title: Comorbidities Among Women With Vulvovaginal Complaints in Family Practice.
abstract: BACKGROUND
  The lifetime prevalence of women suffering from provoked vestibulodynia (PVD) is estimated to be approximately 15%. The etiology of PVD is not yet clear. Recent studies approach PVD as a chronic multifactorial sexual pain disorder. PVD is associated with pain syndromes, genital infections, and mental disorders, which are common diseases in family practice. PVD, however, is not included in the International Classification of Primary Care. Hence, the vulvovaginal symptoms, which could be suggestive of PVD, are likely to be missed.
  
  
  OBJECTIVE
  To explore the relationship between specific vulvovaginal symptoms that could be suggestive of PVD (genital pain, painful intercourse, other symptoms/complaints related to the vagina/vulva), and related diseases such as pain syndromes, psychological symptom diagnoses, and genital infections in family practice.
  
  
  METHODS
  A retrospective analysis of all episodes from 1995 to 2008 in 784 women between 15 and 49 years were used to determine the posterior probability of a selected diagnosis in the presence of specific vulvovaginal symptoms suggestive of PVD expressed in an odds ratio. Selected comorbidities were pain syndromes (muscle pain, general weakness, irritable bowel syndrome [IBS]), psychological symptom diagnoses (anxiety, depression, insomnia), vulvovaginal candidiasis, and sexual and physical abuse.
  
  
  RESULTS
  Women with symptoms suggestive of PVD were 4 to 7 times more likely to be diagnosed with vulvovaginal candidiasis and 2 to 4 times more likely to be diagnosed with IBS. Some symptoms suggestive of PVD were 1 to 3 times more likely to be diagnosed with complaints of muscle pain, general weakness, insomnia, depressive disorder, and feeling anxious.
  
  
  CONCLUSIONS
  Data from daily family practice showed a clear relationship between symptoms suggestive of PVD and the diagnoses of vulvovaginal candidiasis and IBS in premenopausal women. Possibly, family doctors make a diagnosis of vulvovaginal candidiasis or IBS based only on clinical manifestations in many women in whom a diagnosis of PVD would be more appropriate.
authors.affiliation: Radboud University Medical Centre, Department of Primary and Community Care, Unit Gender & Women's Health, Nijmegen, The Netherlands. Electronic address: leusinkp@knmg.nl.
authors.forename: Peter
authors.initials: P
authors.lastname: Leusink
authors.affiliation: Radboud University Medical Centre, Department of Primary and Community Care, Unit Gender & Women's Health, Nijmegen, The Netherlands.
authors.forename: Anne
authors.initials: A
authors.lastname: Kaptheijns
authors.affiliation: Academic Medical Center, Department of Sexology and Psychosomatic Obstetrics and Gynaecology, University of Amsterdam, Nijmegen, The Netherlands.
authors.forename: Ellen
authors.initials: E
authors.lastname: Laan
authors.affiliation: Radboud University Medical Centre, Department of Primary and Community Care, Unit Gender & Women's Health, Nijmegen, The Netherlands.
authors.forename: Kees
authors.initials: K
authors.lastname: van Boven
authors.affiliation: Radboud University Medical Centre, Department of Primary and Community Care, Unit Gender & Women's Health, Nijmegen, The Netherlands.
authors.forename: Antoine
authors.initials: A
authors.lastname: Lagro-Janssen
mesh_terms: D000328:Adult; D001007:Anxiety / Q000150:complications / Q000453:epidemiology*; D015897:Comorbidity; D003863:Depression / Q000150:complications / Q000453:epidemiology*; D004414:Dyspareunia / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D005194:Family Practice; D005260:Female; D005831:Genital Diseases, Female / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D010146:Pain / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D010147:Pain Measurement; D000066550:Physical Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D015995:Prevalence; D012189:Retrospective Studies; D012725:Sexual Behavior / Q000523:psychology*; D011795:Surveys and Questionnaires; D056650:Vulvodynia / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D016387:Women's Health
keywords: Candidiasis; Chronic Pain; Comorbidity; Dyspareunia; Primary Care; Provoked Vestibulodynia; Vulvodynia