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. 2016 Mar;25(3):276-83.
doi: 10.1089/jwh.2015.5397. Epub 2016 Jan 11.

Remission, Relapse, and Persistence of Vulvodynia: A Longitudinal Population-Based Study

Barbara D Reed  1 , Sioban D Harlow  2 , Melissa A Plegue  1 , Ananda Sen  1   3
Affiliations

Remission, Relapse, and Persistence of Vulvodynia: A Longitudinal Population-Based Study

Barbara D Reed et al. J Womens Health (Larchmt). 2016 Mar.

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.

Conclusion: 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.

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Figures

<b>FIG. 1.</b>
FIG. 1.
Proportions with remission without relapse, relapse following remission, or persistence.
See this image and copyright information in PMC

References

    1. Reed BD, Harlow SD, Sen A, et al. . Prevalence and demographic characteristics of vulvodynia in a population-based sample. Am J Obstet Gynecol 2012;206:170.e1–e9 - PMC - PubMed
    1. McKay M, Frankman O, Horowitz BJ, et al. . Vulvar vestibulitis and vestibular papillomatosis. Report of the ISSVD Committee on vulvodynia. J Reprod Med 1991;36:413–415 - PubMed
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    1. Reed BD, Haefner HK, Cantor L. Vulvodynia (Vulvar dysesthesia)—A follow-up study. J Reprod Med 2003;48:409–416 - PubMed

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