title: Remission of vulvar pain among women with primary vulvodynia.
abstract: OBJECTIVE
  To determine whether rates of remission differed among women with primary versus secondary vulvodynia.
  
  
  METHODS
  Using a community-based observational study based in Minneapolis/St. Paul, 138 clinically confirmed cases of vulvodynia between 18 and 40 years old were classified as primary (vulvar pain starting at the time of sexual debut or first tampon insertion) or secondary (vulvar pain starting after a period of pain-free intercourse) and queried regarding their pain history to determine whether they had ever experienced any vulvar pain-free time (remission) or pain-free time lasting 3 months or longer.
  
  
  RESULTS
  Remission prevalence was 26% (9/34) for women in the shortest quartile of duration of vulvar pain (<3.8 y) and 38% (13/34) for the longest quartile of duration (≥13 y). After adjusting for vulvar pain duration, generalized vestibular pain, medical treatment, body mass index, and history of pregnancy, women who had primary vulvodynia were 43% less likely to report remission (95% CI = 0.33-0.99) than women with later onset (secondary cases). The association was strengthened when restricting to only remissions lasting 3 months or longer (adjusted risk ratio = 0.43, 95% CI = 0.22-0.84). Generalized vestibulodynia and obesity also reduced the likelihood of remission.
  
  
  CONCLUSIONS
  Our study underscores the heterogeneity of vulvodynia and provides evidence that primary vulvodynia may have a less wavering course and, as such, a potentially different underlying mechanism than that of secondary vulvodynia.
authors.affiliation: 1Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; and 2Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI.
authors.forename: Ruby H N
authors.initials: RH
authors.lastname: Nguyen
authors.forename: Charu
authors.initials: C
authors.lastname: Mathur
authors.forename: Erin M
authors.initials: EM
authors.lastname: Wynings
authors.forename: David A
authors.initials: DA
authors.lastname: Williams
authors.forename: Bernard L
authors.initials: BL
authors.lastname: Harlow
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D011247:Pregnancy; D011795:Surveys and Questionnaires; D013997:Time Factors; D056650:Vulvodynia / Q000503:physiopathology*; D055815:Young Adult