Abstract
This exploratory case-control study identified possible risk factors associated with vulvar vestibulitis, a problem of unknown etiology. Cases and controls were sampled from two outpatient facilities staffed by university faculty. The practice services a privately insured, self-referred population of patients. The participants were 95 vulvar vestibulitis patients and 188 controls. The main outcome measures were odds ratios (OR) with 95% confidence intervals (CI). As has been suggested by earlier studies, Caucasian women were found to be at significantly greater risk for vulvar vestibulitis than African American women (OR 15.73; 95% CI 2.47-65.2). The basis of this racial difference remains obscure. Nulliparous patients (OR 2.92; 95% CI 1.42-3.02) and patients reporting recurrent "yeast infections" (OR 1.83; 95% CI 1.06-3.16) were found to be at a higher risk of vulvar vestibulitis. Patients who reported prior oral contraceptive use were found to be at lower risk (OR 0.31; 95% CI 0.18-0.56). No difference in risk of vulvar vestibulitis was found by age, history of abnormal Pap smear, history of sexually transmitted disease, history of psychiatric illness, or history of rape or sexual abuse. Evidence of laboratory confirmation of candidiasis was unavailable for both groups studied. Controlling for potential confounding factors of parity and race did not alter the statistical significance of other risk factors studied. Research into the racial difference in risk of this disease may help to elucidate disease etiology. Many patients with vulvar vestibulitis are "functionally infertile" due to dyspareunia, possibly leading to the observed risk of disease in the nulliparous women and the lower reported oral contraceptive use. Careful laboratory documentation of candidiasis, ideally through fungal culture, and careful record of treatment modality should be considered in future studies.
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