Pain Trajectories and Predictors: A 7-Year Longitudinal Study of Women With Vulvodynia |
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| Affiliation: | 1. Department of Psychology, Université de Montréal, Montréal, Quebec, Canada;2. Department of Social and Preventive Medicine, Université de Montréal, Montréal, Quebec, Canada;1. Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, NY, USA;2. Division of Urology, Rush University Medical Center, Chicago, IL, USA;1. Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China;2. Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China;1. Tampere University, Faculty of Medicine and Life Sciences, Tampere, Finland;2. Tampere University Hospital, Department of Urology, Tampere, Finland;3. Herlev and Gentofte Hospital, Department of Urology, Herlev, Denmark;4. Seinäjoki Central Hospital, Department of Surgery, Seinäjoki, Finland;1. Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY, USA;2. Kentucky Spinal Cord Injury Research Center, Louisville, KY, USA;1. Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA;2. Department of Urology, University of Washington, Seattle, WA, USA;3. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA;4. Department of Pediatrics, University of Washington, Seattle, WA, USA |
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| Abstract: | IntroductionA significant proportion of women report a reduction of symptoms over time—even without treatment—yet the natural progression of vulvodynia and which factors may explain decrease vs persistence of pain remain unclear.AimTo identify subgroups of pain trajectories in women with vulvodynia and to predict these different trajectories by treatments undertaken, pain characteristics, and psychosocial factors.MethodsData on pain intensity, treatments undertaken, pain characteristics, and psychosocial factors were collected 3 times over a 7-year period from 173 women who screened positive for vulvodynia. Latent class growth analysis was conducted to identify homogeneous subgroups with distinct pain trajectories. A multivariate binomial logistic regression was used to examine whether treatments, pain characteristics, and psychosocial factors predicted these trajectories.Main Outcome MeasureThe main outcome was pain intensity (0–10), measured at 3 time points with the numerical rating scale.Results2 pain trajectories were identified: 1 where pain persisted (28.9%), and 1 where pain decreased over time (71.1%). Whether a treatment had been undertaken was not predictive of the course of pain over time. Women who were older at first pain onset, had pain at another location than the entrance of the vagina, and reported more anxiety were more likely to have a persistent pain trajectory relative to the decreased pain trajectory.Clinical ImplicationsFindings suggest that the evolution of pain differs among women with vulvodynia depending on pain characteristics and anxiety.Strengths & LimitationsStrengths of the study include the 7-year longitudinal design to examine the natural history of provoked vestibulodynia and the inclusion of biopsychosocial factors as predictors of pain trajectories. However, women with major medical and psychiatric illnesses or deep dyspareunia were not included, and, thus, these factors could not be examined as predictors.ConclusionAssessing baseline characteristics associated with different pain trajectories during medical visits could have positive implications for the management of vulvodynia.Pâquet M, Vaillancourt-Morel M-P, Jodouin J-F, et al. Pain Trajectories and Predictors: A 7-Year Longitudinal Study of Women With Vulvodynia. J Sex Med 2019;16:1606–1614. |
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| Keywords: | Longitudinal Study Pain Trajectories Psychosocial Factors Provoked Vestibulodynia Vulvodynia Dyspareunia |
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