title: Chronic vulvar pain in a cohort of post-menopausal women: Atrophy or Vulvodynia?
abstract: BACKGROUND
  Although postmenopausal vulvar pain is frequently attributed to vaginal atrophy, such symptoms may be due to vulvodynia, a chronic vulvar pain condition. Given the limited research on vulvodynia in postmenopausal women, the objective of this study was to provide preliminary population-based data on the associations of vaginal symptoms, serum hormone levels and hormone use with chronic vulvar pain in a multiethnic sample of post-menopausal women.
  
  
  METHODS
  We used data from 371 participants at the Michigan site of the Study of Women's Health Across the Nation (SWAN) who participated in the 13th follow-up visit. Women completed a validated screening instrument for vulvodynia and provided information on additional vaginal symptoms as well as demographic characteristics, and hormone use by questionnaire. Blood samples were obtained to assess hormone levels. We compared women who screened positive for vulvodynia and women with past or short-duration vulvar pain to women without vulvar pain, using Chi-squared and Fisher's Exact tests. Relative odds ratios and 95 % confidence intervals were calculated using multinomial logistic regression models adjusting for age, body mass index, and race/ethnicity.
  
  
  RESULTS
  Current chronic vulvar pain consistent with vulvodynia was reported by 4.0 % of women, while 13.7 % reported past but not current chronic vulvar pain or short-duration vulvar pain symptoms. One quarter of women who reported current chronic vulvar pain did not report vaginal dryness. Women with current chronic and with past/short duration vulvar pain symptoms were more likely to have used hormones during the preceding year than women without vulvar pain symptoms (13.3 %, 17.6 %, 2.0 %, respectively;p< .01). Increased relative odds of current vulvar pain symptoms were associated with each log unit decrease in serum dehydroepiandrosterone-sulfate, estradiol and testosterone levels at the previous year's visit.
  
  
  CONCLUSIONS
  Some women who experience chronic vulvar pain symptoms do not report vaginal dryness, and others report continued or first onset of pain while using hormones. Vulvodynia should be considered in the differential diagnosis of postmenopausal women presenting with vulvar pain symptoms.
authors.affiliation: Department of Epidemiology, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
authors.forename: Susanna D
authors.initials: SD
authors.lastname: Mitro
authors.affiliation: Department of Epidemiology, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
authors.forename: Siobán D
authors.initials: SD
authors.lastname: Harlow
authors.affiliation: School of Medicine, University of Michigan Ann Arbor, Ann Arbor, MI, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Randolph
authors.affiliation: School of Medicine, University of Michigan Ann Arbor, Ann Arbor, MI, USA.
authors.forename: Barbara D
authors.initials: BD
authors.lastname: Reed