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Reliability and Reproducibility of Novel Methodology for Assessment of Pressure Pain Sensitivity in Pelvis

  • Denniz Zolnoun
    Correspondence
    Address reprint requests to Denniz Zolnoun, MD, MPH, Department of Obstetrics and Gynecology, CB 7570, MacNider Building, University of North Carolina, Chapel Hill, NC 27599-7570.
    Affiliations
    Department of Obstetrics and Gynecology, Pelvic Pain Research Unit, University of North Carolina, Chapel Hill, North Carolina

    Department of Prosthodontics, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina
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  • Eric Bair
    Affiliations
    Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina

    Center for Neurosensory Disorders, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina
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  • Greg Essick
    Affiliations
    Department of Prosthodontics, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina

    Center for Neurosensory Disorders, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina
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  • Richard Gracely
    Affiliations
    Center for Neurosensory Disorders, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina
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  • Vinita Goyal
    Affiliations
    Department of Obstetrics and Gynecology, Pelvic Pain Research Unit, University of North Carolina, Chapel Hill, North Carolina

    Department of Obstetrics and Gynecology, Brown University and Women & Infants Hospital of Rhode Island, Providence, Rhode Island
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  • William Maixner
    Affiliations
    Department of Prosthodontics, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina
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      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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