(71) Management of pediatric and adolescent vulvodynia

Background: Vulvodynia is defined as chronic vulvar pain with unclear origin lasting for at least 3 months. While the prevalence of vulvodynia in pediatric patients is not well established, the lifetime prevalence is estimated to be between 10%-28%. Chronic pain, including vulvodynia, has a significant disease burden and is associated with poor body image, sexual dysfunction, irritable bowel syndrome, and fibromyalgia. Currently, clinical treatment plans for pediatric patients are extrapolated from research in adult populations. This study aims to describe the treatment options, experiences, and outcomes in vulvodynia among pre-pubertal (Tanner 1), peri-pubertal (Tanner 2-3), and pubertal patients (Tanner 4-5).

Methods: This was a retrospective chart review that was descriptive in nature. Female patients aged 0-21 years who presented to the pediatric and adolescent gynecology clinic of a tertiary care hospital with a diagnosis of vulvodynia between January 1, 2015 to August 31, 2022 were eligible for inclusion. Patients who were pregnant or diagnosed with other gynecological conditions that could be a source of pain were excluded. Data was summarized using frequencies and proportions for categorical variables and mean and standard deviation for continuous measures.

Results: There were 24 identified patients, 9 (37.5%) of which were pre-pubertal, 6 (25.0%) peri-pubertal, and 9 (37.5%) pubertal. The average age at the time of diagnosis was 11.0±4.19 years. Most of the patients were white accounting for 58.3% of the population followed by Hispanic at 25.0%. In addition to vulvar pain, 25.0% reported associated dysuria. Other associated symptoms included vaginal discharge, vulvar itching, pain with tampon use, dyspareunia, dyschezia, constipation, urinary incontinence, and pelvic pain. Pain with palpation and erythema were the most common physical exam findings. Treatment approach was variable and non-standardized. Success often required use of multiple medications, and no one treatment alone was identified to be the most effective. Ten patients had improvement in their symptoms, 8 with symptoms unchanged, none with worsened symptoms, and 7 were lost to follow up. The most common identified burden of disease was mood and sleep disturbances, and missing school.

Conclusions: Vulvodynia is a disease of variable presentation with individualized treatment plans. No obvious patterns were identified in presentation or treatment response based on pubertal status. More data is needed to determine if a standard of care can be developed in this population. Furthermore, early diagnosis and initiation of treatment may reduce the psychological stress of having a chronic pain condition and improve function.