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

Abstract

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. 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. 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. 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.