Vol 92, No 6 (2021)
Research paper
Published online: 2021-03-17

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Pilot study of testing a clinical tool for pelvic physical examination in patients with vulvodynia

Ewa Baszak-Radomanska1, Jadwiga Wanczyk-Baszak2, Tomasz Paszkowski2
Pubmed: 33757151
Ginekol Pol 2021;92(6):410-416.


Objectives: Vulvodynia diagnosis is based on medical history and physical examination. The study is aimed to evaluate the clinical usefulness of a pelvic floor physical examination (VAMP protocol) for vulvodynia diagnosis, applied during gynecological examination, proposed as educational and diagnostic tool.
Material and methods: Pelvic physical examinations were performed for 650 non-pregnant female patients. A study group of 449 cases met the vulvodynia diagnostic criteria (120 with provoked, 104 with spontaneous, and 121 with mixed subtype) and were compared with those of 201 healthy individuals. Four anatomical regions were examined: the vulva (V) and anus (A) with a cotton swab, the internal pelvic muscles (M) with a digital examination of the levator ani, and the paraurethral (P) area with digital pressure. Only the maximum pain score for a given area was recorded, using a Numerical Rating Scale. The four anatomical regions were recorded under the VAMP acronym.
Results: Differences in mean scores VAMP protocol were statistically between vulvodynia and comparison group for V = 6.48 vs 0.98; M = 6.29 vs 1.05; and P = 6.89 vs 1.33, with exception of A = 0.03 vs 0.08. Patient age, weight, way of delivery, other concomitant diseases (e.g., dysuria, anal and bowel symptoms), vulvodynia subtype, and pain duration did not influence VAMP scores in patients with vulvodynia and comparison group.
Conclusions: Pelvic examination according to VAPM protocol can be applied in vulvar pain patients for diagnostic purposes. Besides of vulvodynia symptoms any other analyzed variables did not influence on scores of VAMP protocols. We found that cut-off score ≥ 3 even in one of V, M or P component of VAMP protocol can be considered as diagnostic criterium for vulvodynia. Component A (anus area) was not useful for vulvodynia diagnosis.

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  1. Bornstein J, Goldstein AT, Stockdale CK, et al. consensus vulvar pain terminology committee of the International Society for the Study of Vulvovaginal Disease (ISSVD), the International Society for the Study of Womenʼs Sexual Health (ISSWSH), and the International Pelvic Pain Society (IPPS). 2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia. J Low Genit Tract Dis. 2016; 20(2): 126–130.
  2. Reed B, Harlow S, Sen A, et al. Prevalence and demographic characteristics of vulvodynia in a population-based sample. Am J Obstet Gynecol. 2012; 206(2): 170.e1–170.e9.
  3. Jantos MA. Myofascial Perspective on Chronic Urogenital Pain in Women. In: Santoro GA, Wieczorek AP, Bartram C. ed. Pelvic Floor Disorders 2nd ed. Springer : in press.
  4. Butrick CW. Pelvic floor hypertonic disorders: identification and management. Obstet Gynecol Clin North Am. 2009; 36(3): 707–722.
  5. Pukall CF, Binik YM. Vulvodynia. In: Mayer EA, Bushnell MC. ed. Functional Pain Syndromes: presentation and pathophysiology. IASP Press, Seattle 2009: 71–81.
  6. Harlow BL, Stewart EG. A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? J Am Med Womens Assoc (1972). 2003; 58(2): 82–88.
  7. Messelink B, Benson T, Berghmans B, et al. Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurourol Urodyn. 2005; 24(4): 374–380.
  8. Nunns D, Mandal D, Byrne M, et al. British Society for the Study of Vulval Disease (BSSVD) Guideline Group. Guidelines for the management of vulvodynia. Br J Dermatol. 2010; 162(6): 1180–1185.
  9. Goldstein AT, Pukall CF, Brown C, et al. Vulvodynia: Assessment and Treatment. J Sex Med. 2016; 13(4): 572–590.
  10. Gentilcore-Saulnier E, McLean L, Goldfinger C, et al. Pelvic floor muscle assessment outcomes in women with and without provoked vestibulodynia and the impact of a physical therapy program. J Sex Med. 2010; 7(2 Pt 2): 1003–1022.
  11. Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010; 21(1): 5–26.
  12. Reissing ED, Brown C, Lord MJ, et al. Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome. J Psychosom Obstet Gynaecol. 2005; 26(2): 107–113.
  13. Jantos M, Johns S, Torres A, et al. Mapping chronic urogenital pain in women: rationale for a muscle assessment protocol - the IMAP, Part 1. Pelviperineol. 2015; 34: 21–27.
  14. Jantos M, Burns NR. Vulvodynia. Development of a psychosexual profile. J Reprod Med. 2007; 52(1): 63–71.
  15. Sarton J. Assessment of the pelvic floor muscles in women with sexual pain. J Sex Med. 2010; 7(11): 3526–3529.
  16. Aguilar VC, White AB, Rogers RG. Updates on the diagnostic tools for evaluation of pelvic floor disorders. Curr Opin Obstet Gynecol. 2017; 29(6): 458–464.
  17. Zolnoun D, Bair E, Essick G, et al. Reliability and reproducibility of novel methodology for assessment of pressure pain sensitivity in pelvis. J Pain. 2012; 13(9): 910–920.
  18. Meister MR, Shivakumar N, Sutcliffe S, et al. Physical examination techniques for the assessment of pelvic floor myofascial pain: a systematic review. Am J Obstet Gynecol. 2018; 219(5): 497.e1–497.e13.
  19. Jantos M, Johns S, Torres A, et al. Mapping chronic urogenital pain in women: insights into mechanisms and management of pain based on the IMAP, Part 2. Pelviperineol. 2015; 34: 28–36.
  20. Davenport RB, Voutier CR, Veysey EC. Outcome Measurement Instruments for Provoked Vulvodynia: A Systematic Review. J Low Genit Tract Dis. 2018; 22(4): 396–404.
  21. dos Santos Calderon P, Peixoto RF, Gomes VM, et al. Concordance among different pain scales in patients with dental pain. J Orofac Pain. 2012; 26(2): 126–131.
  22. Friedrich EG. Jr. Vulvar vestibulitis syndrome. J Reprod Med. 1987; 32: 110–114.
  23. Bo K, Frawley HC, Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Neurourol Urodyn. 2017; 36(2): 221–244.
  24. Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol. 2019; 31(6): 485–493.
  25. Meister MR, Sutcliffe S, Badu A, et al. Pelvic floor myofascial pain severity and pelvic floor disorder symptom bother: is there a correlation? Am J Obstet Gynecol. 2019; 221(3): 235.e1–235.e15.
  26. Mense S, Simons DG, Russell IJ. Muscle pain: understanding its nature, diagnosis, and treatment. Lippincott Williams & Wilkins : 16–18.
  27. Kavvadias T, Pelikan S, Roth P, et al. Pelvic floor muscle tenderness in asymptomatic, nulliparous women: topographical distribution and reliability of a visual analogue scale. Int Urogynecol J. 2013; 24(2): 281–286.