Reliability and Reproducibility of Novel Methodology for Assessment of Pressure Pain Sensitivity in the Pelvic Region

Introduction: • Vestibulodynia, the most common type of chronic vulvovaginal pain, affects nearly 1 in 10 women at some point in their lifetime1 • Current clinical diagnostic criteria for vestibulodynia dates back to Friedrich’s case series of 86 patients published in 19872 which include 1) entry dyspareunia (painful intercourse), 2) tenderness to pressure within the vestibule, and 3) physical findings limited to erythema without other obvious pathology2 • Fredrich’s criteria is limited to evaluation of the vulvar vestibuleunlike mucosa, the spectrum of normal and abnormal tenderness in the pelvic floor and its constituent muscles (e.g. puborectalis muscle) has not been described • Although the body of literature on vestibulodynia has expanded, no revised criteria including beyond Friedrich’s initial description to include pelvic floor dysfunction have been formulated • Our hypothesis is that vestibulodynia is a heterogeneous disorder and that mucosal and muscle pain sensitivities can be used to identify distinct subgroups of patients • The purpose of this study was three fold: 1) to develop instrumentation and methodology for the objective assessment of vulvar mucosal and pelvic muscle sensitivities, 2) to establish a standardized clinical approach for assessing pain sensitivity in vulvar mucosa and pelvic musculature, and 3) to relate these measures to patients’ clinical pain reports