(050) Vulvodynia: Risk Associated with Vulvar/Vaginal, Psychological and Physical Side Effects of Oral Contraceptive Use

Abstract

Research has shown that hormonal contraceptive (HC) use is associated with risk for vulvar pain [1] and vulvodynia [2,3]. Although some literature has focused on combined hormonal contraceptives (CHCs), Bouchard et al [2] found that risk was higher for those using high progestin potency HCs. In addition to increased risk associated with HC use, research also suggests that characteristics of the menstrual cycle (eg., premenstrual symptoms) are associated with risk for vulvodynia [4]. Test for associations between having a diagnosis of vulvodynia (including vestibulodynia) and experiencing vulvar/vaginal, psychological, and physical side effects from OC use. Test for differences in these associations across estroprogestinic OCs, progesterone only OCs, and OCs of an unknown composition (based on self-reports). A sample of 2199 females participated in a larger study on genito-pelvic pain and sexuality and provided data on both HC use and genito-pelvic pain. Efforts were made to recruit a heterogenous sample, with an oversampling of females with genito-pelvic pain. The dependent variable was a dichotomous variable of whether they had ever received a diagnosis of vulvodynia or vestibulodynia. Predictor variables were: ever used each type of OC (analyses conducted separately for estroprogestinic, progesterone only, and unknown type); and experiencing the following side effects associated with each OC type: vulvar pain (dichotomous), vaginal dryness (dichotomous), decreased sexual desire (dichotomous), affective symptoms (sum of dichotomous responses to: anxiety, nervousness, depression, anger, mood swings) and physical symptoms (sum of dichotomous responses to: cramps, back and joint pain, bloating, cellulite, breast discomfort). Three nominal logistic regression analyses were conducted (one for each OC), and a final nominal logistic regression was conducted combining the relevant predictors for each OC into one analysis. Of the 2199 participants, n=673 had never used OCs, n=827 had used them in the past, and n=699 were currently using them. Regarding vulvar/vaginal pain, n=1083 had no vulvar or vaginal pain, n=341 had only vulvar pain, n=194 had only vaginal pain, and n=581 both vulvar and vaginal pain. Finally, regarding diagnoses, n=582 (26%) had a diagnosis of vulvodynia/vestibulodynia (all types combined). Results from the nominal logistic regressions are presented in Tables 1 and 2. Findings of central importance are: having ever used any of the three categories of OCs was associated with increased risk for a diagnosis; vulvar pain and vaginal dryness were the only side effects of OCs that demonstrated a consistent association with increased risk of having a diagnosis; side effects of estroprogestinic OCs were the most strongly associated with increased risk of having a diagnosis; and the effects observed in the first three models remained significant even when all were included in the same final analysis (with the exception of vulvar pain with progesterone only OC). Use of both estroprogestinic and progesterone only OCs are associated with diagnosis of vulvodynia, but side effects of estroprogestinic OCs demonstrated the strongest association. Genital-specific side effects of OCs may represent indicators of a tissue-specific sensitivity to hormonal changes that are associated with risk for vulvodynia. No.