Mitro Susanna D, Harlow Siobán D, Randolph John F, Reed Barbara D
Department of Epidemiology, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
School of Medicine, University of Michigan Ann Arbor, Ann Arbor, MI, USA.
Womens Midlife Health. 2016;2. doi: 10.1186/s40695-016-0017-z. Epub 2016 Jun 9.
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.
We used data from 371 participants at the Michigan site of the Study of Women's Health Across the Nation (SWAN) who participated in the 13th follow-up visit. Women completed a validated screening instrument for vulvodynia and provided information on additional vaginal symptoms as well as demographic characteristics, and hormone use by questionnaire. Blood samples were obtained to assess hormone levels. We compared women who screened positive for vulvodynia and women with past or short-duration vulvar pain to women without vulvar pain, using Chi-squared and Fisher's Exact tests. Relative odds ratios and 95 % confidence intervals were calculated using multinomial logistic regression models adjusting for age, body mass index, and race/ethnicity.
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. One quarter of women who reported current chronic vulvar pain did not report vaginal dryness. Women with current chronic and with past/short duration vulvar pain symptoms were more likely to have used hormones during the preceding year than women without vulvar pain symptoms (13.3 %, 17.6 %, 2.0 %, respectively; < .01). Increased relative odds of current vulvar pain symptoms were associated with each log unit decrease in serum dehydroepiandrosterone-sulfate, estradiol and testosterone levels at the previous year's visit.
Some women who experience chronic vulvar pain symptoms do not report vaginal dryness, and others report continued or first onset of pain while using hormones. Vulvodynia should be considered in the differential diagnosis of postmenopausal women presenting with vulvar pain symptoms.
尽管绝经后外阴疼痛常被归因于阴道萎缩，但此类症状可能是由外阴痛引起的，外阴痛是一种慢性外阴疼痛病症。鉴于对绝经后女性外阴痛的研究有限，本研究的目的是在一个多民族绝经后女性样本中，提供基于人群的关于阴道症状、血清激素水平和激素使用与慢性外阴疼痛之间关联的初步数据。
我们使用了来自全国女性健康研究（SWAN）密歇根站点的371名参与者在第13次随访时的数据。女性完成了一份经过验证的外阴痛筛查工具，并通过问卷提供了有关其他阴道症状以及人口统计学特征和激素使用情况的信息。采集血样以评估激素水平。我们使用卡方检验和费舍尔精确检验，将外阴痛筛查呈阳性的女性以及有既往或短期外阴疼痛的女性与无外阴疼痛的女性进行比较。使用多项逻辑回归模型计算相对比值比和95%置信区间，并对年龄、体重指数和种族/民族进行了调整。
4.0%的女性报告有与外阴痛相符的当前慢性外阴疼痛，而13.7%的女性报告有既往但非当前的慢性外阴疼痛或短期外阴疼痛症状。报告当前慢性外阴疼痛的女性中有四分之一未报告阴道干燥。有当前慢性以及既往/短期外阴疼痛症状的女性在前一年使用激素的可能性高于无外阴疼痛症状的女性（分别为13.3%、17.6%、2.0%；P<0.01）。前一年访视时血清硫酸脱氢表雄酮、雌二醇和睾酮水平每降低一个对数单位，当前外阴疼痛症状的相对比值增加。
一些经历慢性外阴疼痛症状的女性未报告阴道干燥，而另一些女性在使用激素时报告疼痛持续或首次出现。在对出现外阴疼痛症状的绝经后女性进行鉴别诊断时应考虑外阴痛。
