Oral contraceptive use and prevalence of vulvodynia: are genital-specific side effects of OC use early signs of risk?

BACKGROUND

Past research suggests that oral contraceptive (OC) use increases the risk for vulvodynia/vestibulodynia, although results are often mixed or inconsistent.

AIM: To test whether OC use is associated with having a diagnosis of vulvodynia/vestibulodynia, whether the observed association varies across the type of OC, and whether side effects associated with OC use (ie, genital specific, negative affect, non-genital physical symptoms) are associated with having a diagnosis of vulvodynia/vestibulodynia.

METHODS

A sample of n = 2171 adult females completed a questionnaire regarding OC use and associated side effects, and provided information on having a diagnosis of vulvodynia or vestibulodynia. Recruitment oversampled for women with genitopelvic pain, which provided n = 582 women (26.8% of overall sample) who had a diagnosis of vulvodynia or vestibulodynia. Binary logistic regressions were conducted to test for associations.

OUTCOME: Self-report of having received a diagnosis of vulvodynia or vestibulodynia.

RESULTS

Results showed that all types of OCs were significantly associated with having a diagnosis, and that genital-specific side effects (vulvar/genital pain and vaginal dryness), but not affective or non-genital physical side effects, were associated with having a diagnosis of vulvodynia/vestibulodynia, with the strongest and most consistent effect being for vulvar/genital pain. Specifically, participants who reported vulvar/genital pain as a side effect of OC use were 3-5 times more likely than those without this side effect to have a diagnosis of vulvodynia/vestibulodynia. Analyses also controlled for 23 potential comorbid diagnoses with no or very little change to the associations between vulvodynia/vestibulodynia and the OC-use variables.

CLINICAL IMPLICATIONS: Early recognition and identification of genital-specific side effects of OC use may provide an opportunity for preventing genital pain from becoming chronic and difficult to manage.

STRENGTHS AND LIMITATIONS: This study uses a large sample, assesses unique associations with combined and progestin-only OCs, and for the first time addresses diverse OC-related side effects as potential risk indicators of vulvodynia. Limitations are the lack of prospective data, reliance on self-report measures, recruitment through social media outlets that may result in overestimating the effect sizes, and a lack of information on specific OCs used.

CONCLUSIONS

The present study provides evidence that OC use and genital-specific side effects of OC use are associated with having a diagnosis of vulvodynia/vestibulodynia and provides important information for managing potential OC-related risk for vulvodynia/vestibulodynia.