Quality of life and sexual function after evaluation and treatment at a referral center for vulvovaginal disorders.

OBJECTIVES: This study was undertaken to assess sexual function and quality of life of women after evaluation and treatment of vulvovaginal problems at a University Center. STUDY DESIGN: Subjects were mailed a cover letter and follow-up survey. All new patients (322) referred for evaluation of vulvar problems at a University Vulvar Specialty Clinic between January 1, 1996, and December 31, 1999, were mailed a survey instrument containing specific questions concerning general, vulvar, and sexual health. Medical records from clinic visits were manually abstracted. Groups defined with descriptive statistics and proportional change in symptoms analyzed with chi(2) statistics. RESULTS: Of the 322 women who met the study criteria, 195 returned valid surveys for an overall response rate of 60.5%. The mean duration of follow-up was 28 months. The most common presenting symptoms were vulvar pain (86%), dyspareunia (71%), itching (35%), and skin changes (20%). At follow-up, 128 (66%) reported improvement in symptoms compared with 14 (7%) that worsened (P <.001). Although subjects did not report an increase in the frequency of sexual activity, significantly more women reported an increase in enjoyment (n = 77, 43%) of sexual activity than a decrease (n = 30, 17%, P <.001). CONCLUSION: Most women presenting for evaluation of vulvar pain will report improvement in symptoms and sexual function after treatment in a Vulvar Specialty Clinic.

Characteristics and initial diagnoses in women presenting to a referral center for vulvovaginal disorders in 1996-2000.

OBJECTIVE: To describe the demographics, presenting symptoms, physical examination and laboratory findings, and initial diagnoses in a cohort of women referred for evaluation of vulvovaginal problems. STUDY DESIGN: Descriptive review of medical records of new patients referred for evaluation of vulvar problems between January 1, 1996, and December 31, 1999. Electronic medical records and other documents were manually abstracted. RESULTS: Three hundred twenty-two women met the study criteria. The majority were Caucasian (93.8%) and married (63.9%). The mean age was 41 years, with a range of 13-88. The majority reported at least one vaginal delivery (72.9%) or cesarean section (10.6%). The most common symptoms were vulvar pain (86.3%), dyspareunia (70.8%), itching (36.0%) and skin changes (18.0%). Most patients received a diagnosis in more than one evaluation category. Prevalent diagnoses included Bartholin fossa pain (12.1%), vulvar vestibulitis (19.9%), restriction and fissuring of the posterior labial commissure (20.1%), dysesthetic vulvodynia (32.3%), pelvic floor dysfunction (39.8%) and dermatologic conditions (47.5%). CONCLUSION: Women presenting for evaluation of vulvar disorders represent a heterogeneous population. Among women with vulvar pain, abnormalities of the skin and pelvic floor are common and should be ruled out prior to making a diagnosis of vulvar vestibulitis or dysesthetic vulvodynia.