Vestibular tactile and pain thresholds in women with vulvar vestibulitis syndrome

Abstract

Vulvar vestibulitis syndrome (VVS) is a common cause of dyspareunia in pre-menopausal women. Little is known about sensory function in the vulvar vestibule, despite Kinsey's assertion that it is important for sexual sensation. We examined punctate tactile and pain thresholds to modified von Frey filaments in the genital region of women with VVS and age- and contraceptive-matched pain-free controls. Women with VVS had lower tactile and pain thresholds around the vulvar vestibule and on the labium minus than controls, and these results were reliable over time. Women with VVS also had lower tactile, punctate pain, and pressure-pain tolerance over the deltoid muscle on the upper arm, suggesting that generalized systemic hypersensitivity may contribute to VVS in some women. In testing tactile thresholds, 20% of trials were blank, and there was no group difference in the false positive rate, indicating that response bias cannot account for the lower thresholds. Women with VVS reported significantly more catastrophizing thoughts related to intercourse pain, but there was no difference between groups in catastrophizing for unrelated pains. Pain intensity ratings for stimuli above the pain threshold increased in a parallel fashion with log stimulus intensity in both groups, but the ratings of distress were substantially greater in the VVS group than in controls at equivalent levels of pain intensity. The data imply that VVS may reflect a specific pathological process in the vestibular region, superimposed on systemic hypersensitivity to tactile and pain stimuli.

Should Dyspareunia Be Retained as a Sexual Dysfunction in DSM-V? A Painful Classification Decision

“…Not surprisingly, Pukall found that the vestibular punctate pain pressure thresholds of women suffering from VVS were dramatically lower than those of matched controls (Pukall, Binik, Khalifé, Amsel, & Abbott, 2002; see also Granot, Friedman, Yarnitsky, & Zimmer, 2002). This clearly reflected the clinical phenomenon of VVS.…”

Sexual Pain Disorders: Dyspareunia and Vaginismus

“…• Multimodal therapy : Vulvar vestibilitis (VV) should be treated with a combined, multimodal treatment aimed at reducing: a) the up-regulation of mastcells, both by reducing the agonist stimuli (such as candida infections, microabrasions of the introital mucosa because of intercourse with a dry vagina and/or a contracted pelvic floor, chemicals, allergens etc) that cause degranulation leading to chronic tissue inflammation, and/or with antagonist modulation of its hyper-reactivity, with amitryptiline or aliamide's gel [6,42,44]; b) the up-regulation of pain system secondary to both the proliferation of introital pain fibers [25][26][27] induced by the Nerve Growth Factor produced by the upregulated mast-cells, and the lowered central pain threshold [45]. A thorough understanding of the pathophysiology of pain, in its nociceptive and neuropathic component, is essential.…”

Predictors of Genital Pain in Young Women

“…Variables that have discriminated between healthy controls and women with dyspareunia include vulnerability factors, such as the personality trait neuroticism (e.g., Van Lankveld, Brewaeys, ter Kuile, & Weijenborg, 1995), mood disruptions (e.g., Gates & Galask, 2001), underlying psychopathology, such as obsessive-compulsive traits and phobias (e.g., Meana et al, 1997;Van Lankveld et al, 1995), and individual difference factors like catastrophizing and hypervigilance (Payne et al, 2004;Pukall, Binik, Khalifé, Amsel, & Abbott, 2002). However, many of these studies are limited by a lack of control groups and only a few psychological factors have been consistently addressed in the literature (e.g., depression, anxiety).…”