Reed Barbara D, Harlow Sioban D, Plegue Melissa A, Sen Ananda
1 Department Family Medicine, University of Michigan , Ann Arbor, Michigan.
2 Department of Epidemiology, School of Public Health, University of Michigan , Ann Arbor, Michigan.
J Womens Health (Larchmt). 2016 Mar;25(3):276-83. doi: 10.1089/jwh.2015.5397. Epub 2016 Jan 11.
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.
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.
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.
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.
外阴痛被认为是一种慢性疾病。我们试图评估外阴痛筛查呈阳性的女性中缓解、复发和持续存在的概率及风险因素。
在一项基于人群的纵向研究（女性对女性健康研究）中，对筛查外阴痛呈阳性且至少完成四次随访调查的女性进行基于调查的评估。结局指标包括无复发的缓解、复发（缓解后）以及外阴痛筛查持续呈阳性。采用多项回归分析来评估与结局相关的因素。
在研究期间筛查外阴痛呈阳性的441名女性中，239名完成了另外四次调查。其中，23名（9.6%）外阴痛筛查持续呈阳性，121名（50.6%）缓解且无复发，95名（39.7%）在缓解后复发。总体而言，与复发和持续存在（与仅缓解相比）相关的因素包括既往疼痛严重程度增加（p < 0.001）或性交后疼痛严重程度增加（p = 0.03）、症状持续时间更长（p ≤ 0.001）以及纤维肌痛筛查呈阳性（p < 0.001）。与持续存在（但非复发）相关的因素包括性交时症状更严重（p = 0.001）以及口交时疼痛（p = 0.003）或伴侣触摸时疼痛（p = 0.04）。与复发（但非持续存在）相关的因素包括初次外阴痛筛查时存在诱发性疼痛（p = 0.001）或间质性膀胱炎筛查呈阳性（p = 0.05）。人口统计学特征、疼痛发作年龄以及外阴痛是原发性还是继发性均不能预测结局。
外阴痛症状缓解很常见，约一半缓解者在6 - 30个月内复发。持续不缓解是例外而非普遍情况。与仅缓解者相比，疼痛病史和合并症与更严重的复发和/或持续存在结局相关。这些发现进一步支持了外阴痛具有异质性且常呈发作性模式。
