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Natural History of Comorbid Orofacial Pain Among Women With Vestibulodynia

Bair, Eric MS, PhD*,†; Simmons, Elizabeth BS‡,§; Hartung, Jessica BS, MS‡,§; Desia, Kinnari MD, MPH; Maixner, William DDS, PhD; Zolnoun, Denniz MD, MPH†,‡,§

doi: 10.1097/AJP.0000000000000087
Original Articles

Objectives: We evaluated the stability of the comorbidity between vulvodynia and orofacial pain (OFP) and its associated clinical characteristics over a 2-year follow-up period.

Materials and Methods: In an earlier study of vestibulodynia patients, we administered questionnaires assessing demographic data, self-reported pain, anxiety, somatic awareness, and presence of signs and symptoms suggestive of clinical and subclinical OFP. The present study readministered the same surveys to a subset of the original cohort after a 2-year follow-up period.

Results: Of the 138 women in the previous study, 71 (51%) agreed to participate in the present study. We confirmed our earlier findings that (1) OFP is a highly prevalent (66%) condition among women with vestibulodynia, and (2) compared with women with no OFP symptoms, those with OFP symptoms experience higher levels of anxiety (P=0.005) and somatic awareness (P<0.001). Although OFP symptoms showed improvement in many of the vestibulodynia patients (33%) with OFP symptoms at baseline, 13% had either developed new symptoms or transitioned from subclinical to clinical OFP classification. Intercourse-related pain decreased in 69% of patients and increased in 24% of patients. Consistent with our earlier report, we did not observe significant differences with respect to demographics or severity of pain during intercourse among the subgroups.

Discussion: OFP is a common comorbidity among women with vestibulodynia, although the presence of OFP can vary over time. The comorbidity between vestibulodynia and OFP suggests that common underlying mechanisms may mediate both conditions.

*Departments of Endodontics and Biostatistics, University of North Carolina, Chapel Hill, NC

School of Dentistry, Regional Center for Neurosensory Disorders

Department of Obstetrics & Gynecology, Pelvic Pain Research Unit, University of North Carolina

§Department of Obstetrics and Gynecology, Division of Advanced Laparoscopy and Pelvic Pain, University of North Carolina School of Medicine, Chapel Hill, NC

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Supported in part by Department of Obstetrics and Gynecology at the University of North Carolina at Chapel Hill, NC, National Institute of Heath awards HD 053631 (D.Z.), DE07509 (W.M.), NS045688 (W.M.). The authors declare no conflict of interest.

Reprints: Denniz Zolnoun, MD, MPH, Department of Obstetrics and Gynecology, CB 7570, MacNider Building, University of North Carolina, Chapel Hill, NC 27599-7570 (e-mails:;

Received August 5, 2013

Received in revised form February 14, 2014

Accepted February 13, 2014

© 2015 by Lippincott Williams & Wilkins