We found that patients with vulvodynia, like those with other vulvar conditions, had poor quality of life in all domains measured. In fact, the effects of vulvodynia on social and physical functioning were worse than those of other vulvar conditions. This is consistent with prior studies that have found broad effects on quality of life among women with vulvodynia.4–6
Among women with vulvodynia, a self-reported history of depression was the only characteristic independently associated with worse quality of life.
Compared with dermatologic disorders conventionally regarded as affecting well-being (eg, psoriasis), patients with vulvodynia experienced a more severe impact on quality of life. These findings will be useful to clinicians who treat vulvar disorders, because they illustrate the magnitude and type of impact that vulvodynia has on the quality of life of their patients. Such understanding should enhance the clinician’s ability to provide supportive care.
Analysis of the responses to individual Skindex items allows for a more nuanced understanding of these results. In the emotions domain, women with vulvodynia reported feeling depressed, angry, and frustrated significantly more often than women with other vulvar conditions. The frustration that women with vulvodynia experience could, in part, stem from their significantly higher concern that their vulvar condition will continue (84% vs 67%, P = .003). Likewise, the experience of vulvodynia disproportionately affects the ability of women to form and maintain social relationships. Most women with vulvodynia reported that their condition often or always affects how close they can be with those they love, makes showing affection difficult, and interferes with their sex life. Based on these results, one might postulate that vulvodynia, by impacting a woman’s sexual functioning, can interfere with intimacy and result in generalized social dysfunction. This in turn could lead to frustration, anger, and depression.
Recent attention has focused on potential comorbidities with vulvodynia.4
As in previous studies,7–9
we found that women with vulvodynia were more likely to report a history of frequent vaginal yeast infections than women with other vulvar conditions (65% vs 36%, P
< .001), although some of these women may have been given a misdiagnosis of yeast infections before receiving a diagnosis of vulvodynia. Whether this finding is clinically relevant remains to be elucidated.
Women with vulvodynia were more likely to report a history of other disorders that, like vulvodynia, may operate by a centrally mediated pain-enhancing mechanism.10
For example, we confirmed that women with vulvodynia were significantly more likely to report a history of interstitial cystitis (11% vs 3%, P
= .006), an association that has been documented since the 1990s.11,12
Like Arnold et al,4
we found that women with vulvodynia were somewhat more likely to have fibromyalgia (7% vs 3%, P
= .126) and chronic fatigue syndrome (9% vs 5%, P
= .244), although our results did not reach statistical significance. Overlapping mechanisms in pain perception could account for the association between vulvodynia and a variety of other pain syndromes.10,13
Finally, as has been shown previously for multiple dermatologic conditions14
along with vulvodynia,5
depression correlates strongly with reduced quality of life. In our sample, women with vulvodynia were significantly more likely than patients with other vulvar conditions to report a history of depression (47% vs 28%, P
= .002). In addition, women with vulvodynia were significantly more likely than women with other vulvar disorders to report that they often or always feel depressed by their vulvar condition (41% vs 25%, P
= .006). Although the effects on quality of life could cause depression, it is also possible that depression could potentiate the impact of vulvodynia on emotional functioning.
Patients in this study were evaluated at one academic medical center, and the results may not be typical of patients elsewhere. Nonetheless, the sample is large and the response rate was high. In addition, measurement of comorbid conditions such as depression was by self-report, and may not be valid diagnostically. Finally, the study was cross-sectional, and cannot determine time course of illness, or causal features.
Theoretic framework relating vulvodynia to quality of life
Based on the results of our study, we propose a theoretic framework for the effects of vulvodynia on the quality of life of affected women (). We suggest that vulvodynia begins with an as-yet unspecified initiating event that occurs within a particular context. Once initiated, the experience of vulvodynia leads to physical dysfunction, limiting activities related to work, hobbies, and sexual relations. Socially, vulvodynia interferes with a woman’s ability to initiate and maintain relationships. Emotionally, women experience frustration, anger, and sadness. These effects should not be viewed as independent from each other, but as interacting. For example, discomfort with sexual intercourse (physical) can impact a woman’s ability to develop and maintain intimate relationships (social), which can in turn lead to feelings of loneliness, anger, and frustration (emotional).
Framework for effects of vulvodynia on quality of life of affected women.