Provoked Vestibulodynia in Women with Pelvic Pain

Carol Bao; Heather Noga; Catherine Allaire; Christina Williams; Mohamed A Bedaiwy; Leslie A Sadownik; Lori A Brotto; Kelly B Smith; Paul J Yong

doi:10.1016/j.esxm.2019.03.002

Sexual Health · Sexual Pain

Provoked Vestibulodynia in Women with Pelvic Pain

Bao C, Noga H, Allaire C, Williams C, Bedaiwy MA, Sadownik LA, Brotto LA, Smith KB, Yong PJ

Published June 2019 Sexual medicine

DOI 10.1016/j.esxm.2019.03.002 PMID 30954496 PMC PMC6523038

RRM Academy Synopsis

Women with pelvic pain and vestibulodynia report worse sexual pain

In a cross-sectional study of 129 women with pelvic pain, women with provoked vestibulodynia reported worse sexual pain and poorer sexual quality of life. Vestibulodynia is touch-triggered pain at the vaginal opening. Among these women, pain with deep penetration rated 7 or more out of 10 affected about 7 out of 10 with vestibulodynia and 4 out of 10 without.

Key Findings

Among women with pelvic pain, severe superficial dyspareunia (pain at entry, 7 or more out of 10) affected 51% with vestibulodynia and 8% without it (odds ratio, OR = 12.00 (4.48–32.16)).
Among women with pelvic pain, severe deep dyspareunia (pain with deep penetration, 7 or more out of 10) affected 71% with vestibulodynia and 37% without it (OR = 4.08 (1.83–9.10)).
Poorer sexual quality of life (Endometriosis Health Profile score 50% or more) affected 27 of 34 women with vestibulodynia with data (79%) and 29 of 62 without (47%). OR = 4.39 (1.67–11.57).
Painful bladder syndrome affected 25 of 42 women (60%) with vestibulodynia and 28 of 87 (32%) without (OR = 3.10 (1.45–6.65)). Depression and anxiety symptoms and catastrophizing were also more common.
The groups showed no significant difference in dysmenorrhea, chronic pelvic pain (OR = 2.10 (0.99–4.45), P = .06), functional quality of life, endometriosis or irritable bowel syndrome.

Interpretation

The study is a cross-sectional analysis of a prospective registry. One gynecologist examined consecutive women at one referral center. The groups were compared at a single point in time, so the results describe associations. Vestibulodynia was defined partly by superficial dyspareunia of at least 4 out of 10, so higher superficial pain is built into the group. The authors note that the examiner was not blinded and that the sample was too small to separate causes of pelvic pain. They propose cross-sensitization, in which one painful structure sensitizes its neighbors, as a possible explanation.

RRM Context

Pain with intercourse is a symptom with identifiable sources, and restorative reproductive medicine evaluates it that way. Many women in this registry had confirmed or suspected endometriosis. Those with vestibulodynia more often had bladder and pelvic floor tenderness. A cause-based evaluation asks which sources add to the pain. Restorative care also brings both partners into the conversation about painful intercourse.

Our editorial summary of this paper, not the article's abstract.

Abstract

Introduction

Pelvic pain and vulvar pain are common conditions in women. In this study, we sought to characterize the clinical picture of patients with concurrent pelvic pain and provoked vestibulodynia (PVD).

Aim

To analyze the association between sexual/clinical characteristics and a diagnosis of PVD among women with pelvic pain.

Methods

Cross-sectional analysis of a prospective registry at a tertiary referral center for pelvic pain and endometriosis, involving consecutive non-menopausal sexually active patients 18-49 years-old seen by a single gynecologist from January 2016-December 2017. The sample was divided into 2 groups: pelvic pain with PVD; and pelvic pain alone (without PVD).

Main Outcome Measures

Superficial dyspareunia and deep dyspareunia on a 11-point numeric rating scale, and the sexual quality-of-life subscale of the Endometriosis Health Profile-30 (0-100%).

Results

There were 129 patients that met study criteria: one third with pelvic pain and PVD (n = 42) and two-thirds with pelvic pain alone (without PVD) (n = 87). Women with pelvic pain and PVD had significantly more severe superficial dyspareunia ≥7/10 (OR = 12.00 (4.48-32.16), P < .001), more severe deep dyspareunia ≥7/10 (OR = 4.08 (1.83-9.10), P = .001), and poorer sexual quality of life (Endometriosis Health Profile-30 ≥50%) (OR = 4.39 (1.67-11.57), P = .002), compared with the group with pelvic pain alone. Women with pelvic pain and PVD also had more anxiety, depression, and catastrophizing, more frequent tenderness of the bladder and pelvic floor, and more common diagnosis of painful bladder syndrome. On the other hand, there were no significant differences between the 2 groups in terms of dysmenorrhea, chronic pelvic pain, abdominal wall allodynia, positive Carnett test for abdominal wall pain, functional quality of life, endometriosis, and irritable bowel syndrome.

Conclusions

In the pelvic pain population, PVD may be associated with more negative impact on dyspareunia, sexual quality of life, and bladder/pelvic floor function, but it may not significantly impact abdominopelvic pain or day-to-day function in general. Bao C, Noga H, Allaire C, et al. Provoked Vestibulodynia in Women with Pelvic Pain. Sex Med 2019;7:227-234.

Topics

Sexual Health › Sexual Pain › Vulvodynia · General Gynecology › Pelvic Pain › Chronic Pelvic Pain

Carol Bao, Heather Noga, Catherine Allaire, Christina Williams, Mohamed A Bedaiwy, Leslie A Sadownik, Lori A Brotto, Kelly B Smith, Paul J Yong

C Bao, H Noga, Cathy Allaire, Kate Allaire, C Allaire, C Williams, M Bedaiwy, L Sadownik, L Brotto, K Smith, P Yong

PMID 30954496 30954496 DOI 10.1016/j.esxm.2019.03.002 10.1016/j.esxm.2019.03.002 Bao et al. 2019, Bao 2019

Provoked Vestibulodynia in Women with Pelvic Pain

Women with pelvic pain and vestibulodynia report worse sexual pain

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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