Pain Rating in Women with Provoked Vestibulodynia: Evaluating Influence of Race.

BACKGROUND: Chronic pain may be perceived differently according to gender and race, which may affect physical health and psychological wellbeing. We evaluated daily pain ratings in black women as compared to white women with provoked vestibulodynia (PVD). METHODS: Seventy-one women (44 black, 27 white) rated pain severity with tampon insertion and sexual intercourse and recorded daily vulvar pain level on a visual analogue scale (0 = no pain to 10 = worst pain imaginable). In addition, they completed the Brief Pain Inventory (BPI) Interference Scale and Hamilton Anxiety Depression Scale (HADS). Multivariate analysis was performed to determine the effect of race on pain intensity after adjusting for functional impairment, affective distress and demographic characteristics. RESULTS: Pain ratings from tampon insertion (6.37 ± 1.89 vs. 5.61 ± 1.98, p = .12) and sexual intercourse (6.28 ± 2.11 vs. 5.29 ± 2.50, p = 0.24) were similar, but daily vulvar pain (4.57 ± 2.27 vs 2.74 ± 2.43, p = <.01) was significantly higher in black women. BPI-interference scores were associated with small, but significant increases in tampon insertion pain (p = <.01, beta = .06 units) and daily pain (p < .01, beta = .10 units) and to a lesser degree with sexual intercourse pain when corrected for multiple comparisons (p = .05, beta = .06 units). Race had no effect on pain after adjusting for other variables. CONCLUSION: While race was associated with functional impairment, after accounting for this, race was not associated with level of vulvar pain with PVD.

Presenting Symptoms Among Black and White Women with Provoked Vulvodynia.

BACKGROUND: The prevalence of vulvodynia has been reported to be lower in black compared to white and Latina women. Use of different terminology to describe vulvar pain symptoms may play a role in lower prevalence. The objectives were to compare pain descriptors used by black and white women with provoked vulvodynia (PVD) to determine the effect of race on symptom reporting. METHODS: Ninety-two women, self-identified as black (n = 55) and white (n = 37) with clinically confirmed PVD completed a questionnaire containing demographic information and vulvar pain characteristics. Variables that were significant with race retained in the logistic regression model were included in multivariate analysis to determine the effect of race on reporting of vulvar pain symptoms. RESULTS: Of statistical significance, white women more often described their pain as burning as compared with black women (84% vs. 22%, p ≤ 0.0001). White women more frequently reported their pain as stinging (51% vs. 29%, p = 0.03) and itching (32% vs. 15%, p = 0.04) as well, whereas there was a trend for black women to more often describe their pain as aching (67% vs. 49%, p = 0.07). Overall, white women were 19 times as likely to report their pain as burning (adjusted odds ratio [aOR] 18.51, 99% confidence interval [CI] 4.46-76.86). CONCLUSIONS: These data suggest that black women are less likely to self-report their vulvar pain as burning, the classic symptom of PVD. Cultural influences and different underlying pain mechanisms may contribute to differences in symptom reporting by race.

Differences in pain subtypes between Hispanic and non-Hispanic white women with chronic vulvar pain.

OBJECTIVES: Compared with non-Hispanic Whites, Hispanic women have significantly higher prevalence of chronic vulvar pain (CVP), which is known to have heterogeneous subtypes. However, it is not known whether subtypes differ by ethnicity, and improved understanding of subtypes may allow for targeted clinical assessment and therapies. We examined subtypes to determine whether they differed by ethnicity. METHODS: Data were from 1,551 women who reported chronic vulvar pain consistent with vulvodynia in a population-based, cross-sectional study of women from the Minneapolis/St. Paul metropolitan area, during the years 2010-2013, who returned a validated screener survey about vulvar pain. RESULTS: Among women with CVP, Hispanics reported more primary vulvodynia (adjusted [adj.] risk ratio=1.47; p<0.01), defined as pain with first intercourse or tampon use, and tended to be more likely to describe a burning pain (adj. risk ratio=1.45; p=0.06). Hispanic women with CVP were 17% more likely than non-Hispanic Whites with CVP to have their pain alleviated with some type of behavior/remedy (p=0.01); for example, among the subgroup of women with CVP who used yeast cream, Hispanics more often reported benefit to their pain (adj. risk ratio=1.51; p<0.01). DISCUSSION: We examined women with CVP and found that in comparison to their non-Hispanic White counterparts, Hispanic women are more likely to report a burning sensation and more likely to have primary vulvodynia, a subtype that is associated with great burden on the lives of affected women.