08/09/2025
This retrospective web-based study was conducted to understand the association between the diagnosis of vulvodynia/vestibulodynia and oral contraceptive (OC) use. Over 2100 women completed a questionnaire regarding OC use and potential side effects. There was a purposeful over-sampling of women with vulvodynia or vestibulodynia (over a quarter of the sample, 582 women). Three side effect groupings were evaluated: ge***al-specific changes (pain/dryness), psychological changes (desire, affect), and non-ge***al physical pain (cramps/back pain).
About 50% of participants reported vulvar or vaginal pain and 27% reported a diagnosis of vulvodynia or vestibulodynia. A diagnosis of vulvodynia/vestibulodynia was 5 times more likely in women who took combined oral contraceptives and almost 3 times more likely with progestin only contraceptives. Vaginal dryness was 2.5-3 times more likely in both groups. Affective and non-ge***al pain was not significantly associated with a diagnosis of vulvodynia/vestibulodynia in OC users. This study was not designed to determine causation as this would require a randomized controlled trial; however, it does highlight the importance of identifying and monitoring potential ge***al side effects with these wide-spread medications.
The findings are in line with what I see clinically as a vulvar pain specialist. Oral contraceptives are very useful medications, but like other medications, there are always benefits and side effects. It is important to match the patient with a medication that increases benefits and limits side effects and consider alternatives when side effects become disruptive to function. This is essential in our consultation with patients and informed consent as clinicians.
