(046) Treatment Outcomes Across Vulvodynia Subgroups: A Phenotype-Based Approach

Abstract Introduction Vulvodynia is a condition characterized by chronic vulvar pain, without an identifiable cause. It affects approximately 7-8% of women, with lifetime prevalence up to 16%, and presents significant diagnostic and therapeutic challenges due to the heterogeneous clinical presentation. The condition’s variable symptomatology, inconsistent response to treatments, and multifactorial etiology have further complicated treatment algorithms. A recent understanding of vulvodynia suggests that patient subgrouping using clinical phenotypes may improve treatment outcomes by enabling targeted therapeutic approaches. Classification algorithms have been previously published to create a systematic framework for categorizing vulvodynia patients into distinct subgroups. These groups are based on pain characteristics, anatomical location, and associated clinical features. However, limited evidence exists regarding treatment efficacy across these specific subgroups, making it difficult to develop evidence-based clinical pathways for personalized care. Objective This study evaluates patient variability in vulvodynia by classifying affected individuals into five distinct subgroups using a previously published algorithm, and to identify which treatment modalities were employed for each subgroup and which interventions demonstrated successful outcomes. Methods A retrospective chart review was conducted on patients diagnosed with vulvodynia at our institution. Patients with well documented diagnosis and treatment plans were included. Patients were categorized into five subgroups (hormonal, pelvic floor, infectious, inflammatory, neuroproliferative) according to the algorithm previously published by Dr. Andrew T. Goldstein et. Al. Subgroups were based on clinical presentation, pain patterns, and examination findings. Demographic data including age, race, ethnicity, and parity were collected. Complete treatment histories were extracted from medical records, including but not limited to topical estrogen, topical estrogen/testosterone, gabapentin, amitriptyline, pelvic floor physical therapy, vestibulectomy, and clotrimazole. Treatment success was defined as patient-reported significant symptom relief. Categorical variables were analyzed using chi-square tests, with statistical significance defined as p 0.05. Results A total number of 227 patients were identified with the diagnosis of vulvodynia. Of those patients who met criteria the most common subtypes were hormonal and pelvic floor dysfunction. Overall, 86.8% of patients with known outcomes achieved clinical improvement. Estrogen/testosterone combination therapy was most frequently prescribed with a 55.9% success rate overall. When stratified by subtype, hormonal vulvodynia patients demonstrated significantly superior response to estrogen/testosterone therapy compared to non-hormonal subtypes (70.0% vs 35.7%, p 0.05). Amitriptyline showed the highest treatment-specific success rate at 70.0%, though the difference from other treatments was not statistically significant. Pelvic floor physical therapy demonstrated limited efficacy overall. These findings suggest that treatment response is significantly influenced by subtype classification and supports a phenotypic approach to vulvodynia management. Conclusions This study demonstrates substantial heterogeneity in vulvodynia, using systematic classification, with hormonal dysfunction representing the predominant clinical phenotype. The significant association between subtype classification and treatment response, particularly the hormonal subtype, underscores the importance of phenotype-based treatment selection. The novelty of this study is the inclusion of the quantification of subgroup prevalence and treatment-specific success rates in a classified cohort. These findings support phenotype-directed treatment algorithms as a strategy to optimize outcomes and reduce ineffective trials. Prospective validation studies are needed to establish evidence-based, standardized protocols for personalized vulvodynia management. Disclosure No.