Abstract
Vestibulodynia, the most common type of chronic vulvovaginal pain, impairs the psychological,
physical health of nearly 10% of women at some point in their lifetime. The aim of
this investigation was to establish reliable standardized methodologies for assessment
of pain sensitivity in vulvar mucosa and pelvic musculature. We enrolled 34 women
with vestibulodynia and 21 pain-free controls. The participants underwent a nuanced
exam that consisted of palpation of precisely located vulvar mucosal and pelvic muscle
sites. These measurements remained highly stable when participants were reexamined
after 2 weeks, with high within-examiner correlation. Vestibulodynia patients reported
greater sensitivity than pain-free controls at the majority of examination sites,
particularly at mucosal sites on the lower vestibule. The pain threshold measures
at the lower mucosal sites were also associated with the participants’ self-reported
pain levels during intercourse. These mucosal pain threshold measurements were used
to discriminate between vestibulodynia cases and controls with high sensitivity and
specificity. This data supports the feasibility of contemporaneous assessment of vulvar
mucosa and underlying musculature in the pelvic region, offering the hope of a more
precise case definition for vestibulodynia and related disorders.
Perspective
This study describes performance characteristics of novel methodologies for assessing
pelvic muscle and mucosal sensitivity. These pain sensitivity measures were reproducible
and associated with subjective pain reports and vestibulodynia case status and represent
an important step toward a more precise case definition for vestibulodynia and related
disorders.
Key words
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Article info
Publication history
Accepted:
June 14,
2012
Received in revised form:
May 22,
2012
Received:
March 13,
2012
Footnotes
Supported in part by the Department of Obstetrics and Gynecology at the University of North Carolina at Chapel Hill, National Institute of Heath awards HD 053631 (D.Z.), DE07509 (W.M.), NS045688 (W.M.), and UL1RR025747 from the National Center for Research Resources.
The authors have conflicts of interest to report.
Identification
Copyright
© 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.
