Provoked Vestibulodynia in Women with Pelvic Pain

Carol Bao, Heather Noga, Catherine Allaire, Christina Williams, Mohamed A Bedaiwy, Leslie A Sadownik, Lori A Brotto, Kelly B Smith, Paul J Yong, Carol Bao, Heather Noga, Catherine Allaire, Christina Williams, Mohamed A Bedaiwy, Leslie A Sadownik, Lori A Brotto, Kelly B Smith, Paul J Yong

Abstract

Introduction: Pelvic pain and vulvar pain are common conditions in women. In this study, we sought to characterize the clinical picture of patients with concurrent pelvic pain and provoked vestibulodynia (PVD).

Aim: To analyze the association between sexual/clinical characteristics and a diagnosis of PVD among women with pelvic pain.

Methods: Cross-sectional analysis of a prospective registry at a tertiary referral center for pelvic pain and endometriosis, involving consecutive non-menopausal sexually active patients 18-49 years-old seen by a single gynecologist from January 2016-December 2017. The sample was divided into 2 groups: pelvic pain with PVD; and pelvic pain alone (without PVD).

Main outcome measures: Superficial dyspareunia and deep dyspareunia on a 11-point numeric rating scale, and the sexual quality-of-life subscale of the Endometriosis Health Profile-30 (0-100%).

Results: There were 129 patients that met study criteria: one third with pelvic pain and PVD (n = 42) and two-thirds with pelvic pain alone (without PVD) (n = 87). Women with pelvic pain and PVD had significantly more severe superficial dyspareunia ≥7/10 (OR = 12.00 (4.48-32.16), P < .001), more severe deep dyspareunia ≥7/10 (OR = 4.08 (1.83-9.10), P = .001), and poorer sexual quality of life (Endometriosis Health Profile-30 ≥50%) (OR = 4.39 (1.67-11.57), P = .002), compared with the group with pelvic pain alone. Women with pelvic pain and PVD also had more anxiety, depression, and catastrophizing, more frequent tenderness of the bladder and pelvic floor, and more common diagnosis of painful bladder syndrome. On the other hand, there were no significant differences between the 2 groups in terms of dysmenorrhea, chronic pelvic pain, abdominal wall allodynia, positive Carnett test for abdominal wall pain, functional quality of life, endometriosis, and irritable bowel syndrome.

Conclusions: In the pelvic pain population, PVD may be associated with more negative impact on dyspareunia, sexual quality of life, and bladder/pelvic floor function, but it may not significantly impact abdominopelvic pain or day-to-day function in general. Bao C, Noga H, Allaire C, et al. Provoked Vestibulodynia in Women with Pelvic Pain. Sex Med 2019;7:227-234.

Keywords: Dyspareunia; Endometriosis; Painful Bladder Syndrome; Pelvic Floor; Pelvic Pain; Vestibulodynia; Vulvodynia.

Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.

References

    1. Howard F.M. Chronic pelvic pain. Obstet Gynecol. 2003;101:594–611.
    1. Bornstein J., Goldstein A.T., Stockdale C.K. 2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classifcation of Persistent Vulvar Pain and Vulvodynia. J Low Genit Tract Dis. 2016;20:126–130.
    1. Sadownik L.A. Etiology, diagnosis, and clinical management of vulvodynia. Int J Womens Health. 2014;6:437–449.
    1. American Psychiatric Association . 5th Edition. American Psychiatric Association; Philadelphia: 2013. Diagnostic and Statistical Manual of Mental Disorders.
    1. Nunns D., Mandal D. Psychological and psychosexual aspects of vulvar vestibulitis. Genitourin Med. 1997;73:541–544.
    1. Danielsson I., Sjöberg I., Wikman M. Vulvar vestibulitis: Medical, psychosexual and psychosocial aspects, a case-control study. Acta Obstet Gynecol Scand. 2000;79:872–878.
    1. Gates E.A., Galask R.P. Psychological and sexual functioning in women with vulvar vestibulitis. J Psychosom Obstet Gynecol. 2001;22:221–228.
    1. Pukall C.F., Goldstein A.T., Bergeron S. Vulvodynia: Definition, prevalence , impact , and pathophysiological factors. J Sex Med. 2016;13:291–304.
    1. Smith K.B., Pukall C.F., Chamberlain S.M. Sexual and relationship satisfaction and vestibular pain sensitivity among women with provoked vestibulodynia. J Sex Med. 2013;10:2009–2023.
    1. Leusink P., Kaptheijns A., Laan E. Comorbidities among women with vulvovaginal complaints in family practice. J Sex Med. 2016;13:220–225.
    1. Nguyen R.H.N., Veasley C., Smolenski D. Latent class analysis of comorbidity patterns among women with generalized and localized vulvodynia: Preliminary findings. J Pain Res. 2013;6:303–309.
    1. Gardella B., Porru D., Nappi R.E. Interstitial cystitis is associated with vulvodynia and sexual dysfunction—A case-control study. J Sex Med. 2011;8:1726–1734.
    1. Lester R.A., Brotto L.A., Sadownik L.A. Provoked vestibulodynia and the health care implications of comorbid pain conditions. J Obstet Gynaecol Canada. 2018;37:995–1005.
    1. Brauer M., Kuile M.M., Laan E. Cognitive-affective correlates and predictors of superficial dyspareunia cognitive-affective correlates and predictors. J Sex Marital Ther. 2008;35:1–24.
    1. Brawn J., Morotti M., Zondervan K.T. Central changes associated with chronic pelvic pain and endometriosis. Hum Reprod Updat. 2014;20:737–747.
    1. Yosef A., Allaire C., Williams C. Multifactorial contributors to the severity of chronic pelvic pain in women. Am J Obstet Gynecol. 2016;215:760. e1-e14.
    1. Giesecke J., Reed B.D., Haefner H.K. Quantitative sensory testing in vulvodynia patients and increased peripheral pressure pain sensitivity. Obstet Gynecol. 2004;104:126–133.
    1. Orr N.L., Noga H., Williams C. Deep dyspareunia in endometriosis: Role of the bladder and pelvic floor. J Sex Med. 2018;15:1158–1166.
    1. Pukall C.F., Young R.A., Roberts M.J. The vulvalgesiometer as a device to measure genital pressure-pain threshold. Physiol Meas. 2007;28:1550–1563.
    1. Jones G., Jenkinson C., Kennedy S. Evaluating the responsiveness of the Endometriosis Health Profile Questionnaire: The EHP-30. Qual Life Res. 2004;13:705–713.
    1. Jones G., Kennedy S., Barnard A. Development of an endometriosis quality-of-life instrument: The Endometriosis Health Profile-30. Am Coll Obstet Gynecol. 2001;98:258–264.
    1. Spitzer R.L., Kroenke K., Williams J.B.W. A brief measure for assessing generalized anxiety disorder. Arch Intern Med. 2006;166:1092–1097.
    1. Suleiman S., Johnson D.E. The abdominal wall: An overlooked source of pain. Am Fam Physician. 2001;64:431–438.
    1. Osman A., Barrios F.X., Kopper B.A. Factor structure, reliability, and validity of the Pain Catastrophizing Scale. J Behav Med. 1997;20:589–606.
    1. Allaire C., Williams C., Bodmer-Roy S. Chronic pelvic pain in an interdisciplinary setting: 1 year prospective cohort. Am J Obstet Gynaecol. 2018;218:114. e1-e12.
    1. Sullivan M., Bishop S., Pivik J. The Pain Catastrophizing Scale: Development and validation. Psych Assess. 1995;7:524–532.
    1. Cohen J. Lawrence Erlbaum Associates; Mahwah, NJ: 1988. Statistical Power Analysis for the Behavioral Sciences.
    1. Jantos M. Can pain mapping in vulvodynia cases provide insights into mechanisms and management of pain. J Low Genit Tract Dis. 2015;19:S13.
    1. Sutton K.S., Pukall C.F., Chamberlain S. Pain, psychosocial, sexual, and psychophysical characteristics of women with primary vs. secondary provoked vestibulodynia. J Sex Med. 2009;6:205–214.
    1. Zolnoun D., Park E.M., Moore C.G. Somatization and phychological distress among women with vulvar vestibulitis syndrome. Int J Gynaecol Obstet. 2008;103:38–43.
    1. Yong P.J., Williams C., Yosef A. Anatomic sites and associated clinical factors for deep dyspareunia. Sex. Med. 2017;5:e184–e195.
    1. Yong P.J., Mui J., Allaire C. Pelvic floor tenderness in the etiology of superficial dyspareunia. J Obstet Gynaecol Canada. 2014;36:1002–1009.
    1. Nourmoussavi M., Bodmer-Roy S., Mui J. Bladder base tenderness in the etiology of deep dyspareunia. J Sex Med. 2014;11:3078–3084.
    1. Malykhina A.P. Neural mechanisms of pelvic organ cross-sensitization. Neuroscience. 2007;149:660–672.
    1. Vieira-Baptista P., Lima-Silva J., Beires J. Women without vulvodynia can have a positive ‘Q-tip test’: A cross sectional study. J Psychosom Obstet Gynecol. 2017;38:256–259.
    1. Brotto L.A., Yong P., Smith K.B. Impact of a multidisciplinary vulvodynia program on sexual functioning and dyspareunia. J Sex Med. 2015;12:238–247.
    1. Khandker M., Brady S.S., Vitonis A.F. The influence of depression and anxiety on risk of adult onset vulvodynia. J Womens Health. 2011;20:1445–1451.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever