Attitudes towards pregnancy in patients with vulvodynia

Qualitative studies indicate that vulvodynia affects women’s reproductive desires and timing [1]. However, little is known about the prevalence of these attitudes amongst patients with vulvodynia, or the relationship between pain severity and reproductive planning. We aimed to further characterize the effects of vulvodynia on women’s reproductive wishes, hypothesizing that desire for pregnancy would decrease with increasing pain score and fear of pregnancy would increase with worsening pain score. Retrospective chart review. We retrospectively analyzed patient intake questionnaires completed prior to evaluation at an ambulatory vulvar disorders clinic from 1996 to 2018. Questions addressed symptom history, vulvar pain characteristics, and pregnancy desires. Only those diagnosed with vulvodynia in their subsequent clinic visit were included in our sample. Patients with incomplete questionnaires were excluded. Our primary outcomes were pain severity and unpleasantness scores (0-100) compared between women reporting presence versus absence of desire for pregnancy, as well as between those noting fear of pregnancy or lack thereof. Descriptive statistics and Student's t-tests were used as appropriate. This study was approved by the University of Michigan Institutional Review Board. 424 patients diagnosed with vulvodynia (generalized or localized) were eligible for analysis. Their mean age was 40.2 years (SD 15.1); 13.2% (N=56) of them had never had a pregnancy. Nearly one third of the sample (27.8%, N=118) reported a desire for pregnancy. Of those desiring pregnancy, 63.6% (N=75/118) were having at least weekly vaginal intercourse. Mean pain intensity score among those desiring pregnancy was not different between those having and not having at least weekly intercourse (67.1 vs 71.1, p=0.38). Similarly, mean pain unpleasantness was comparable between these groups (78.1 vs 79.0, p=0.81). Of the total 424 patients, 15.1% (N=64) fear pregnancy. This fear was not associated with increased pain intensity (p=0.99) or unpleasantness scores (p=0.28). Although vulvodynia has far-reaching effects on women’s quality of life, our study suggests that women with more intense or unpleasant pain do not avoid or fear pregnancy more than those with less pain.