(100) Pediatric Vulvodynia: A Retrospective Analysis of Comorbidities Using the TriNetX Global Health Research Network

Background: Vulvodynia is vulvar pain of at least 3 months duration, without an identifiable cause. In adults, vulvodynia is associated with urogenital symptoms, immunological issues, and other chronic pain conditions. In children and adolescents, only one published case series described an association with urinary symptoms. Associations with other conditions and immunologic issues remain unknown. This study aims to evaluate the association of urogenital symptoms, immunological issues and chronic pain disorders with vulvodynia in children and adolescents using a large research network database (TriNetX).

Methods: This IRB exempt retrospective cohort study utilized de-identified patient medical records between January 2015 and July 2023 from TriNetX, a HIPAA compliant health research network driven by Children’s Mercy Hospital Oracle Cerner Millennium data. Statistical analysis was performed using TriNetX and SPSS Version 28.0 (IBM Corp, Armonk, NY).

Results: A single vulvodynia cohort (n=1,410) consisting of females aged 0-18 years-old was identified from TriNetX. Figure 1 shows the development of four further sub cohorts to evaluate associated genitourinary symptoms, chronic pain, immune, and autoimmune disorders with relevant immunological markers. Conditions most commonly associated with vulvodynia included dermatitis and eczema (n=470, 33.3%), pain in joint (n=370,26.2%), pain with micturition (n=310,22%) and migraine (n=160,11.3%). Table 1 shows the comparison of immunological markers between the four sub-cohorts. C-reactive Protein (CRP) was significantly higher in the genitourinary (1198.9 ± 391.3 mg/L) and chronic pain cohorts (145.7 ± 160 mg/L) (p=0.03) compared to the immune disorders and autoimmune cohorts. Eosinophil levels approached statistical significance with levels highest in the autoimmune cohort (4.2 ± 2.5%) (p=0.05) as compared to the genitourinary, immune disorders and chronic pain sub-cohorts.

Conclusions: In children and adolescents, vulvodynia is associated not only with genitourinary symptoms but also with chronic pain disorders (migraine headache) and immune disorders (dermatitis and eczema). Elevated CRP in children with vulvodynia, although nonspecific, suggests a possible inflammatory component as etiology. Further research is needed to clarify the etiology of vulvodynia in the pediatric population.