title: Remission, Relapse, and Persistence of Vulvodynia: A Longitudinal Population-Based Study.
abstract: BACKGROUND
  Vulvodynia has been considered to be a chronic disorder. We sought to estimate the probability of and risk factors for remission, relapse, and persistence among women screening positive for vulvodynia.
  
  
  METHODS
  Survey-based assessment in a longitudinal population-based study of women (the Woman to Woman Health Study) who screened positive for vulvodynia and completed at least four follow-up surveys. Outcome measures included remission without relapse, relapse (after remission), and persistence of a positive vulvodynia screen. Multinomial regression was used to assess factors associated with outcomes.
  
  
  RESULTS
  Of 441 women screening positive for vulvodynia during the study, 239 completed 4 additional surveys. Of these, 23 (9.6%) had consistently positive vulvodynia screens, 121 (50.6%) remitted without relapse, and 95 (39.7%) relapsed following remission. Overall, factors associated with both relapse and persistence (compared with remission alone) included increased severity of pain ever (p < 0.001) or after intercourse (p = 0.03), longer duration of symptoms (p ≤ 0.001), and screening positive for fibromyalgia (p < 0.001). Factors associated with persistence (but not relapse) included more severe symptoms with intercourse (p = 0.001) and pain with oral sex (p = 0.003) or partner touch (p = 0.04). Factors associated with relapse (but not persistence) included having provoked pain (p = 0.001) or screening positive for interstitial cystitis (p = 0.05) at first positive vulvodynia screen. Demographic characteristics, age at pain onset, and whether vulvodynia was primary or secondary did not predict outcome.
  
  
  CONCLUSIONS
  Remission of vulvodynia symptoms is common with approximately half of remitters experiencing a relapse within 6-30 months. Persistence without remission is the exception rather than the rule. Pain history and comorbid conditions were associated with the more severe outcomes of relapse and/or persistence compared with those who remitted only. These findings provide further support that vulvodynia is heterogeneous and often occurs in an episodic pattern.
authors.affiliation: 1 Department Family Medicine, University of Michigan , Ann Arbor, Michigan.
authors.forename: Barbara D
authors.initials: BD
authors.lastname: Reed
authors.affiliation: 2 Department of Epidemiology, School of Public Health, University of Michigan , Ann Arbor, Michigan.
authors.forename: Sioban D
authors.initials: SD
authors.lastname: Harlow
authors.affiliation: 1 Department Family Medicine, University of Michigan , Ann Arbor, Michigan.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Plegue
authors.affiliation: 1 Department Family Medicine, University of Michigan , Ann Arbor, Michigan.|3 Department of Biostatistics, School of Public Health, University of Michigan , Ann Arbor, Michigan.
authors.forename: Ananda
authors.initials: A
authors.lastname: Sen
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D005260:Female; D005356:Fibromyalgia / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D010146:Pain / Q000150:complications / Q000453:epidemiology*; D011159:Population Surveillance; D012008:Recurrence; D012044:Regression Analysis; D012075:Remission, Spontaneous; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014845:Vulvar Diseases / Q000453:epidemiology / Q000503:physiopathology; D056650:Vulvodynia / Q000150:complications / Q000453:epidemiology*; D016387:Women's Health; D055815:Young Adult