Comorbidity Pattern and Autonomic Nervous System Dysfunction in Patients with Chronic Vulvar Discomfort

Abstract

This study examines novel concepts of comorbidity in patients with chronic vulvar discomfort using data from the DATRIV (Diagnostic Accuracy of Three Rings Vulvoscopy) study, which involved 328 participants categorized into four groups: asymptomatic individuals with normal or impaired vulvar skin and patients with chronic vulvar discomfort, classified as either vulvodynia or vulvar dermatosis. Clinical data were collected through a structured questionnaire and analyzed using statistical software, including StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). The study received approval from the Institutional Review Board of Polyclinic Harni, and all participants provided written informed consent. The findings reveal significantly higher comorbidity rates in patients with chronic vulvar discomfort compared to other groups (p = 0.0000). A substantial percentage of asymptomatic participants with both normal (63.4%) and impaired (70.7%) vulvar skin also reported comorbid conditions. Analysis of comorbidity curves revealed distinct patterns of symptom progression, with a gradual increase in frequency from asymptomatic individuals to patients with vulvodynia, followed by a decline in vulvar dermatosis cases. These patterns highlight the central role of autonomic nervous system (ANS) dysfunction, where sympathetic hyperactivity and parasympathetic depression contribute to separate comorbidity chains. These dysfunctions may act independently or concurrently, leading to various health issues. The elevated comorbidity rates and overlapping symptomatology suggest complex pathophysiology driven by ANS dysregulation. Further research on comorbidity clusters may unveil new therapeutic targets and guide the development of multifaceted treatment strategies.