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Vulvodynia: A Common and Under-Recognized Pain Disorder in Women and Female Adolescents -- Integrating Current Knowledge into Clinical Practice
Studies of women found that the incidence of symptom onset is highest between the ages of 18 and 25. Once thought to affect primarily Caucasian women, recent studies indicate that Hispanic women are significantly more likely to develop vulvodynia, and may present with different vulvar pain subtypes. Because vulvodynia is rarely covered in medical school curricula and residency programs, symptoms mimic those of common vulvovaginal infections, and in many cases, no abnormalities of the vulvar tissue can be seen upon examination, women are often misdiagnosed. In 2003, the first federally funded population-based epidemiologic study in Boston found that almost 60 percent of patients reported visiting three or more health care providers to receive a diagnosis, 40 percent of whom remained undiagnosed after three consultations.
Using prevalence estimates of three to seven percent, Xie and colleagues demonstrated the significant economic impact of vulvodynia in the U.S. of $31 to $72 billion in direct and indirect costs.
This slide summarizes common themes experienced by women with vulvodynia and their interrelation (Donaldson 2010). Living with vulvodynia often limits certain activities of daily living, such as sitting for extended periods, and engaging in sexual intercourse and physical exercise. In severe cases, women have to resign from their jobs and apply for disability. Several studies summarize the negative biopsychosocial outcomes, personal distress and sexual dysfunction reported by vulvodynia sufferers. Xie found that women with vulvodynia report lower quality of life scores than kidney transplant recipients and those with prior osteoporosis-related fractures (Xie 2012). Newly diagnosed women report substantial impact of vulvar pain on their lives, and little control over their symptoms (Piper 2012). Among women of reproductive age, Johnson found that barriers to consistent health care frequently experienced in early adulthood contributed to not finding successful medical management (Johnson 2015). However, those who became pregnant reported finding a personally acceptable level of pain (Johnson 2015). Stigma and isolation are common. Only 1 in 4 women report feeling comfortable discussing the condition with women friends (Nguyen/MacLehose 2012). They also report an increase in feelings of invalidation and isolation when they have co-existing pain disorders (Nguyen/Ecklund 2012).