Pain Trajectories and Predictors: A 7-Year Longitudinal Study of Women With Vulvodynia.

INTRODUCTION

A 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.

AIM

To identify subgroups of pain trajectories in women with vulvodynia and to predict these different trajectories by treatments undertaken, pain characteristics, and psychosocial factors.

METHODS

Data 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 MEASURE

The main outcome was pain intensity (0-10), measured at 3 time points with the numerical rating scale.

RESULTS

2 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 IMPLICATIONS

Findings suggest that the evolution of pain differs among women with vulvodynia depending on pain characteristics and anxiety.

STRENGTHS & LIMITATIONS: Strengths 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.

CONCLUSION

Assessing 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.