| dc.description.abstract | Background: Chronic vulvar pain is a bothersome symptom, with detrimental effects on sexual function and quality of life. It is generally accepted that the etiology is multifactorial, hence the treatment guidelines suggest a multidisciplinary approach, but these patients are often seen by a single gynecologist in Norway today. Vulvar teams (VT) (of gynecologists and dermatologists) have been established in Oslo and Trondheim, but as of now, there is a lack of studies comparing assessment and treatment options for vulvodynia patients in Norway.
The aim of this study was 1) to describe patients who were seen at St. Olavs Hospital for vulvar conditions, and especially for vulvodynia; 2) to explore whether those referred for vulvar pain actually had vulvodynia; and 3) to explore whether patients referred for vulvar pain were assessed and treated differently in the VT versus by the gynecologist in the general gynecology outpatient clinic at St. Olavs Hospital.
Methods: We conducted a retrospective, descriptive pilot study of medical records that contained certain ICD-10 diagnoses registered at the department of gynecology at St. Olavs Hospital during the year 2016. Our initial search retrieved 1204 records. Of these, 383 had vulvar conditions, and were eligible. Of these, 31 declined participation and 82 were excluded due to follow-up only, yielding a final sample of 270 patients.
Results: 79 patients got a vulvodynia diagnosis. Patients with vulvodynia were younger than other vulvar patients (mean age 29.8 vs 45.6 years), they were more likely to report a history of mental health problems or another chronic pain condition (aOR 3.8, [1.8-7.8] and aOR 2.1, [1.1-4.0], respectively), and they were more likely to have visited private gynecologists before. Altogether, 134 had been referred for vulvar pain, of which a vulvodynia diagnosis was the conclusion in 71 (53%). Most of the assessments had been conducted by a gynecologist, as only 27 patients had been seen by the VT. Fungal diagnostics and microscopy of discharge were significantly more often conducted by the VT compared to a gynecologist only. A tendency to increased use of cotton swab test and palpation of the pelvic floor musculature did not reach significance.
Conclusion: Albeit being younger, vulvodynia patients have more comorbid chronic pain and mental health problems. A strength of the VT is the presence of a dermatologist that can diagnose vulvar conditions such as genital dermatoses and infections. We found only small differences in assessment practices, but our study sample was small. Further research is needed.
Keywords: Vulvodynia, chronic vulvar pain, vestibulodynia, pain, gynecology, Scandinavia, vulva, multimodal treatment, multidisciplinary vulvar team | en_US |
