WASHINGTON — Patients with vulvodynia receive different treatments for their condition depending on their race and ethnicity, according to research presented at the annual meeting of the American College of Obstetricians and Gynecologists (ACOG) 2026 Annual Meeting.

Black and Hispanic patients were more frequently prescribed symptomatic treatments while White and non-Hispanic patients more frequently received therapies that target underlying pathophysiology, said Mitali Sharma, BS, medical student at Case Western Reserve University School of Medicine in Cleveland.

“Some of the differences in care we observed may be due to differing patient needs, but as aspiring ob/gyns, my peers and I felt that this is an important discussion to have with regard to how we can improve recognition and comprehensive pain management in patients with idiopathic vulvar pain.”

Vulvodynia is typically a clinical diagnosis of exclusion, defined as more than 3 months of idiopathic vulvar burning, stinging, or aching sensations. Pain is assessed by using a cotton swab to palpate the vulva and surrounding areas, while the patient quantifies it as mild, moderate, or severe.

The pain can be localized or generalized, provoked or spontaneous (or a mix), and can have different temporal patterns: persistent, intermittent, or delayed.

“Vulvodynia is a difficult disease to diagnose,” said Mark H. Einstein, MD, MS, chair of ob/gyn and women’s health in the Montefiore Health System and a professor of ob/gyn and women’s health at Albert Einstein College of Medicine in New York City. The conditions clinicians first consider when a patient reports burning, stinging, or aching in the vulva are infections, such as a yeast infection or sexually transmitted infection, or another dermatitis, said Einstein, who was not involved in this research.

Further, no consensus exists on optimal treatment methods; clinicians typically take a multifactorial approach. It often starts with vulvar care, which can include recommending 100% cotton underwear, reducing irritants, and using cool gel packs, mild soaps, and lubrication, Sharma said.

Another approach is cognitive behavioral therapy and mindfulness-based cognitive therapy, which “have been shown to assist patients in coping with pain and addressing the fear-avoidance cycle that perpetuates pain and sexual dysfunction,” she said. Other treatments can involve antidepressants and anticonvulsants, neuromuscular blocking agents, topical or oral analgesics, topical estrogen, pelvic floor physical therapy, or, in extreme cases, vulvectomy or vestibulectomy.

To explore whether the condition is managed differently for different demographic groups, the researchers analyzed cross-sectional data from 48,262 patients coded with vulvodynia in the TriNetX clinical research database. The population included 33,566 White patients, 32,433 non-Hispanic patients, 3037 Black patients, and 3049 Hispanic patients.

“Before we even began to run analyses, we noticed that patients who identify as White or non-Hispanic make up the vast majority of those who hold a documented diagnosis code for vulvodynia,” Sharma told attendees. “Rather than true disease prevalence, we wondered if this might be due to symptom reporting, symptom description, or recognition and treatment of vulvar pain by providers.”

They compared treatments by race and ethnicity using procedure codes and prescription codes. The three procedure codes were for psychotherapy, physical medicine and rehabilitation, and excision of the vulva, perineum, and introitus. The prescription codes included those for various over-the-counter oral and topical analgesics, lidocaine and benzocaine, antidepressants and benzodiazepines, topical triamcinolone and topical estradiol, botulinum toxin A, skeletal muscle relaxants, and neuromuscular blocking agents. 

Because the study involved multiple comparisons, the researchers used a Bonferroni correction that determined a necessary P value of less than .0025 for significance in looking for differences between treatments by race or ethnicity.

The researchers found that, compared with White patients, Black patients were more frequently prescribed pain relievers, particularly nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and topical analgesics, as well as muscle relaxants, topical antifungals, and hydroxyzine (P ≤ .0025). White patients, meanwhile, were more likely than Black patients to be prescribed topical estrogens, benzodiazepines, and antidepressants and to receive a vulvar excision.

Similar differences were seen in comparing ethnicity, with Hispanic patients more likely than non-Hispanic patients to be prescribed NSAIDs and acetaminophen. Non-Hispanic patients were more likely than Hispanic patients to be prescribed topical estrogens, antidepressants, benzodiazepines, triamcinolone, and aspirin and to be referred for physical medicine and rehabilitation (P ≤ .0025).

These findings speak to the importance of refining how vulvodynia is assessed, identified, and managed, Einstein told Medscape Medical News. “I think what this sort of study screams is the need for a more broad-based checklist approach to minimize any sort of potential bias in being able to get the patient to the right individuals and hopefully to an intervention that is going to improve the patient’s symptoms and quality of life.”

The findings were potentially limited by substantial over-representation of non-Hispanic White patients in the data analyzed.

“The vast underrepresentation of people of color in this data may be due to various influences, such as differences in symptom description and diagnostic accuracy,” Sharma said.

She referenced a 2015 study in the Journal of Women’s Health that found Black women with provoked vulvodynia were less likely to describe their pain using classic terms such as “burning.” Instead, they described their pain as “aching” or “throbbing,” and the differences in description often led to missed or delayed diagnosis.

“Burning” is one of those key words that physicians typically will associate with vulvodynia, Sharma said. “But that could be potentially problematic because a lot of different people experience pain differently, and if they don’t use that buzzword, then are we missing those diagnoses?”

Further, she said, that really places the responsibility of diagnostic accuracy on the patient, which is not how we should be practicing medicine.

Another potential contributing factor to the diagnostic disparities is access to specialized care, she said, referencing a 2018 study in the Archives of Sexual Behavior that suggested only half of women who experience vulvar pain will seek help and only 2% receive a diagnosis.

Einstein noted that vulvodynia is not typically a condition that a primary gynecologic clinical provider will handle. “It’s usually handled by individuals who see a lot of these types of vulvar disorders,” he said.

No external funding was noted. Sharma and Einstein reported having no disclosures.

Tara Haelle is a science/health journalist based in Dallas.