Michigan. Questionnaires addressed symptom characteristics and their predictors, pregnancy response and treatments used. Analysis included t tests, nonparametric tests and multivariate analyses to assess associations between the degree of improvement (in the amount of pain experienced) since diagnosis and potential predictors of that outcome.


RESULTS
Of 234 questionnaires mailed, 104 were completed. Based on a 7-point pain scale (0-6, with 6 indicating excruciating pain), the level of pain at the time of the survey (1.6 +/- 1.3) was significantly lower than that at the time of diagnosis (4.5 +/- 1.5) (P < .0001). Of the 104 women, 56.8% reported > 50% improvement in their pain since diagnosis, and the pain had worsened in 1.9%. Greater improvement was noted with higher pain levels at baseline and with a shorter time since onset. The majority of women who had been pregnant since developing vulvar pain reported improvement (30%) or no change (40%) in symptoms during and after pregnancy. Treatments (nonrandom) rated as most effective included antidepressants (used for pain control) and anticonvulsant medications, biofeedback and counseling.


CONCLUSIONS
Most women with vulvar dysesthesia reported markedly less pain at follow-up, although few reported a "cure." Pregnancy was not associated with worsening of vulvar symptoms for most women. Controlled clinical trials will be needed to elucidate treatments that are most effective.
Reed
Barbara D
BD
Departments of Family Medicine and of Obstetrics and Gynecology, School of Literature, Science and Arts, University of Michigan, Ann Arbor, USA. barbr@umich.edu
Haefner
Hope K
HK
Cantor
Lauren
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001676:Biofeedback, Psychology; D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000209:etiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000473:pathology*; D011379:Prognosis; D013577:Syndrome; D016896:Treatment Outcome; D014845:Vulvar Diseases / Q000188:drug therapy* / Q000473:pathology*
D000927:Anticonvulsants; D000928:Antidepressive Agents