Highlights
- •Provoked vestibulodynia is usually defined by pain with touch in the vestibule.
- •Pain from muscular activation also contributes significantly to vestibulodynia.
- •Psychosocial factors differentially affect muscular and mucosal pain.
- •Higher muscular pain is correlated with worse sexual functioning.
Abstract
Diagnostic criteria for provoked vestibulodynia (PVD) rely on mucosal pain in the
vulvar vestibule, with less emphasis on pain from pelvic floor muscles. It is unknown
how psychosocial variables associated with PVD are differentially associated with
mucosal versus muscle pain. Analysis of data from the National Vulvodynia Registry
(n = 202) revealed several factors associated with increased mucosal pain: pain duration
(P = .043), the McGill sensory subscore (P = .0086) and the Gracely pain scale (P< .001). Increased mucosal pain was also associated with decreased arousal (P = .036). On the other hand, factors significantly associated with greater muscle
pain included number of comorbid pain conditions (P = .001), decreased intercourse frequency post PVD onset (P = .02) and higher scores on the McGill sensory (P = .0001) and affective (P = .0002) subscores, the Gracely pain scale (P = .0012), and state anxiety (P < .001). Sexual function was also significantly impacted by high pelvic floor muscular
pain, with lower scores for arousal (P = .046), orgasm (P = .0014) and satisfaction (P = .013), and higher pain (P = .01). Significant differences in the relationship between muscle and mucosal pain
for pain duration (P = .005), McGill affective score (P = .001), orgasm (P = .049), change in intercourse frequency (P = .027), and state anxiety (P = .030) suggest the possibility of mucosal or muscle pain predominant PVD subtypes.
Perspective
Patients with higher pelvic floor muscle pain scores than mucosal pain scores may
represent different subgroups or characteristics of patients with provoked vestibulodynia.
This research highlights the importance of assessment of the pelvic floor muscles
in addition to the cotton swab test of the vestibule.
Key words
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Article info
Publication history
Published online: July 13, 2020
Accepted:
July 12,
2020
Received in revised form:
March 6,
2020
Received:
February 11,
2019
Footnotes
Conflict of interest: The National Vulvodynia Association, the Patty Brisben Foundation for Women's Sexual Health and AdventHealth Orlando funded this study. The authors have no conflicts of interest to disclose. Dr. Lamvu has additional research grant funding from Pfizer and serves as a research consultant for AbbVie Inc. and Uroshape LLC. Dr. Rapkin serves on a Data Safety and Monitoring Board for Bayer Pharmaceuticals and as a speaker for AbbVie Inc. However, this work is unrelated to the research topic presented in this manuscript.
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© 2020 by United States Association for the Study of Pain, Inc.
