NEW YORK (Reuters Health) - Women with vulvar vestibulitis, a condition marked by painful intercourse, are more likely than other women to have taken birth control pills for long periods of time and to use those with a particular composition of hormones, according to Quebec researchers.

The findings do not prove that oral contraceptives cause the condition, but suggest an avenue of further research. Dr. Celine Bouchard of the Hospital du Saint-Sacrement in Quebec told Reuters Health that physicians should not discourage women from taking oral contraceptives (OC).

"Until our results are validated by another similar study with a larger cohort of patients, I would be reluctant to suggest to physicians to inform young girls about this association. OCs prescribed to girls under the age of 16 is still the best method of contraception to prevent undesired pregnancies," she said.

"If a young girl is being prescribed OCs for non-contraceptive benefits, I would suggest that this entity should be addressed," Bouchard added.

The authors found that women with vulvar vestibulitis were much less likely (4% vs. 17%) to have never taken the pill than their pain-free peers. Furthermore, women who had used oral contraceptives were almost 7 times as likely as those who hadn't to develop vulvar vestibulitis, and the risk increased to more than nine-fold in women who started using the pill before the age of 16. Chances of developing vulvar vestibulitis increased further in women who used the pill for up to 2 to 4 years.

Bouchard and her team interviewed 138 women with vulvar vestibulitis about their use of birth control pills before being diagnosed, along with 309 women without the condition.

Women with vulvar vestibulitis feel pain in the tissue surrounding the opening of the vagina during intercourse, or when the tissue is touched. The condition most commonly affects young women.

Not surprisingly, vulvar vestibulitis can have a significant impact on a patient's ability to have intercourse. Treatment of the condition is only rarely successful, and women may undergo surgery to remove the sensitive tissue from the opening of their vaginas in order to have sex without pain.

Researchers remain equally puzzled over the cause of vulvar vestibulitis. Although some initial investigators suggested the condition might be psychosomatic, more recent theorists have proposed that the pain develops from multiple physical instigators, possibly from chronic yeast infections, an altered pH balance in the vagina, or the use of irritating creams.

However, say Bouchard and her colleagues, previous investigations into the cause of vulvar vestibulitis have included small numbers of women, and no later studies have found the same results. Recently, they and others have proposed that oral contraceptives might play a role in the onset of the condition, and one study found that women with vulvar vestibulitis used oral contraceptives for longer periods than those who were pain-free.

In the new study, a particular type of oral contraceptive was linked to a higher risk of developing the condition, Bouchard and her team note in the recent issue of the American Journal of Epidemiology.

More specifically, pills that contained higher amounts of the sex hormones androgen and progestin and a low amount of estrogen were more likely than other pills to be linked to vulvar vestibulitis.

In an interview with Reuters Health, Bouchard explained that she and her team suspect that oral contraceptives may act on receptors present in the vulvar tissues, causing the tissues to become more sensitive to irritating chemicals. Eventually, the tissues may become painful to touch, she noted.

Bouchard emphasized that the pill is not associated with all cases of vulvar vestibulitis--some women with the condition report never having used oral contraceptives.

Nevertheless, the findings from the present study suggest that in some cases, the link exists.

"We are very confident that there is a link between OCs and the development of vulvar vestibulitis," she said.

"This is a major public health problem since a large percentage of women uses OCs for some time in their life," Bouchard added.

SOURCE: American Journal of Epidemiology 2002;156:254-261.

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