OBJECTIVE: To examine the association of adult-onset vulvodynia with oral contraceptive use. STUDY DESIGN: We conducted a population-based study of 177 women experiencing vulvar pain consistent with clinical criteria for vulvodynia and community-matched controls. Analyses were repeated and validated in clinically confirmed clinic-based and population-based cases and matched controls. RESULTS: In our analyses of population-based cases and controls, oral contraceptive use was associated with a nonsignificant, 30% increase in the risk of vulvodynia (95% CI 0.7-2.3) and was highest among women whose first use occurred before age 18 (OR = 2.5, 95% CI 1.1-5.8). These findings were similar when restricted to clinically confirmed cases. CONCLUSION: These findings do not support the strong associations observed in clinic-based studies. In our study, clinically confirmed clinic-based cases, as compared to population-based cases, were more often oral contraceptive users, earlier-age users and users for longer periods. Thus, observational studies using clinic-based cases might not adequately represent oral contraceptive use in all women with vulvodynia.