title: Provoked vestibulodynia--medical factors and comorbidity associated with treatment outcome.
abstract: BACKGROUND
  Provoked vestibulodynia (PVD) is the most common cause of dyspareunia in young women. The etiology is unclear, and there is little knowledge of how to predict treatment outcome.
  
  
  OBJECTIVE
  The aim of this study was to identify medical factors associated with treatment outcome and coital pain in women with PVD.
  
  
  METHODS
  Seventy women previously treated for PVD at a vulvar open care unit completed questionnaires and a quantitative sensory testing session.
  
  
  METHODS
  Concomitant bodily pain and treatment outcome were surveyed using a study specific questionnaire. Coital pain was rated on a visual analog scale (VAS), range 0-100. Psychometric screening was carried out using the Hospital Anxiety and Depression Scale. Pressure pain thresholds on the arm, leg, and in the vestibulum were measured using pressure algometers.
  
  
  RESULTS
  Major improvement/complete recovery was more likely in PVD patients with a maximum of one other concomitant pain disorder compared with patients with four or more (odds ratio = 7.8, confidence interval: 1.2-49.4, P = 0.03). In a multiple linear regression model, the number of other pain disorders (P < 0.01) and a diagnosis of primary PVD (P = 0.04) were positively associated with the coital VAS pain score. Women with secondary PVD reported major improvement/complete recovery to a higher extent than women with primary PVD (z = 2.11, P = 0.04).
  
  
  CONCLUSIONS
  A successful treatment outcome was more likely in PVD patients with fewer other concomitant pain conditions. The number of other bodily pain conditions was also associated to the intensity of the coital pain. Additionally, the results indicate higher incomplete response rates to treatment in women with primary PVD compared with secondary PVD.
authors.affiliation: Karolinska Institutet, Division of Obstetrics and Gynecology, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden. ulrika.heddini@ds.se
authors.forename: Ulrika
authors.initials: U
authors.lastname: Heddini
authors.forename: Nina
authors.initials: N
authors.lastname: Bohm-Starke
authors.forename: Kent W
authors.initials: KW
authors.lastname: Nilsson
authors.forename: Ulrika
authors.initials: U
authors.lastname: Johannesson
mesh_terms: D000328:Adult; D003075:Coitus / Q000502:physiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D010146:Pain / Q000453:epidemiology; D010147:Pain Measurement; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014844:Vulva / Q000503:physiopathology; D056650:Vulvodynia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult