(041) Vulvovaginal Pain Experiences: pain type, pelvic exam, and condom use
Authors: Adams O , Gesselman A 
Published: June 2023

Abstract

Introduction
Research suggests that chronic vulvovaginal pain (CVVP), including conditions like vaginismus and vulvodynia, has a lifelong prevalence of at least 9% and affects approximately 13 million women or higher. [1] Despite this high prevalence, average diagnostic delay of 24 months and negative healthcare experiences are frequently reported in the literature. [2-3] For non-white CVVP suffers, diagnostic delay may be larger problem—Harlow & Steward (2003) found that among women who sought treatment for chronic vulvar pain, 63.1% of white women, 46.2% of Black women, and 50% of Hispanic women obtained a diagnosis. Diagnostic delay, negative healthcare experiences, and racial disparities in seeking a diagnosis all may impact access to quality healthcare for this population. Depending on pain severity, CVVP sufferers may also experience disruptions in sexual and reproductive healthcare, as CVVP can inhibit preventative measures for certain STIs and cancers. [1] Harlow, B. L., & Stewart, E. G. (2003). A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? Journal of the American Medical Women’s Association (1972), 58(2), 82–88. [2] Buchan, A., Munday, P., Ravenhill, G., Wiggs, A., & Brooks, F. (2007). A Qualitative Study of Women with Vulvodynia: I. The Journey into Treatment. The Journal of Reproductive Medicine, 52(1), 15–18. [3] Ogden, J., & Ward, E. (1995). Help seeking behaviour in sufferers of vaginismus. Journal of Sexual and Marital Therapy, 10, 23–30.

Objectives
This pilot study aimed to explore how women of different racial identities experienced chronic or acute vulvovaginal pain, with a particular focus on whether pain severity or type (e.g. burning, stinging, aching, throbbing, stabbing) affected access to and behavior towards pelvic exams or Pap smears and condom use.

Methods
Participants (N=295) were recruited via social media and online forums focused on sexual health. Only participants who were between age 18 and 50 and who had no history of perimenopause or menopause were eligible. Participants completed a 99-item questionnaire that combined researcher-designed items and validated scales and covered topics like pain type and severity, pelvic exam and Pap smear experiences, condom use experiences, and healthcare and health information seeking experiences, among others.

Results
60% of participants reported avoiding a pelvic exam or Pap smear at least once due to anticipated pain, and 46% reported being unable to complete one due to actual pain. Similarly, 52.1% reported avoiding condom use at least once due to pain. In addition, participants reported significant racial differences in which pain descriptors they endorsed, with non-white women endorsing “throbbing” and “stinging” more often than white women.

Conclusions
This pilot study indicates that women with chronic or acute vulvovaginal pain may be missing out on important preventative healthcare measures like condom use and Pap smear. Furthermore, significant racial differences in how women describe their pain also suggests that diagnostic guidelines should be sensitive to these differences to ensure that all women receive accurate and timely diagnoses for their pain.

Disclosure
No.