Provoked vestibulodynia—medical factors and comorbidity associated with treatment outcome

Ulrika Heddini, Nina Bohm-Starke, Kent W Nilsson, Ulrika Johannesson
Journal of Sexual Medicine 2012, 9 (5): 1400-6

INTRODUCTION: 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.

AIM: 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.

MAIN OUTCOME MEASURES: 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).

CONCLUSION: 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.

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