Are unexplained vaginal symptoms associated with psychosocial distress? A pilot investigation

Vaginal complaints cannot be definitively diagnosed in approximately one-third of women. We sought to determine if women without a diagnosis had higher levels of psychiatric disorders.

This was an observational study in an urban family practice clinic. Prior to seeing a clinician, women with vaginal complaints completed the Patient Health Questionnaire (PHQ); symptoms were measured by the Vaginal Complaints Scale (VCS). Patients were then examined and treated by a family physician. At one and two weeks' time patients were contacted by phone regarding symptom resolution and clinical outcomes.

We enrolled 47 patients; one patient was excluded. A diagnosis was made in 36. Eighteen had bacterial vaginosis, 16 had candida, three trichomonas, two HSV, one chlamydia; there were eight dual diagnoses. PHQ diagnoses were slightly less common in women without an identified cause for their symptoms. We obtained follow-up data from 45 subjects at one week and 34 subjects at two weeks' time. At two weeks' follow-up, 97% of subjects had complete resolution or improvement of their symptoms. Symptom improvement was equivalent among women with a diagnosis and those without. We estimate 180 subjects would be needed to detect a clinically meaningful difference in PHQ diagnoses.

Our pilot study did not find an association between psychiatric diagnoses made by the PHQ and unexplained vaginal symptoms. Nearly all patients experienced rapid resolution of symptoms irrespective of whether a diagnosis had been made or not. These findings are limited primarily by the small sample size.