Consulting a Patient on Hormonal Contraception: A Clinical Case of Vulvar Vestibulitis

Olga Ya. Leshchenko

 
International Journal of Biomedicine. 2021;11(4):590-593.
DOI: 10.21103/Article11(4)_CR1
Originally published December 10, 2021

Abstract: 

This article presents a clinical case of a 23-year-old female who developed vulvodynia and dyspareunia while taking combined oral contraceptives (OCs). The case study shows that physicians should not recommend any combination of OCs over another to reduce weight gain, headache, breast tenderness, breakthrough bleeding, sexual dysfunction, dyspareunia, and decreased libido. Hormonal contraception counseling should be based on known, evidence-based recommendations and not be limited to the unnecessary substitution of one drug for another.

Keywords: 
vestibulodynia • vulvar vestibulitis • dyspareunia • hormonal oral contraceptives • pain
References: 
  1. de Castro Coelho F, Barros C. The Potential of Hormonal Contraception to Influence Female Sexuality. Int J Reprod Med. 2019 Mar 3;2019:9701384. doi: 10.1155/2019/9701384.
  2. Harlow BL, Wise LA, Stewart EG. Prevalence and predictors of chronic lower genital tract discomfort. Am J Obstet Gynecol. 2001 Sep;185(3):545-50. doi: 10.1067/mob.2001.116748. 
  3. Bazin S, Bouchard C, Brisson J, Morin C, Meisels A, Fortier M. Vulvar vestibulitis syndrome: an exploratory case-control study. Obstet Gynecol. 1994 Jan;83(1):47-50.
  4. Bouchard C, Brisson J, Fortier M, Morin C, Blanchette C. Use of oral contraceptive pills and vulvar vestibulitis: a case-control study. Am J Epidemiol. 2002 Aug 1;156(3):254-61. doi: 10.1093/aje/kwf037. 
  5. Greenstein A, Ben-Aroya Z, Fass O, Militscher I, Roslik Y, Chen J, Abramov L. Vulvar vestibulitis syndrome and estrogen dose of oral contraceptive pills. J Sex Med. 2007 Nov;4(6):1679-83. doi: 10.1111/j.1743-6109.2007.00621.x. 
  6. Berglund AL, Nigaard L, Rylander E. Vulvar pain, sexual behavior and genital infections in a young population: a pilot study. Acta Obstet Gynecol Scand. 2002 Aug;81(8):738-42. doi: 10.1034/j.1600-0412.2002.810809.x. 
  7. Bohm-Starke N, Johannesson U, Hilliges M, Rylander E, Torebjörk E. Decreased mechanical pain threshold in the vestibular mucosa of women using oral contraceptives: a contributing factor in vulvar vestibulitis? J Reprod Med. 2004 Nov;49(11):888-92. 
  8. Friedrich EG Jr. Vulvar vestibulitis syndrome. J Reprod Med. 1987 Feb;32(2):110-4. 
  9. Bergeron S, Binik YM, Khalifé S, Pagidas K, Glazer HI. Vulvar vestibulitis syndrome: reliability of diagnosis and evaluation of current diagnostic criteria. Obstet Gynecol. 2001 Jul;98(1):45-51. doi: 10.1016/s0029-7844(01)01389-8. 
  10. van der Meijden WI, Boffa MJ, Ter Harmsel WA, Kirtschig G, Lewis FM, Moyal-Barracco M, Tiplica GS, Sherrard J. 2016 European guideline for the management of vulval conditions. J Eur Acad Dermatol Venereol. 2017 Jun;31(6):925-941. doi: 10.1111/jdv.14096.
  11. Harlow BL, Wise LA, Stewart EG. Prevalence and predictors of chronic lower genital tract discomfort. Am J Obstet Gynecol. 2001 Sep;185(3):545-50. doi: 10.1067/mob.2001.116748.
  12. Foster DC. Vulvar disease. Obstet Gynecol. 2002 Jul;100(1):145-63. doi: 10.1016/s0029-7844(02)02080-x. 
  13. Kungurtseva EA, Popkova SM, Leschenko OY. [Reciprocal formation of mucosal microflora of open cavities of different habitats in women as an important factor of their reproductive health]. Vestn Ross Akad Med Nauk. 2014;(9-10):27-32. doi: 10.15690/vramn.v69i9-10.1128. [Article in Russian].
  14. de Kruiff ME, ter Kuile MM, Weijenborg PT, van Lankveld JJ. Vaginismus and dyspareunia: is there a difference in clinical presentation? J Psychosom Obstet Gynaecol. 2000 Sep;21(3):149-55. doi: 10.3109/01674820009075622. 
  15. Meana M, Binik YM, Khalife S, Cohen DR. Biopsychosocial profile of women with dyspareunia. Obstet Gynecol. 1997 Oct;90(4 Pt 1):583-9. doi: 10.1016/s0029-7844(98)80136-1.
  16. Bergeron S, Binik YM, Khalifé S, Pagidas K. Vulvar vestibulitis syndrome: a critical review. Clin J Pain. 1997 Mar;13(1):27-42. doi: 10.1097/00002508-199703000-00006. 
  17. Bouchard C, Brisson J, Fortier M, Morin C, Blanchette C. Use of oral contraceptive pills and vulvar vestibulitis: a case-control study. Am J Epidemiol. 2002 Aug 1;156(3):254-61. doi: 10.1093/aje/kwf037. 
  18. Bohm-Starke N, Hilliges M, Blomgren B, Falconer C, Rylander E. Increased blood flow and erythema in the posterior vestibular mucosa in vulvar vestibulitis(1). Obstet Gynecol. 2001 Dec;98(6):1067-74. doi: 10.1016/s0029-7844(01)01578-2.
  19. Witkin SS, Gerber S, Ledger WJ. Differential characterization of women with vulvar vestibulitis syndrome. Am J Obstet Gynecol. 2002 Sep;187(3):589-94. doi: 10.1067/mob.2002.125889.
  20. Glazer HI, Rodke G, Swencionis C, Hertz R, Young AW. Treatment of vulvar vestibulitis syndrome with electromyographic biofeedback of pelvic floor musculature. J Reprod Med. 1995 Apr;40(4):283-90.
  21. ACOG educational bulletin. Vulvar nonneoplastic epithelial disorders. Number 241, October 1997 (Replaces no. 139, January 1990). American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 1998 Feb;60(2):181-8. 
  22. Nyirjesy P, Sobel JD, Weitz MV, Leaman DJ, Small MJ, Gelone SP. Cromolyn cream for recalcitrant idiopathic vulvar vestibulitis: results of a placebo controlled study. Sex Transm Infect. 2001 Feb;77(1):53-7. doi: 10.1136/sti.77.1.53.
  23. Bornstein J, Livnat G, Stolar Z, Abramovici H. Pure versus complicated vulvar vestibulitis: a randomized trial of fluconazole treatment. Gynecol Obstet Invest. 2000;50(3):194-7. doi: 10.1159/000010309.
  24. Burrows LJ, Goldstein AT. The treatment of vestibulodynia with topical estradiol and testosterone. Sex Med. 2013 Aug;1(1):30-3. doi: 10.1002/sm2.4. 
  25. Leshchenko O. Vaginal estriol and injections of autoplasma reduce the symptoms of vulvovaginal atrophy. MATURITAS. 2019;124:152. doi: 10.1016/j.maturitas.2019.04.120.       
  26. Leshchenko O, Atalyan A. Vaginal estriol and injections of autoplasma (plasmolifting) reduce the symptoms of vulvovaginal atrophy Journal of Lower Genital Tract Disease. 2017;21(2 S1):46.
  27. Bergeron S, Binik YM, Khalifé S, Pagidas K, Glazer HI, Meana M, Amsel R. A randomized comparison of group cognitive--behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain. 2001 Apr;91(3):297-306. doi: 10.1016/S0304-3959(00)00449-8.
  28. Edgardh K, Abdelnoor M. Vulvar vestibulitis and risk factors: a population-based case-control study in Oslo. Acta Derm Venereol. 2007;87(4):350-4. doi: 10.2340/00015555-0250.
  29. Moreau C, Trussell J, Gilbert F, Bajos N, Bouyer J. Oral contraceptive tolerance: does the type of pill matter? Obstet Gynecol. 2007 Jun;109(6):1277-85. doi: 10.1097/01.AOG.0000260956.61835.6d. 
  30. Sabatini R, Cagiano R. Comparison profiles of cycle control, side effects and sexual satisfaction of three hormonal contraceptives. Contraception. 2006 Sep;74(3):220-3. doi: 10.1016/j.contraception.2006.03.022.
  31. Schaffir J. Hormonal contraception and sexual desire: a critical review. J Sex Marital Ther. 2006 Jul-Sep;32(4):305-14. doi: 10.1080/00926230600666311.
  32. Grossman Barr N. Managing adverse effects of hormonal contraceptives. Am Fam Physician. 2010 Dec 15;82(12):1499-506. 

Download Article
Received August 25, 2021.
Accepted September 13, 2021.
©2021 International Medical Research and Development Corporation.