(076) Association of Combined Oral Contraceptive Use With Hormonally Mediated Vestibulodynia Versus Other Vulvovaginal Pain Diagnoses in an Urban Sexual Health Clinic

Abstract Introduction Hormonally mediated vestibulodynia (HMV) is characterized by provoked pain at the vestibule associated with alterations in sex hormone levels and heightened vestibular tissue sensitivity. Combined oral contraceptive (cOCP) use has been proposed as a risk factor for HMV due to suppression of endogenous hormone production. Large-scale cross-sectional research demonstrates that cOCPs are associated with a diagnosis of vulvodynia or vestibulodynia. However, these results are controversial and inconsistent, and few studies have directly compared the association between cOCP use and HMV versus other vulvovaginal pain diagnoses in clinical populations. Clarifying this relationship is essential to improve diagnostic differentiation, guide patient counseling, and enhance understanding of hormonal contributions to vulvovaginal pain. Objective This study aims to determine whether prior or current cOCP use is more strongly associated with hormonally mediated vestibulodynia compared to other vulvovaginal pain diagnoses among patients seen in an urban sexual health clinic. Methods This study conducted a retrospective chart review on patients who attended an OB/GYN-based sexual health clinic in Washington DC for a sexual health consult (SHC) between January 2022 and August 2025. Patients initially seen prior to 2022 or who were not seen for a SHC were excluded. Of data collected from 241 total patient charts, 190 patients met the criteria for current contraceptive use and 145 met the criteria for history of contraceptive use. Results Among 42 patients currently using cOCPs, 24 (57.1%) had a diagnosis of HMV compared to 36 of the 148 (24.3%) non-cOCP users. Current cOCP use was significantly associated with HMV (χ2 = 16.32, p = 0.00005; OR = 4.15, 95% CI 2.02–8.50). Among 107 patients with a history of cOCP use, 42 (39.3%) had HMV compared to 6 out of the 38 (15.8%) non-cOCP users. A history of cOCP use was also significantly associated with HMV (χ2 = 6.91, p = 0.008; OR = 3.45, 95% CI 1.33–8.95). Conclusions Both history and current use of cOCPs were significantly associated with a diagnosis of HMV, suggesting hormonal pharmaceuticals like cOCPs play an important role in the pathophysiology of vulvovaginal pain disorders. Several charts contained unspecified current or past contraceptive use, showing a gap in clinical practice that could be easily filled through consistently identifying cOCP use in patients. The multitude of patients identified with concomitant vulvovaginal pain disorders (including hypertonic pelvic floor dysfunction and neuroproliferative vestibulodynia) suggests the need for further studies with isolated diagnoses. We plan to conduct future analyses of larger sample sizes to isolate HMV-only cases to refine these associations. Further studies could also look at the association with duration of cOCP use. Disclosure No.