(072) Association of Endometriosis and Vestibulodynia

Abstract Introduction Current literature has discovered connection between endometriosis and neuroproliferative vestibulodynia (NPV), two conditions that are linked by clinical symptoms of pain and histologic features. Tissue samples from patients with neuroproliferative vestibulodynia have demonstrated similar inflammatory markers, immune infiltrates and proliferation of nerve endings to tissue samples from patients with endometriosis and other inflammatory conditions such as mast-cell activation syndrome. It is known that patients with one chronic pain condition often have other comorbid pain conditions. However, there are limited studies examining the occurrence of both endometriosis and neuroproliferative vestibulodynia in the same patient. Additionally, there are currently no studies examining the relationship between hormonally-mediated vestibulodynia and endometriosis. Objective To compare rates of neuroproliferative vestibulodynia in patients with and without endometriosis who presented for evaluation due to sexual dysfunction. Also, given that histologic samples for both endometriosis and NPV demonstrate mast cells, we also examined incidence of mast cell activation syndrome (MCAS), as well as other conditions (postural orthostatic hypotension syndrome (POTS), hypermobility or hypermobile Ehlers-Danlos syndrome EDS) that are commonly associated with MCAS. Methods Sexual medicine consult notes from 240 patients establishing care at an academic sexual medicine clinic were reviewed. Patient-reported history of endometriosis, MCAS, POTS, and EDS/hypermobility were collected and compared to their clinical diagnoses of neuroproliferative vestibulodynia and hormonally-mediated vestibulodynia. Due to small sample size, Fisher’s exact test was performed to calculate statistical significance of these findings (p 0.05). Results Similar rates of neuroproliferative vestibulodynia (NPV) were seen in patients who did and did not report history of endometriosis (14.29% and 14.15%, p = 1). Similar rates of hormonally-mediated vestibulodynia (HMV) were also seen in patients with endometriosis and without endometriosis (40% and 35%, p = 0.57). Rates of MCAS, POTS, and EDS/hypermobility were higher in patients with NPV (9% and 2.4%, p = 0.076). Rates of these conditions were also higher in those with endometriosis (8.6% vs 2%, p = 0.066). None of the findings were statistically significant. Conclusions This is the first descriptive analysis to examine the relationship between hormonally-mediated vestibulodynia and endometriosis. However, this study is limited by multiple factors, including small sample size. The diagnosis did not differentiate consistently between clinically and biopsy proven endometriosis. This analysis also does not account for potential confounding factors. Future analyses will be performed on a larger sample size. Finally, this is an observational study and therefore cannot suggest causation. More research is needed that examines the overlap in incidence and pathophysiology between endometriosis, vestibulodynia, and other chronic pain conditions. Additional research is also needed to examine the relationship between these conditions and the MCAS/POTS/EDS triad. Disclosure No.