Surface electromyography diagnostics in women with partial vaginismus with or without vulvar vestibulitis and in asymptomatic women

Abstract

The aim of this study was to investigate to what extent women with superficial dyspareunia can be diagnosed for both partial vaginismus (PaV) and vulvar vestibulitis (VVS) and to discover to what extent surface electromyography (sEMG) of the pelvic floor muscles (PFM) can distinguish between women with PaV solely, PaV+ VVS, and asymptomatic women. A total of 224 consecutive women with superficial dyspareunia were examined clinically for both PaV and VVS diagnoses. We examined 47 women with PaV+/-VVS and 27 asymptomatic women with sEMG of the PFM. The results showed that 102/224 women with superficial dyspareunia and 33/47 women with PaV in the sEMG part of the study had both PaV and VVS. All women with VVS had vaginismus, while 42/224 had PaV but not VVS. sEMG measurements revealed no significant differences between the three groups of women (PaV solely, PaV + VVS, and asymptomatic). Almost half of the women with superficial dyspareunia referred to our clinic have both the diagnosis PaV and VVS. sEMG was not a method of any value to distinguish between women with PaV solely, PaV + VVS, or asymptomatic women. The increased tone found clinically in the PFM of women with PaV+/-VVS may be of other origin than electrogenic contractions.

The DSM Diagnostic Criteria for Vaginismus

“…Engman, Lindehammar, and Wijma (2004) found no significant differences in sEMG measures between women diagnosed with vaginismus and women suffering from dyspareunia or matched controls. Similarly, van der Velde (1999) found no significant sEMG differences between women diagnosed with vaginismus and normal controls.…”

Pelvic floor muscle function in women with provoked vestibulodynia and asymptomatic controls

“…Our study showed no significant differences in sEMG between women with PVD and controls in resting or peak activity. This finding is contradictory to other studies [9;10;25], but in accordance with the study by Engman where no difference between groups except for the lower values in the PVD group of 60 second holding activity was found [11]. Our study confirms a significantly lower activity over the 10 seconds holding time in the PVD group, which also corresponds with the findings by Polpeta et al [26].…”

“…A study comparing patients with Tension-Type Headache with controls found no difference between groups in the muscular activity of the neck muscles measured with sEMG during cognitive stress [30]. Engman et al questioned whether the increased tone observed clinically ought to be of a another origin than elevated PFM activity [11]. Some of the results from our study are in line with those of Engman et al Although we found a statistically significant difference in VRP, is it difficult to know if a difference of only three cmH 2 O is of clinical relevance, especially as it was not confirmed by the sEMG resting activity.…”

“…More specifically vaginal overactivity, lack of pelvic floor muscle strength and "restriction of the vaginal opening" have been hypothesized to be associated with PVD [8;9], but there are few studies assessing these variables in women with PVD compared to controls [10], and the reported findings on overactivity of the PFM are contradictory [9][10][11][12]. The reliability and validity of digital palpation of the PFM has been questioned [13], and vaginal surface EMG (sEMG) recordings may be flawed by cross-talk activity from other muscles.…”

Post-Coital Burning Pain and Pain at Micturition: Early Symptoms of Partial Vaginismus With or Without Vulvar Vestibulitis?

“…This neglect of the pain component is probably due to the fact that many articles only report on total primary vaginismus (referred to as "severe, preventing penetration" in DSM-IV-TR), where intercourse has never been possible often because of phobic reactions. In the partial form of vaginismus (Engman, Lindehammar, & Wijma, 2004;Wijma & Wijma, 1997), (described as a mild contraction, "inducing some tightness and discomfort" in DSM-IV-TR), the main symptom is pain during and after intercourse. The intercourse-related pain described by this group of women is clinically very difficult, or impossible, to distinguish from the pain described by women with vulvar vestibulitis (de Kruiff, ter Kuile, Weijenborg, & van Lankveld, 2000; van Lankveld, Brewaeys, ter Kuile, & Weijenborg, 1995;Wijma, Jansson, Nilsson, Hallbook, & Wijma, 2000).…”