Idiopathic vulvodynia - a psychosomatic disease? A cross-sectional single-center study

Idiopathic vulvodynia is a chronic vulvar pain condition that occurs with a high burden of disease and frustratingly low therapeutic success. Psychosomatic factors are discussed to be involved in the onset and presentation of the disease. Sexual abuse has been positively associated with vulvar pain in general; similarly, patients suffering from vulvar pain are discussed to carry certain personality characteristics. Our aim was to examine two psychosomatic aspects: sexual violence/abuse and specific personality traits as associated factors for this particular patient cohort of idiopathic vulvodynia. This cross-sectional single-center study recruited 85 previously diagnosed vulvar pain patients (34 idiopathic vulvodynia, 31 eczema and 20 lichen patients) that visited the vulva clinic and 30 asymptomatic women that consulted the contraception or dysplasia consultation clinic at university hospital Zürich. Underage women and patients with vulvar pain due to other somatic diseases were excluded. All participants completed the Big Five Inventory-42 (BFI-42) questionnaire and the 3 vulvar pain groups additionally completed a customised questionnaire regarding vulvar pain symptoms and history of sexual violence/abuse. In the statistical analysis, the idiopathic vulvodynia patients were compared to the other vulvar pain groups in terms of history of sexual violence/abuse, vulvar pain symptom severity and personality traits. For the latter analysis, the asymptomatic control group was also included. Furthermore, an age-adjusted logistic regression was performed as confounder-control in the sexual violence/abuse analysis and Wilcoxon rank-sum tests included in the personality analysis. In total, 25% of all vulvar pain patients had a history of sexual abuse, with a prevalence of 17.7% in the idiopathic vulvodynia group. Symptom severity results were similar in idiopathic vulvodynia and other vulvar pain patients, whether they had experienced sexual violence/abuse or not. Also, the logistic regression analysis did not find any age-dependent association of sexual violence/abuse history and vulvodynia. Furthermore, no distinctive divergence in personality traits could be detected in idiopathic vulvodynia patients, neither in comparison to genital eczema or lichen patients, nor to control women. A finding that was further emphasised by Wilcoxon rank-sum testing. Median neuroticism scores in idiopathic vulvodynia patients were, however, highest in patients that reported the least or medium symptom severity. Sexual violence/abuse rates of all vulvar pain groups were higher than the estimated rate in the general female population. However, our findings did not suggest a higher prevalence of history of sexual violence/abuse in the idiopathic vulvodynia patients compared to the other vulvar pain groups and no specific personality profile could be demonstrated in idiopathic vulvodynia patients. Furthermore, the subgroup analyses did not show particularly high rates of sexual violence/abuse history or a distinct personality profile in idiopathic vulvodynia patients with more severe symptoms. Due to limited sample size in the present study, such correlations might, however, only be visible in larger patient cohorts. Also, other psychosomatic factors might be of more relevance in distinguishing the disease of idiopathic vulvodynia from other vulvar pain conditions.