Vulvar vestibulitis syndrome: reliability of diagnosis and evaluation of current diagnostic criteria

Abstract

Vulvar vestibulitis can be reliably diagnosed in women with dyspareunia. Pain is limited to the vulvar vestibule and can be rated and described in a consistent fashion by these women. Erythema does not appear to be a useful diagnostic criterion.

Provoked Vestibulodynia: Mediators of the Associations Between Partner Responses, Pain, and Sexual Satisfaction

“…Although positively correlated, sexual satisfaction may be distinguished, in part, from sexual functioning because it emphasizes the interpersonal aspect of sexual activities, whereas sexual functioning focuses on the intrapersonal aspects of the sexual response (Rosen et al, 2000). Although studies have shown significant improvements in sexual function across treatment groups for women with PVD, prior research has evidenced little success in terms of improving sexual functioning above clinical thresholds, regardless of the type of intervention (Bergeron, Binik, Khalifé, Pagidas, & Glazer, 2001;Bergeron, Khalifé, Glazer, & Binik, 2008;Masheb, Kerns, Lozano, Minkin, & Richman, 2009). Consequently, changes in the more subjective measures of sexual distress and satisfaction are emerging as important outcome variables and key targets for intervention.…”

Randomized clinical trial of multimodal physiotherapy treatment compared to overnight lidocaine ointment in women with provoked vestibulodynia: Design and methods

“…The participant is asked to evaluate the average intensity of pain on an 11-point scale from 0 (no pain) to 10 (most intense pain). This scale, highly recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) [34], is widely used in RCTs for chronic pain conditions as well as for women with PVD and has shown good validity, reliability and responsiveness [18], [24], [30] and [34]. Table 3.…”

“…In order to confirm the PVD diagnosis, all women underwent a medical history interview and a physical examination including a standardized pelvic examination performed by a gynecologist of our team [18]. This evaluation followed the diagnostic criteria defined by Friedrich [2] and more recently modified by Bergeron et al [30]: 1) pain in the vestibule following touch or an attempted vaginal penetration; 2) acute pain during the cotton-swab test which consists in applying pressure following a random order to the vulvar vestibule. The inter-rater reliability of this diagnostic method has been demonstrated [30].…”

“…This evaluation followed the diagnostic criteria defined by Friedrich [2] and more recently modified by Bergeron et al [30]: 1) pain in the vestibule following touch or an attempted vaginal penetration; 2) acute pain during the cotton-swab test which consists in applying pressure following a random order to the vulvar vestibule. The inter-rater reliability of this diagnostic method has been demonstrated [30]. Vulvar pain occurring in the absence of an underlying recognizable disease and provoked spontaneously as a result of physical contact can be classified as PVD [31].…”

“…Likewise, to avoid pain explained by childbirth-related lesions and to limit the confounding effect of pregnancy and delivery on PFM function, only nulliparous women were recruited. Women with moderate or severe pain during intercourse were included as they are representative of the PVD population [30], and their pain may also correspond to a typical level of severity at which many women will seek medical advice [6]. It will also prevent a floor effect and thus ensure that the intervention will have a measurable efficacy [62].…”