Does Degree of Vulvar Sensitivity Predict Vulvodynia Characteristics and Prognosis?

Abstract

Although women with vulvodynia typically have increased vulvar sensitivity, data on characteristics associated with the degree of vulvar sensitivity are lacking. We measured vulvar sensitivity by cotton swab test and vulvodolorimeter among a subset of 335 women, ages <70 years, in the longitudinal Woman to Woman Health Study. Comparing the vulvodynia screening results from their online/paper survey to that at the time of the examination, 42 cases had ongoing vulvodynia, 66 cases had a recent remission, 22 controls now had a recent onset of vulvodynia, and 205 controls remained asymptomatic. Vulvar sensitivity was greater in each vulvodynia group compared to controls (P<0.001), and was associated with younger age at first onset of pain (p=0.025), pain after intercourse (p=0.008), describing the pain as a “pressure,” “burning,” or “irritating” (p=0.015, p=0.005, and p=0.006, respectively), with increased severity of pain ever (p=0.012), and with subsequent persistent or relapsing vulvodynia (p<0.001 for each). A score of >1 for the cotton swab summary score best differentiated cases from controls (sensitivity 71.9%; specificity 72.0%). Although 13.8% of women with vulvodynia had no increased sensitivity on cotton swab testing, they did not differ in most clinical characteristics or clinical course from those with increased vulvar sensitivity. Perspective: This study demonstrated that women with vulvodynia have more vulvar sensitivity than controls, but the spectrum of sensitivity is broad. Furthermore, those with and without vulvar sensitivity did not differ in most vulvar pain characteristics or in prognosis, suggesting a positive swab test is not required to substantiate the diagnosis.

Comparing Vestibule Examination Techniques: Light Touch, Serial Forces, and the Lidocaine Test

“…11 Instruments vary, as do suggested anatomic sites, summation formulas and the range of testing forces, some expressed in Newtons and some in grams. 11,12,20,32 Consistently, the differences in sensitivity of vestibule tissues are striking between affected women and controls, whether measured quantitatively or with the qualitative swab test. Importantly, studies comparing qualitative swab testing to quantitative pressure testing find strong correlation.…”

“…Importantly, studies comparing qualitative swab testing to quantitative pressure testing find strong correlation. 12,32 Consistent with the definition of allodynia, the condition of PVD is characterized by exquisite sensitivity to very light vestibule touch. The Kaplan-Meier sensory curves for PVD are steep, 11 indicating dramatically increasing sensitivity with little pressure change.…”

“…Consistently, the differences in sensitivity of vestibule tissues are striking between affected women and controls, whether measured quantitatively or with the qualitative swab test. Importantly, studies comparing qualitative swab testing to quantitative pressure testing find strong correlation 12,32 …”

“…There is not unanimity about the best practice for this test regarding specific forces to apply or locations to test 8,9 . Pain research specialists have introduced several quantitative measuring tools to study PVD 10–13 . In this article, we present a technique for vestibule physical examination that uses the cotton swab in a manner that specifically targets the vestibule mucosa, and we compare a vulvalgesiometer, measuring representative pain thresholds and pain tolerance thresholds.…”

“…8,9 Pain research specialists have introduced several quantitative measuring tools to study PVD. [10][11][12][13] In this article, we present a technique for vestibule physical examination that uses the cotton swab in a manner that specifically targets the vestibule mucosa, and we compare a vulvalgesiometer, measuring representative pain thresholds and pain tolerance thresholds. In addition, we offer data to compare 2 pain scales in hopes of generating discussion about which pain scale is best suited for this exquisitely sensitive pain condition of vestibulodynia.…”