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abstract & commentary
Synopsis: Women with vulvodynia are psychologically similar to women without vulvar symptoms.
Source: Reed BD, et al. J Reprod Med 2000;45: 624-632.
The purpose of this article was to determine the psychological functioning of a group of women with vulvodynia based on several well-established psychological tests. The same tests were then to be administered to a group of control women and a group of women with chronic pelvic pain. The results from the three groups were then compared and contrasted.
The women with vulvodynia were enrolled in three clinics at the University of Michigan, and included only those women who had been seen at the Center for Vulvar Diseases. The chronic pelvic pain cohort was recruited from the University of Michigan Pain Center, and the control women were recruited from those who were seen for routine gynecologic examinations.
All of the women who agreed to participate in this study received a questionnaire that contained two major parts. The first part included general demographic information as well as information concerning relationships with partners. The second portion of the questionnaire included a number of standardized psychological and functional inventories. These were designed to detect depression, relationship adjustment, pain intensity, functional activity, degree of somatic complaint, and overall affective distress. The results were analyzed using common statistical techniques.
Overall, women with vulvodynia were similar to the control group and dissimilar to the chronic pain group. Specifically, women with chronic pelvic pain were considerably more likely to report a history of sexual or physical abuse than either of the other two cohorts, have a history of past depression, and have increased somatic complaints. Interestingly, the women with vulvodynia did not differ in their sexual activities from the control group. However, women with vulvodynia report the lowest frequency of vaginal intercourse among the three groups.
In summary, women with vulvodynia do not exhibit an increased frequency of psychological disorders, marital maladjustment, abuse, or increased somatic complaints.
Comment by Kenneth L. Noller, MD
Last fall I attended the 15th World Congress of the International Society for the Study of Vulvovaginal Disease held in New Mexico. Not surprisingly, a majority of the papers that were presented at the meeting dealt with "vulvodynia." While many of the papers were quite interesting, the ones that dealt with treatment of the disease were confusing. Some studies suggested that treatment should be primarily aimed at behavior modification, others suggested techniques which would largely fall under the category of "physical therapy," and others recommended medical or surgical treatment. Most interesting, virtually all reported the same treatment results.
While the treatment of vulvodynia (especially chronic vulvar vestibulitis) remains confusing, more and more is being learned about the frequency of the disease and the background of those who develop it. This article from Reed and colleagues is one of the best I have ever seen (or heard).
Ten years ago many clinicians told patients with vulvodynia that the symptoms were "all in your head." Numerous small studies have suggested that not to be true, and this study from Reed et al that used a wide variety of standardized psychological tests confirms that women with vulvodynia are not "crazy." Indeed, the women in this study with vulvodynia were virtually identical to the control women, except for the fact of their vulvular pain and its affect on their ability to have vaginal intercourse. While I would have liked to have seen more information in the article concerning the number of women approached for participation, nonparticipation rates, and a comparison of the demographics of those who did and did not participate, overall, this study is well-done and believable. One facet of the study that makes it easier to believe is the fact that Reed et al included a chronic pelvic pain cohort as one of the comparison groups. It has long been known that women with chronic pelvic pain are different from controls, with markedly higher rates of physical and sexual abuse, and depression compared to unaffected women. The women with vulvodynia did not match any of these variable characteristics of chronic pelvic pain.