Myriam Pâquet1, Marie-Pier Vaillancourt-Morel2, Jean-François Jodouin2, Marc Steben3, Sophie Bergeron2. 1. Department of Psychology, Université de Montréal, Montréal, Quebec, Canada. Electronic address: myriam.paquet@umontreal.ca. 2. Department of Psychology, Université de Montréal, Montréal, Quebec, Canada. 3. Department of Social and Preventive Medicine, Université de Montréal, Montréal, Quebec, Canada.
Abstract
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.
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.