Wulwodynia – Epidemiologia

Wulwodynia
Epidemiologia

Wulwodynia, definiowana jako przewlekły ból sromu trwający minimum 3 miesiące bez jednoznacznej przyczyny, stanowi istotny problem zdrowotny kobiet w różnym wieku i grupach etnicznych. Epidemiologia wskazuje na roczną zachorowalność na poziomie 3,1-4,2 przypadków na 100 kobietolat, a punktowa częstość występowania waha się od 3% do 16%, z wyższą częstością u młodszych kobiet (np. 7,6/100 osobolat w wieku 20 lat) oraz u kobiet pochodzenia hiszpańskiego (22,7/100 osobolat). Wulwodynia współwystępuje często z innymi schorzeniami bólowymi, takimi jak zespół śródmiąższowego zapalenia pęcherza moczowego (ok. 25% współwystępowania) oraz zaburzeniami psychicznymi (lęk, depresja). Czynniki ryzyka obejmują m.in. zaburzenia snu, przewlekły ból w innych lokalizacjach, wcześniejsze infekcje bakteryjne i grzybicze, a także styl życia, np. noszenie obcisłych spodni i usuwanie włosów z wzgórka łonowego, co zwiększa ryzyko odpowiednio dwukrotnie i o 74%.

Epidemiologia wulwodynii (wulwodynii)

Wulwodynia (przewlekły ból sromu) jest istotnym problemem zdrowotnym kobiet, który charakteryzuje się utrzymującym się dyskomfortem lub bólem sromu, trwającym co najmniej 3 miesiące, bez wyraźnie identyfikowalnej przyczyny. Pomimo powszechności tego schorzenia, dokładne dane epidemiologiczne są trudne do określenia ze względu na różnorodność definicji, kryteriów diagnostycznych oraz niedostateczne rozpoznawanie i raportowanie tego schorzenia¹².

Częstotliwość występowania

Badania epidemiologiczne wskazują, że wulwodynia jest stosunkowo częstym schorzeniem ginekologicznym. Roczna zachorowalność na wulwodynię szacowana jest na poziomie 3,1-4,2 przypadków na 100 kobietolat, z różnicami zależnymi od wieku, pochodzenia etnicznego i stanu cywilnego¹². Występowanie punktowe według badań finansowanych przez National Institutes of Health (NIH) wynosi od 3% do 7% wśród kobiet w wieku reprodukcyjnym¹.

Szacunki dotyczące częstości występowania wulwodynii w populacji ogólnej znacznie się różnią w zależności od badania:

Według niektórych badań, od 8% do 12% kobiet cierpi na wulwodynię w pewnym momencie życia¹
Dane z USA wskazują, że schorzenie to dotyka od 5% do 16% kobiet, co przekłada się na nawet 6 milionów Amerykanek¹
Inne badania sugerują, że przewlekły ból sromu może dotyczyć nawet 16% populacji²³
Badanie przeprowadzone w dzielnicach Bostonu wykazało, że nawet 16% badanych kobiet doświadczyło wulwodynii¹
Niektóre szacunki wskazują, że do wieku 40 lat około 7-8% kobiet doświadcza bólu sromu zgodnego z kryteriami wulwodynii¹

Szczególnie niepokojące jest to, że częstość występowania wulwodynii wzrosła w ciągu ostatnich trzech dekad, co może wynikać zarówno ze zwiększonej świadomości i częstszego zgłaszania objawów, jak i rzeczywistego wzrostu czynników etiologicznych¹.

Różnice wiekowe

Wulwodynia dotyka kobiety w każdym wieku, jednak częstość występowania może różnić się w zależności od grupy wiekowej¹²:

Badania wskazują, że nastolatki i młode kobiety są szczególnie narażone na wulwodynię, z częstością występowania sięgającą 7,6 przypadków na 100 osobolat w wieku 20 lat¹
Amerykańskie badanie National Health and Social Life Survey wykazało, że 21% aktywnych seksualnie kobiet w wieku 18-29 lat doświadczyło bólu podczas stosunku seksualnego w ciągu ostatnich 12 miesięcy¹
W grupie wiekowej 30-49 lat odsetek ten wynosił 13%, a w grupie 50-59 lat – 8%¹
Badanie przeprowadzone wśród 1425 aktywnych seksualnie kanadyjskich kobiet w wieku 13-19 lat wykazało, że 20% zgłaszało ból przy wejściu do pochwy podczas stosunku przez ponad sześć miesięcy¹
Brytyjskie badanie na próbie 6777 aktywnych seksualnie kobiet w wieku 16-74 lat wykazało, że częstość występowania bólu podczas stosunku płciowego była najwyższa (9,5%) u osób w wieku 16-24 lat oraz u osób w wieku 55-64 lat (10,4%)¹

Warto zauważyć, że częstość występowania wulwodynii pozostaje stosunkowo stała we wszystkich dekadach życia aż do 70 roku życia¹². Oznacza to, że schorzenie to nie ogranicza się tylko do kobiet w wieku reprodukcyjnym, ale dotyka również kobiety po menopauzie¹.

Zróżnicowanie etniczne

Wulwodynia dotyka kobiety wszystkich grup etnicznych, jednak istnieją pewne różnice w częstości występowania¹:

Badania sugerują, że kobiety pochodzenia hiszpańskiego mogą być bardziej narażone na rozwój objawów bólu sromu (22,7 przypadków na 100 osobolat) w porównaniu do innych grup etnicznych¹²
Wskaźniki wśród kobiet czarnoskórych (16,2%), białych (14,4%) i azjatyckich (11,1%) były podobne, choć niższe niż wśród kobiet pochodzenia hiszpańskiego¹

Co ciekawe, wcześniejsze badania sugerowały, że wulwodynia występuje prawie wyłącznie u kobiet białych, jednak nowsze dane wskazują na jej obecność we wszystkich grupach etnicznych¹.

Czynniki ryzyka i współwystępowanie

Badania epidemiologiczne wskazują na kilka istotnych czynników ryzyka i stanów współistniejących związanych z wulwodynią¹:

Zaburzenia snu¹
Przewlekły ból w innych lokalizacjach¹
Współistniejące zaburzenia bólowe¹
Zaburzenia psychologiczne¹²
Stan cywilny (bycie mężatką lub życie w związku partnerskim zwiększa ryzyko do 4,9 przypadków na 100 osobolat)¹
Wcześniejsze objawy bólu sromu, które nie spełniały kryteriów wulwodynii (11,5 przypadków na 100 osobolat)¹
Historia objawów sugerujących wcześniejszą wulwodynię (7,5 przypadków na 100 osobolat)¹

Niedawne badanie przeprowadzone przez School of Public Health wykazało również, że noszenie obcisłych dżinsów lub spodni cztery lub więcej razy w tygodniu prawie dwukrotnie zwiększa ryzyko wulwodynii w porównaniu do kobiet, które rzadko lub nigdy ich nie nosiły¹. Dodatkowo, usuwanie włosów z wzgórka łonowego zwiększało ryzyko wulwodynii o 74% w porównaniu do kobiet, które usuwały włosy tylko z okolicy bikini¹.

Badania typu case-control wykazały, że kobiety z wulwodynią częściej zgłaszały wcześniejsze diagnozy bakteryjnej waginozy (OR = 22,2), zakażeń grzybiczych pochwy (OR = 4,9) i wirusa brodawczaka ludzkiego (OR = 7,1)¹. Były również bardziej narażone na zły stan zdrowia (OR = 5,7) i historię depresji trwającej 2 tygodnie lub dłużej w ciągu ostatniego roku (OR = 4,4)¹.

Współwystępowanie z innymi schorzeniami

Wulwodynia często współwystępuje z innymi schorzeniami bólowymi i zaburzeniami funkcjonalnymi¹:

Szczególnie często odnotowuje się współwystępowanie z zespołem śródmiąższowego zapalenia pęcherza moczowego/zespołem bólowym pęcherza (IC/BPS), z około 25% kobiet z IC/BPS zgłaszających również wulwodynię¹
Częste są również współistniejące zaburzenia psychologiczne, takie jak lęk i depresja¹²

Niedostateczne rozpoznanie i opóźniona diagnostyka

Pomimo stosunkowo wysokiej częstości występowania, wulwodynia pozostaje schorzeniem niedostatecznie rozpoznawanym i często błędnie diagnozowanym¹:

Dane wskazują, że jedynie 1,4% kobiet, które szukały pomocy medycznej, otrzymało prawidłową diagnozę¹
Wiele kobiet nigdy nie szuka leczenia – 48% w Minneapolis/St. Paul (MSP) i 30% w Boston Metropolitan Area (BMA)¹
Spośród tych, które szukały pomocy, około 50% nie otrzymało żadnej diagnozy, mimo dostępu do opieki zdrowotnej¹²
Ponad 60% kobiet musiało skonsultować się z co najmniej trzema lekarzami, zanim otrzymało diagnozę¹

Opóźniona diagnostyka wynika z wielu czynników, w tym z braku wiedzy wśród pracowników służby zdrowia, trudności w rozmawianiu o objawach i przekonania, że ból sromu lub dyspareunia są w pewnym stopniu normalne¹².

Wpływ na jakość życia

Wulwodynia ma znaczący wpływ na jakość życia kobiet, wpływając na aspekty fizyczne, psychologiczne i społeczne¹:

Zaburzenia snu i koncentracji¹
Wpływ na relacje seksualne i intymne¹²
Trudności w wykonywaniu codziennych czynności¹
Obniżona satysfakcja seksualna¹
Konsekwencje psychoseksualne, takie jak lęk, depresja i zakłócenie relacji międzyludzkich¹

Badanie przeprowadzone wśród polskich kobiet z wulwodynią wykazało, że jakość życia była najniższa w domenie fizycznej, a najwyższa w domenie psychologicznej¹. Nasilenie bólu korelowało negatywnie z postrzeganą jakością życia i oceną zdrowia – im większy ból, tym niższa postrzegana jakość życia¹.

Obciążenie ekonomiczne

Wulwodynia stanowi znaczące obciążenie ekonomiczne¹:

Szacuje się, że koszty związane z wulwodynią w USA wynoszą od 31 do 72 miliardów dolarów rocznie¹
Koszty te wynikają zarówno z bezpośrednich wydatków na opiekę zdrowotną, jak i z pośrednich kosztów związanych z utratą produktywności i obniżoną jakością życia¹

Wyzwania w badaniach epidemiologicznych wulwodynii

Badania epidemiologiczne dotyczące wulwodynii napotykają na liczne wyzwania¹²:

Różnorodność definicji i kryteriów diagnostycznych¹
Trudności w badaniu tak wrażliwego tematu¹
Historyczny brak badań nad schorzeniami dotykającymi głównie kobiety¹
Ograniczona wielkość próby w wielu badaniach, szczególnie w zakresie kobiet z aktualnymi objawami bólu sromu spełniającymi kryteria przesiewowe¹

W 2011 roku ponad 80 badaczy spotkało się na konferencji dotyczącej stanu badań nad wulwodynią w National Institute of Child Health and Human Development w USA. Uczestnicy konferencji zgodzili się, że baza dowodowa dla badań nad wulwodynią jest ograniczona i że nie ma wystarczających dowodów naukowych, aby osiągnąć konsensus co do preferowanych metod diagnozy i leczenia¹.

Uczestnicy zgodzili się również, że dalsze postępy wymagają wiedzy specjalistycznej naukowców z dziedziny neurologii, badań nad bólem i innych obszarów, ale zbyt niewielu badaczy we wszystkich dziedzinach, szczególnie w dziedzinach innych niż ginekologia, posiada wystarczającą wiedzę i zainteresowanie wulwodynią¹.

Aktualne badania kliniczne

Według danych z findexpertmd.com, istnieje co najmniej 81 badań klinicznych dotyczących wulwodynii, w tym 1 aktywne, 46 zakończonych i 10 rekrutujących¹. Te badania mogą przyczynić się do lepszego zrozumienia epidemiologii i skutecznych metod leczenia wulwodynii.

Obecne badania koncentrują się na różnych aspektach leczenia wulwodynii, w tym¹²³:

Skuteczność samodzielnego zarządzania objawami
Stosowanie leków przeciwdepresyjnych, takich jak amitryptylina
Miejscowe stosowanie gabapentyny
Wykorzystanie rozszerzaczy pochwowych
Rola diety (np. ograniczenie spożycia szczawianów)
Skuteczność wulwektomii (chirurgicznego usunięcia części sromu)
Przezskórna elektryczna stymulacja nerwów (TENS)

Warto zauważyć, że obecnie istnieje duża luka między badaniami, które są publikowane, a opcjami, które docierają do pacjentów¹. Przyszłe badania powinny koncentrować się na ocenie podejścia multimodalnego w leczeniu wulwodynii, wraz z dalszymi badaniami nad etiologią tego schorzenia¹.

Podsumowanie danych epidemiologicznych

Dane epidemiologiczne dotyczące wulwodynii wskazują, że jest to stosunkowo częste schorzenie dotykające kobiety we wszystkich grupach wiekowych i etnicznych¹. Szacowana częstość występowania waha się od 3% do 16%, z wyższymi wskaźnikami wśród młodszych kobiet i kobiet pochodzenia hiszpańskiego¹².

Pomimo powszechności, wulwodynia pozostaje schorzeniem niedostatecznie rozpoznawanym i często błędnie diagnozowanym, z jedynie niewielkim odsetkiem kobiet otrzymujących prawidłową diagnozę¹. Schorzenie to ma znaczący wpływ na jakość życia kobiet, wpływając na aspekty fizyczne, psychologiczne i społeczne, oraz stanowi znaczące obciążenie ekonomiczne¹².

Potrzebne są dalsze badania, aby lepiej zrozumieć epidemiologię wulwodynii, zidentyfikować czynniki ryzyka i opracować skuteczne strategie leczenia. Szczególnie ważne jest zwiększenie świadomości wśród pracowników służby zdrowia, aby zmniejszyć opóźnienia w diagnostyce i zapewnić odpowiednie leczenie¹.

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Materiały źródłowe

#1 Similarities between interstitial cystitis/bladder pain syndrome and vulvodynia: implications for patient management – Fariello – Translational Andrology and Urology
https://tau.amegroups.org/article/view/8158/html
Epidemiology with regard to IC/BPS and vulvodynia has been primarily hampered by the varied definitions for these syndromes. Nevertheless, most investigations indicate that these conditions not only have a high prevalence and have common co-morbidities; but that they are frequently identified in the same patient. […] Among women age 18 and over in the US, recent data suggest between 3.3 and 7.9 million women have symptoms of IC/BPS. The prevalence of vulvodynia has been estimated to range between 4-16%, effecting more than 2.4 million women in the US. The association between IC/BPS and vulvodynia is often reported, with 25% of women with IC/BPS also reporting to have vulvodynia. […] Patients often have overlapping symptoms making diagnosis of one or both conditions all the more difficult. Frequency of both conditions is often underestimated due to the fact that many in the medical community believe these conditions to be psychological in origin or because women reluctant to discuss their symptoms.
#1 Vulvodynia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK430792/
Vulvodynia is a chronic pain condition characterized by persistent vulvar discomfort or pain lasting at least 3 months without a clearly identifiable cause. […] The annual incidence of vulvodynia was reported as 3.1% in 2012 by Reed. In 2014, the incidence was 4.2 cases per 100 woman-years, varying by age, ethnicity, and marital status. An independent population-based study funded by the National Institutes of Health (NIH) reported a point prevalence of 3% to 7% among reproductive-aged women. […] By age 40, 7% of American women will experience symptoms consistent with vulvodynia. Notably, only 1.4% of women who sought medical care received a correct diagnosis.
#1 Chronic Vulvar Pain and Health-Related Quality of Life in Women with Vulvodynia
https://www.mdpi.com/2075-1729/13/2/328
The prevalence of the disease in populations around the world has not yet been well studied, and when making statistical comparisons, large discrepancies are apparent. However, on the basis of the most recent data, it is estimated that, in general, it affects 8 to 12% of women. This, for example, ranges from 5 to 16%, or up to 6 million women, in the United States of America. Unfortunately, in Poland, as a result of a lack of sufficient studies, exact data on this subject are not available. […] Taking into account the prevalence of vulvodynia and the underestimation resulting from diagnostic difficulties, it is important to conduct research to better understand this disease. Various studies indicate that vulvodynia significantly affects all aspects of a womanâs life, significantly reducing quality; however, to the best of our knowledge, the Polish population has yet to be assessed. The aim of this study was to investigate the severity of chronic vulvar pain in women with vulvodynia and its impact on their HRQoL. We hypothesized that the HRQoL of women with vulvodynia would be reduced.
#1 Vulvar Pain and Vulvodynia – Vulvovaginal Disorders
https://vulvovaginaldisorders.org/vulvar-pain-and-vulvodynia/
Findings from available epidemiologic studies, well described in Bergeron et alâs excellent article, indicate that vulvodynia is a common gynecological pain syndrome, prevalent in women of all ages. […] In a preliminary survey, (prior to the first epidemiological study in the US), researchers showed that women from the general population were willing to provide sensitive information on lower genital tract discomfortâa first step toward bringing notice to this understudied disorder. […] Subsequently, the main study of >5,000 women in Boston neighborhoods found that as many as 16% of these women experienced vulvodynia. […] By restricting the population to women with no lifetime histories of pelvic disorders such as endometriosis or leiomyomata, the authors conservatively estimated that at least 9% of women will experience a condition likely to meet vulvodynia criteria at some point.
#1 Prevalence of symptoms consistent with a diagnosis of vulvodynia: population-based estimates from 2 geographic regions – PubMed
https://pubmed.ncbi.nlm.nih.gov/24080300/
By age 40 years, 7-8% in BMA and MSP reported vulvar pain consistent with vulvodynia. […] Many women in MSP (48%) and BMA (30%) never sought treatment, and 50% who sought care with known health care access received no diagnosis. […] Using identical screening methods, we report high prevalence of vulvar pain in 2 geographic regions, and that access to health care does not increase the likelihood of seeking care for chronic vulvar pain.
#1 Epidemiology of Vulvar Pain | Obgyn Key
https://obgynkey.com/epidemiology-of-vulvar-pain/
Vulvar pain is a very common problem that affects women of all age groups. The incidence of vulvar pain has increased over the past three decades. The reason is twofold: on one hand, there is certainly greater awareness about vulvar pain, which is increasingly reported to healthcare providers (HCPs), and on the other hand, there is a real increase of etiologic factors. The prevalence of isolated pain syndromes causing vulvar pain is difficult to estimate because of the private nature of this symptom, the lack of widespread knowledge among healthcare providers about vulvar pain disorders, and the belief, by some women, that vulvar or sexual pain of some extent is normal. The reported prevalence rates of dyspareunia ranged widely, from 1 % in Sweden to 46 % in one US study. Overall the most frequent prevalence figures range between 10 and 20 %. The prevalence of vulvar pain and sexual dysfunction is high after childbirth and in the postpartum and puerperium periods, and data indicate that up to 86 % of women report one or more vulvar complain soon after delivery. The reported prevalence rates of perineal pain at 12-24 months postpartum range from 5 to 33 %. A recent Australian prospective study on 1507 nulliparous women indicates that prevalence of dyspareunia at 3, 6, 13, and 18 month is of 44, 45, 28, and 23 % respectively.
#1 Vulvar Endometriosis Mimicking as Primary Vulvodynia in a Young Nulliparous Woman: Algorithm of Care Following a Rapid Literature Review | Adedipe | Journal of Clinical Gynecology and Obstetrics
https://jcgo.org/index.php/jcgo/article/view/735/460
Vulvar endometriosis is rare and can present as primary vulvodynia in the young woman. […] The lifetime prevalence of this condition has been estimated at 8%, and this prevalence remains constant across all decades up to the age of 70 years. […] Vulvodynia affects women of all ages, reproductive stages, and ethnicities. […] Vulvodynia or vulvar pain syndrome is a multifactorial clinical syndrome of vulvar pain, sexual dysfunction, and psychological distress. […] It is estimated that 10-18% of American women have the disease with an economic burden of $31-72 billion dollars a year. […] The exact etiology of vulvodynia is unknown. Most likely, there is not one single etiology but a set of overlapping etiologies, more so as the disease progresses. […] Early identification of a possible vulvar endometriosis helps in getting the therapy right at first visit and hopefully reduces the burden of disease.
#1 Vulvar Pain in Adolescents | Obgyn Key
https://obgynkey.com/vulvar-pain-in-adolescents/
Adolescents are the age cohort more vulnerable to vulvar pain. A recent study on 1786 women, assessed for onset of vulvodynia, suggests that the incidence rate was 4.2 cases per 100 person-years, and rates per 100 person-years were greater in women who were younger (7.6 cases per 100 person-years at age 20, compared with 3.3 cases per 100 person-years at age 60), Hispanic (9.5), and married or living as married (4.9); had reported symptoms of vulvar pain but did not meet vulvodynia criteria on the initial survey (11.5); and had reported past symptoms suggesting a history of vulvodynia (7.5). Increased risk of new onset vulvodynia also included baseline sleep disturbance, chronic pain in general, specific comorbid pain disorders, and specific comorbid psychological disorders (Reed et al. 2014). Previous studies suggest an overall prevalence of vulvodynia in the general US population of 8.3 % (Reed et al. 2012a). Chronic vulvar pain may affect up to 16 % of the population, according to other studies (Sadownik 2014). Overall, a prevalence of 710 % is the most consistent across studies in the USA (Iglesias-Rios et al. 2015).
#1 Vulvar Pain and Vulvodynia – Vulvovaginal Disorders
https://vulvovaginaldisorders.org/vulvar-pain-and-vulvodynia/
However, another large study of women from Nepal, evaluated at a dermatology outpatient clinic, indicated that only 1% had vulvodynia. […] It is possible that this low number reflects patient embarrassment and reluctance to report vulvar pain or dyspareunia, or provider lack of education or disregard of the condition and discomfort with management of these women. […] All of these factors have resulted in widespread ignorance about this devastating condition. […] Although women of all ages may experience vulvodynia, prevalence may vary with age groups. […] In the USA, the National Health and Social Life Survey revealed that 21% of sexually active women aged 18-29 years experienced pain during sexual intercourse during the prior 12 months. […] Percentages were lower in older women: 13% of women aged 30-49 years and 8% in the 50-59 years group.
#1 Vulvar Pain and Vulvodynia – Vulvovaginal Disorders
https://vulvovaginaldisorders.org/vulvar-pain-and-vulvodynia/
Of 1,425 sexually active Canadian women aged 13-19 years, 20% identified pain at the vaginal opening during intercourse for over six months. […] 6,777 sexually active British women aged 16-74 years, participating in a probability sample survey, showed that the prevalence of pain with sexual intercourse was highest (9.5%) in those aged 16-24 years and in those aged 55-64 years (10.4%). […] The high prevalence in postmenopausal women in this study, compared with other studies, may arise from the inclusion of only sexually active women in the British sample. […] In addition, whether or not treatment for postmenopausal vaginal atrophy was being used was not addressed.
#1 Vulvodynia | Doctor
https://patient.info/doctor/vulvodynia-pro
Vulvodynia affects women of all ages and ethnicity. […] Lifetime prevalence has been estimated at 8% and is constant across all decades up to the age of 70. […] Provoked vestibulodynia is the most common presentation.
#1 Chronic vulvar pain in a cohort of post-menopausal women: Atrophy or Vulvodynia? | Women’s Midlife Health | Full Text
https://womensmidlifehealthjournal.biomedcentral.com/articles/10.1186/s40695-016-0017-z
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. […] 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. […] Vulvodynia should be considered in the differential diagnosis of postmenopausal women presenting with vulvar pain symptoms. […] The prevalence of chronic vulvar pain in mid-life women has been estimated to be 8.9-38 % percent, making chronic vulvar pain a major health concern for women in this age group.
#1 The National Vulvodynia Association
https://www.nva.org/
Persistent vulvar pain affects women of all ages, including adolescents […] Vulvodynia is prevalent in all ethnic and racial groups […] For more than 30 years, the National Vulvodynia Association (NVA), a nonprofit organization, has been dedicated to improving the health and quality of life for women with chronic vulvar pain.
#1 Epidemiology of Vulvodynia: More Study Is Neededlogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/wh200306170000007/2003/06/17/epidemiology-vulvodynia-more-study-needed
Epidemiology of Vulvodynia: More Study Is Needed […] The prevalence of vulvodynia — chronic vulvar pain in the absence of objective findings — is unknown. This report, from the first 14 months of a 42-month, NIH-funded study, provides the first population-based prevalence estimate. […] About 16% of the women reported having experienced chronic vulvar pain at some point in their lives; cumulative incidence was highest among Hispanic women (22.7%) and was similar among black (16.2%), white (14.4%), and Asian (11.1%) women. […] Only 54% of symptomatic women had ever sought treatment; more than 60% of these women saw 3 or more clinicians, and only 61% received diagnoses. […] The diagnosis of vulvodynia excludes women with vulvar dermatoses, infections, or other explanations for their symptoms; thus, without physical examination, women who reported vulvar pain in this study cannot be considered to definitively have had vulvodynia.
#1 Vulvodynia and Vulvar Vestibulitis: Challenges in Diagnosis and Management | AAFP
https://www.aafp.org/pubs/afp/issues/1999/0315/p1547.html
Vulvodynia is a syndrome of unexplained vulvar pain that is frequently accompanied by physical disabilities, limitation of daily activities (such as sitting and walking), sexual dysfunction and psychologic disability. The incidence and prevalence of vulvodynia have not been well studied. Age distribution for the condition may range from the 20s to the 60s, and it is limited almost exclusively to white women. […] In a general gynecologic practice population, the prevalence of this condition may be as high as 15 percent. […] Most patients consult several physicians before being diagnosed. Many are treated with multiple topical or systemic medications, with minimal relief. […] Since physical findings are few and cultures and biopsies are frequently negative, patients may be told that the problem is primarily psychologic, thus invalidating their pain and adding to their distress.
#1 Tight Pants and Pubic-Hair Removal Increase Risk of Vulvodynia | SPH
https://www.bu.edu/sph/news/articles/2019/tight-pants-and-pubic-hair-removal-increase-risk-of-vulvodynia/
They found that women who wore tight-fitting jeans or pants four or more times per week had twice the odds of vulvodynia compared to women who never or rarely did. […] Those who removed hair from the mons pubis (the soft mound of skin above the genitals) were 74 percent more likely to experience vulvodynia than women who only removed hair from the bikini area. […] Compared with women who reported removing only bikini-area hair less than monthly, those who removed hair from the mons pubis weekly or more were nearly twice as likely to experience vulvodynia. […] It was important for me to know that this is a highly prevalent condition, and that there are women out there who are embarrassed to talk about it. […] I am hopeful that this study’s findings will lead to further research into evidence-based predictors of vulvodynia, and improve physicians’ understanding of and treatment of this condition.
#1 Epidemiology of vulvar vestibulitis syndrome: an exploratory case-control study. | Sexually Transmitted Infections
https://sti.bmj.com/content/75/5/320
BACKGROUND: Vulvar vestibulitis syndrome (VVS) is a chronic, persistent syndrome characterised by vestibular pain, tenderness, and erythema. […] RESULTS: Cases were more likely than controls to report every vaginal and urinary symptom at the time of interview measured, particularly vaginal soreness or pain (60.7%) and pain during intercourse (64.3%). […] Cases were more likely than controls to report self reported history of physician diagnosed bacterial vaginosis (OR = 22.2, 95% CI = 2.8, 177.2, p value = 0.0001), vaginal yeast infections (OR = 4.9, 95% CI = 1.4, 18.0, p value = 0.01), and human papillomavirus (OR = 7.1, 95% CI = 0.6, 81.2, p value = 0.08). […] Cases were more likely than controls to report poor health status (OR = 5.7, 95% CI = 1.1, 28.7, p value = 0.02) and history of depression for 2 weeks or more during the past year (OR = 4.4, 95% CI = 1.6, 12.3, p value = 0.002). […] CONCLUSION: Self reported history of bacterial vaginosis, yeast infections, and human papillomavirus were strongly associated with VVS. An infectious origin for VVS should be pursued in larger controlled studies, using questionnaire and laboratory measures.
#1 Vulval pain: clinical review | GPonline
https://www.gponline.com/vulval-pain-clinical-review/womens-health/article/1422001
Vulvodynia (vulval pain) in women is defined as the sensation of vulval burning and soreness in the absence of any obvious skin condition or infection. […] It is estimated that around 16% of women have suffered from vulval pain for at least three months at any time in their life. The average age of occurrence of vulvodynia is around 30 years of age. A high prevalence is observed in all decades of life until age 70. Despite the high prevalence, it is still an underestimated condition, as it can potentially be dismissed as a psychological condition. […] Psychological morbidity has been found to be high in women with vulval pain syndromes. Studies have confirmed profound psychosexual ramifications such as anxiety, depression and disruption of interpersonal relationships prevalent among women with vulvodynia. […] Good evidence for effective treatment is lacking. Tricyclic antidepressants may be helpful in those with unprovoked pain. Surgery is only suitable in certain women with localised provoked pain.
#1 Vulvodynia (vulval pain)
https://www.nhs.uk/conditions/vulvodynia/
Vulvodynia is pain in the vulva (area around the outside of the vagina) that lasts at least 3 months and does not have a specific cause. It can have a big effect on your life, but there are treatments that can help. […] Vulvodynia can affect women of all ages. Anyone with a vulva can have vulval pain. […] Vulvodynia can have a big impact on your life, affecting things like your sleep, concentration and sexual relationships. […] If the cause of your vulval pain cannot be found, you may be referred to a specialist for help managing the pain. […] The main aim of treatment for vulvodynia is to help manage the pain. […] No single treatment works for everyone, and you may need to try several treatments to find out what works best for you. […] The exact cause of vulvodynia is not known.
#1 Chronic Vulvar Pain and Health-Related Quality of Life in Women with Vulvodynia
https://www.mdpi.com/2075-1729/13/2/328
Vulvodynia is defined as chronic vulvar pain in the perineal area. It affects women around the world and is a significant health problem. The authors of this study examined the intensity of vulvar pain and the impact of vulvodynia on quality of life in a group of Polish women. It was observed that vulvodynia mainly occurs in young people with a high level of education, and predominantly in unmarried women, divorcees, and widows. In addition, the disease reduces quality of life, which is mainly due to difficulties in performing activities of daily living and a decrease in sexual satisfaction. The more pain a woman feels, the worse her quality of life. It was concluded that vulvodynia is a major problem among the Polish female population. Thus, research in this regard should be continued by scientists and health care professionals.
#1 Chronic Vulvar Pain and Health-Related Quality of Life in Women with Vulvodynia
https://www.mdpi.com/2075-1729/13/2/328
The quality of life of women with vulvodynia was described in accordance with the guidelines provided in the WHOQOL-BREF questionnaire. The domains of respondentsâ quality of life are shown in Table 5. The respondents rated their quality of life best in the psychological domain, and marginally worse in the environmental and social domains. The physical domain had the lowest scores. […] The severity of pain was significantly higher in women who assessed their level of stress in their everyday life as medium or high as compared with women who assessed it as low. Those who rated their stress level as low experienced the lowest range of pain. Respondents that reported medium to high stress levels experienced the widest range of pain on the VAS. […] The severity of pain on the VAS correlated significantly and negatively with the respondentsâ quality of life and their health perception, indicating that the greater the pain experienced, the lower the perceived quality of life and health.
#1 What is vulvodynia?
https://www.bbc.com/future/article/20180725-the-health-condition-vulvodynia-is-painful-and-misunderstood
Vulvodynia was first documented in medical texts in 1880, described as supersensitiveness of the vulva and a fruitful source of dyspareunia (painful intercourse), according to Lisa Goldstein, executive director of the National Vulvodynia Association. […] Today, research shows that 16% of women in the US suffer from vulvodynia at some point in their lives. […] But due to a variety of factors including the difficulty of studying such a sensitive subject, variations in definitions and diagnostic criteria and a historic lack of research on health conditions that primarily affect women it has gone under-researched. […] In 2011, more than 80 researchers came together for a conference on the state of vulvodynia research at the National Institute of Child Health and Human Development in the US. Participants at the conference agreed that the evidence base for vulvodynia research is sparse, and that there is insufficient scientific evidence to form a consensus on preferred methods of diagnosis and treatment, they concluded.
#1 Chronic vulvar pain in a cohort of post-menopausal women: Atrophy or Vulvodynia? | Women’s Midlife Health | Full Text
https://womensmidlifehealthjournal.biomedcentral.com/articles/10.1186/s40695-016-0017-z
More than a quarter of women who reported current chronic vulvar pain did not report vaginal dryness, a common complaint associated with vaginal atrophy. […] These results provide additional evidence that chronic vulvar pain in postmenopausal women has a heterogeneous etiology and, in many women, may not be explained by estrogen deficiency-related atrophy alone. […] This analysis was constrained by the limited sample size, particularly the small number of women with current vulvar pain symptoms meeting our screening criteria. […] Future research should focus on the diagnosis and treatment of women who do not respond to this intervention.
#1 What is vulvodynia?
https://www.bbc.com/future/article/20180725-the-health-condition-vulvodynia-is-painful-and-misunderstood
Their report added that participants agreed that moving forward required expertise from scientists in neurology, pain research and other areas, but that too few investigators in all fields, but particularly in fields other than gynecology, were sufficiently knowledgeable and interested in vulvodynia. […] As a result, the condition largely remains a mystery. There is often no identifiable cause, and there is no one-size-fits-all cure. […] It often takes a team of specialists to diagnose vulvodynia and other pelvic pain disorders, says Rachel Gelman, a pelvic floor physical therapist at the Pelvic Health and Rehabilitation Center in San Francisco. […] Some research has linked vulvodynia to autoimmune disorders, nerve damage, allergic reactions, chronic yeast infections and even ethnicity, says Stoehr.
#1 Top Published Expert Doctors for Vulvodynia
https://findexpertmd.com/d/Vulvodynia
278 top medical experts on Vulvodynia across 28 countries and 36 U.S. states, including 138 MDs (Physicians). This is based on an objective analysis of their Scientific Publications, Clinical Trials, Medicare, and NIH Grants. […] Vulvodynia impacts negatively on a woman’s quality of life as it interferes with sexual and daily activities. […] Clinical Trials: at least 81 including 1 Active, 46 Completed, 10 Recruiting.
#1 Published research – The Vulval Pain Society
https://vulvalpainsociety.org/research/published-research/
In this section of the website we report on selected studies from published research on vulval pain and make our own comments on what is reported. […] At the moment there is a big gap between research that is reported and options that filter down to the patient. […] OBJECTIVE: To conduct a prospective study to determine the efficacy of self-management interventions, amitriptyline, and amitriptyline plus topical triamcinolone in reducing vulval pain in women with vulvodynia. […] CONCLUSIONS: This first randomized, prospective trial suggests that self-management has a modest effect and that low-dose amitriptyline (with and without topical triamcinolone) is not effective in reducing pain in women with vulvodynia. […] This study suggests that there is no difference in outcome between self-management, amitriptyline tablets and amitryptyline and triamcinolone (which is a steroid ointment applied to the vulva).
#1 Persistent Vulvar Pain | ACOG
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2016/09/persistent-vulvar-pain
Persistent vulvar pain is a complex disorder that frequently is frustrating to the patient and the clinician. It can be difficult to treat and rapid resolution is unusual, even with appropriate therapy. Vulvar pain can be caused by a specific disorder or it can be idiopathic. Idiopathic vulvar pain is classified as vulvodynia. […] The classification of vulvodynia is based on the site of the pain; whether it is generalized, localized, or mixed; whether it is provoked, spontaneous, or mixed; whether the onset is primary or secondary; and the temporal pattern (whether the pain is intermittent, persistent, constant, immediate, or delayed). […] Although optimal treatment remains unclear, consider an individualized, multidisciplinary approach to address all physical and emotional aspects possibly attributable to vulvodynia. […] Future research should aim at evaluating a multimodal approach in the treatment of vulvodynia, along with more research on the etiologies of vulvodynia.
#1 Vulvodynia and Vulvar Vestibulitis: Challenges in Diagnosis and Management | AAFP
https://www.aafp.org/pubs/afp/issues/1999/0315/p1547.html
Research indicates that vulvodynia and vulvar vestibulitis are being identified by physicians with increasing frequency. Since the physician sees only what he already knows, family physicians must be aware of and recognize this condition early. Failure to consider vulvodynia as the cause of vulvar pain is the most common reason for misdiagnosis. […] Vulvodynia is a multifactorial problem with subsets that may overlap. Proper management is based on identification of the subsets of vulvodynia and identification of any concurrent infections that may be appropriately treated. Family physicians working together with gynecologists who are experienced in treating patients with vulvodynia can properly diagnose vulvodynia, identify subsets and institute the management plan that can best benefit the patient.
#2 Vulvodynia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK430792/
Vulvodynia is a chronic pain condition characterized by persistent vulvar discomfort or pain lasting at least 3 months without a clearly identifiable cause. […] The annual incidence of vulvodynia was reported as 3.1% in 2012 by Reed. In 2014, the incidence was 4.2 cases per 100 woman-years, varying by age, ethnicity, and marital status. An independent population-based study funded by the National Institutes of Health (NIH) reported a point prevalence of 3% to 7% among reproductive-aged women. […] By age 40, 7% of American women will experience symptoms consistent with vulvodynia. Notably, only 1.4% of women who sought medical care received a correct diagnosis.
#2 Vulvar Pain in Adolescents | Obgyn Key
https://obgynkey.com/vulvar-pain-in-adolescents/
Adolescents are the age cohort more vulnerable to vulvar pain. A recent study on 1786 women, assessed for onset of vulvodynia, suggests that the incidence rate was 4.2 cases per 100 person-years, and rates per 100 person-years were greater in women who were younger (7.6 cases per 100 person-years at age 20, compared with 3.3 cases per 100 person-years at age 60), Hispanic (9.5), and married or living as married (4.9); had reported symptoms of vulvar pain but did not meet vulvodynia criteria on the initial survey (11.5); and had reported past symptoms suggesting a history of vulvodynia (7.5). Increased risk of new onset vulvodynia also included baseline sleep disturbance, chronic pain in general, specific comorbid pain disorders, and specific comorbid psychological disorders (Reed et al. 2014). Previous studies suggest an overall prevalence of vulvodynia in the general US population of 8.3 % (Reed et al. 2012a). Chronic vulvar pain may affect up to 16 % of the population, according to other studies (Sadownik 2014). Overall, a prevalence of 710 % is the most consistent across studies in the USA (Iglesias-Rios et al. 2015).
#2 The National Vulvodynia Association
https://www.nva.org/
Persistent vulvar pain affects women of all ages, including adolescents […] Vulvodynia is prevalent in all ethnic and racial groups […] For more than 30 years, the National Vulvodynia Association (NVA), a nonprofit organization, has been dedicated to improving the health and quality of life for women with chronic vulvar pain.
#2 Vulvar Endometriosis Mimicking as Primary Vulvodynia in a Young Nulliparous Woman: Algorithm of Care Following a Rapid Literature Review | Adedipe | Journal of Clinical Gynecology and Obstetrics
https://jcgo.org/index.php/jcgo/article/view/735/460
Vulvar endometriosis is rare and can present as primary vulvodynia in the young woman. […] The lifetime prevalence of this condition has been estimated at 8%, and this prevalence remains constant across all decades up to the age of 70 years. […] Vulvodynia affects women of all ages, reproductive stages, and ethnicities. […] Vulvodynia or vulvar pain syndrome is a multifactorial clinical syndrome of vulvar pain, sexual dysfunction, and psychological distress. […] It is estimated that 10-18% of American women have the disease with an economic burden of $31-72 billion dollars a year. […] The exact etiology of vulvodynia is unknown. Most likely, there is not one single etiology but a set of overlapping etiologies, more so as the disease progresses. […] Early identification of a possible vulvar endometriosis helps in getting the therapy right at first visit and hopefully reduces the burden of disease.
#2 Vulvar Pain and Vulvodynia – Vulvovaginal Disorders
https://vulvovaginaldisorders.org/vulvar-pain-and-vulvodynia/
They continued: âIf our lifetime cumulative incidence estimate is anywhere near the true prevalence, approximately 14 million US women may experience this problem in their lifetimes.â […] Another US study replicated Harlow and Stewartâs work, demonstrating that 8% of women 18-40 years old gave a history of vulvar burning or pain upon contact continuing over 3 months, limiting or preventing vaginal penetration/intercourse. […] The study indicated that women of Hispanic origin were more likely to develop vulvar pain symptoms than non-Hispanic white women. […] Arnold and Bachmann, et al. found a lifetime prevalence of 9.9%; 45% of these women revealed an adverse effect on their sexual experiences. […] A lifetime prevalence of 13% was shown in a recent, large study from Spain, and a Portuguese survey indicated a lifetime prevalence of 16%.
#2 What is vulvodynia?
https://www.bbc.com/future/article/20180725-the-health-condition-vulvodynia-is-painful-and-misunderstood
The risk of getting vulvodynia is also heightened by psychological conditions like depression and anxiety, as well as potentially by childhood events like chronic stress or sexual abuse. […] There are ways to cope with the pain and treat symptoms of the condition, says Stoehr. But it may take time to find the proper therapy for each individual. This isnt the common cold, she said. Rather it often requires symptom management for the rest of the patients life. […] It’s so important for women to be their own advocates, especially for chronic conditions that don’t have a lot of research, said Stoehr.
#2 Epidemiology of Vulvodynia: More Study Is Neededlogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/wh200306170000007/2003/06/17/epidemiology-vulvodynia-more-study-needed
Epidemiology of Vulvodynia: More Study Is Needed […] The prevalence of vulvodynia — chronic vulvar pain in the absence of objective findings — is unknown. This report, from the first 14 months of a 42-month, NIH-funded study, provides the first population-based prevalence estimate. […] About 16% of the women reported having experienced chronic vulvar pain at some point in their lives; cumulative incidence was highest among Hispanic women (22.7%) and was similar among black (16.2%), white (14.4%), and Asian (11.1%) women. […] Only 54% of symptomatic women had ever sought treatment; more than 60% of these women saw 3 or more clinicians, and only 61% received diagnoses. […] The diagnosis of vulvodynia excludes women with vulvar dermatoses, infections, or other explanations for their symptoms; thus, without physical examination, women who reported vulvar pain in this study cannot be considered to definitively have had vulvodynia.
#2 Epidemiology of Vulvar Pain | Obgyn Key
https://obgynkey.com/epidemiology-of-vulvar-pain/
Vulvar pain is a very common problem that affects women of all age groups. The incidence of vulvar pain has increased over the past three decades. The reason is twofold: on one hand, there is certainly greater awareness about vulvar pain, which is increasingly reported to healthcare providers (HCPs), and on the other hand, there is a real increase of etiologic factors. The prevalence of isolated pain syndromes causing vulvar pain is difficult to estimate because of the private nature of this symptom, the lack of widespread knowledge among healthcare providers about vulvar pain disorders, and the belief, by some women, that vulvar or sexual pain of some extent is normal. The reported prevalence rates of dyspareunia ranged widely, from 1 % in Sweden to 46 % in one US study. Overall the most frequent prevalence figures range between 10 and 20 %. The prevalence of vulvar pain and sexual dysfunction is high after childbirth and in the postpartum and puerperium periods, and data indicate that up to 86 % of women report one or more vulvar complain soon after delivery. The reported prevalence rates of perineal pain at 12-24 months postpartum range from 5 to 33 %. A recent Australian prospective study on 1507 nulliparous women indicates that prevalence of dyspareunia at 3, 6, 13, and 18 month is of 44, 45, 28, and 23 % respectively.
#2 Chronic vulvar pain in a cohort of post-menopausal women: Atrophy or Vulvodynia? | Women’s Midlife Health | Full Text
https://womensmidlifehealthjournal.biomedcentral.com/articles/10.1186/s40695-016-0017-z
More than a quarter of women who reported current chronic vulvar pain did not report vaginal dryness, a common complaint associated with vaginal atrophy. […] These results provide additional evidence that chronic vulvar pain in postmenopausal women has a heterogeneous etiology and, in many women, may not be explained by estrogen deficiency-related atrophy alone. […] This analysis was constrained by the limited sample size, particularly the small number of women with current vulvar pain symptoms meeting our screening criteria. […] Future research should focus on the diagnosis and treatment of women who do not respond to this intervention.
#2 Published research – The Vulval Pain Society
https://vulvalpainsociety.org/research/published-research/
This study suggests that the benefits might not be as great as we can expect. […] OBJECTIVE: To evaluate the clinical efficacy and tolerability of topical gabapentin in the treatment of women with vulvodynia. […] CONCLUSION: Topical gabapentin seems to be well-tolerated and associated with significant pain relief in women with vulvodynia. […] OBJECTIVE: To assess the effectiveness of a specific set of vaginal dilators (Amielle Comfort) as a part of vestibulodynia therapy. […] CONCLUSION: Among women with previous therapy for vestibulodynia, vaginal dilator use was associated with improvement in symptoms. […] OBJECTIVE: To examine the relationship between dietary oxalates and the development of vulvodynia. […] CONCLUSION: Dietary oxalate consumption does not appear to be associated with an elevated risk of vulvodynia.
#2 Chronic Vulvar Pain and Health-Related Quality of Life in Women with Vulvodynia
https://www.mdpi.com/2075-1729/13/2/328
Vulvodynia is defined as chronic vulvar pain in the perineal area. It affects women around the world and is a significant health problem. The authors of this study examined the intensity of vulvar pain and the impact of vulvodynia on quality of life in a group of Polish women. It was observed that vulvodynia mainly occurs in young people with a high level of education, and predominantly in unmarried women, divorcees, and widows. In addition, the disease reduces quality of life, which is mainly due to difficulties in performing activities of daily living and a decrease in sexual satisfaction. The more pain a woman feels, the worse her quality of life. It was concluded that vulvodynia is a major problem among the Polish female population. Thus, research in this regard should be continued by scientists and health care professionals.
#3 Vulvar Pain and Vulvodynia – Vulvovaginal Disorders
https://vulvovaginaldisorders.org/vulvar-pain-and-vulvodynia/
Findings from available epidemiologic studies, well described in Bergeron et alâs excellent article, indicate that vulvodynia is a common gynecological pain syndrome, prevalent in women of all ages. […] In a preliminary survey, (prior to the first epidemiological study in the US), researchers showed that women from the general population were willing to provide sensitive information on lower genital tract discomfortâa first step toward bringing notice to this understudied disorder. […] Subsequently, the main study of >5,000 women in Boston neighborhoods found that as many as 16% of these women experienced vulvodynia. […] By restricting the population to women with no lifetime histories of pelvic disorders such as endometriosis or leiomyomata, the authors conservatively estimated that at least 9% of women will experience a condition likely to meet vulvodynia criteria at some point.
#3 Published research – The Vulval Pain Society
https://vulvalpainsociety.org/research/published-research/
OBJECTIVE: To determine whether vestibulectomy is an effective long-term treatment and investigate the levels of patient satisfaction in women with localized provoked vulvodynia. […] CONCLUSION: Vestibulectomy is an effective long-term treatment for women with provoked localized vulvodynia; the procedure is associated with high levels of patient satisfaction and low complication rates. […] CONCLUSIONS: TENS is a simple, effective and safe short-term (3 months) treatment for the management of vestibulodynia. […] Women with sexually-related pain from vestibulodynia may benefit from treatment from TENS using a vaginal probe.