title: Evaluation of female external genitalia sensitivity to pressure/touch: a preliminary prospective study using Semmes-Weinstein monofilaments.
abstract: OBJECTIVE
  To assess the use of pressure aesthesiometers (Semmes-Weinstein monofilaments) in the evaluation of female external genitalia. The pressure aesthesiometers are widely used to assess the pressure/touch perceptions of the hand, face, and breast dermatomes.
  
  
  METHODS
  Thirty-two consecutive neurologically intact women (mean age 48.7 +/- 13.8 years) and 5 neurologically impaired women referred for a routine gynecologic examination were prospectively enrolled. The monofilaments were applied to the S2-S5 vulvar dermatomes using specific anatomic landmarks. Test-retest reliability studies were performed at the same clinical session. A comparison was made between premenopausal (n = 17) and postmenopausal (n = 15) women; hypoestrogenic (n = 9) and normoestrogenic (n = 23) women; postmenopausal women with (n = 6) and without (n = 9) estrogen replacement therapy; women with normal (n = 18) and abnormal (n = 14) sexual function; and neurologically impaired (n = 5) and neurologically intact (n = 5) women, matched by age, parity, and estrogen status.
  
  
  RESULTS
  A clear association was found between reduced vulvar sensitivity to pressure/touch and estrogen deficiency, sexual dysfunction, and neurologic impairment. Postmenopausal women had significantly reduced sensitivity to pressure/touch compared with premenopausal women. Similar decreased sensitivity was found in hypoestrogenic compared with normoestrogenic women, with significantly reduced sensitivity in postmenopausal women not using estrogen replacement therapy. Women with sexual dysfunction and those with neurologic impairment had significantly reduced vulvar sensitivity to pressure/touch. No correlation was found between the sensitivity to pressure/touch and either levator ani muscle bulk or the levator contraction score, but significant differences were found between women with and without vulvovaginal atrophy at the time of the examination. Test-retest analysis confirmed the reliability of the monofilaments in testing vulvar sensation.
  
  
  CONCLUSIONS
  The Semmes-Weinstein monofilaments may be used as a valid and reliable diagnostic tool in the evaluation of vulvar sensitivity to pressure/touch. Additional studies with larger series are needed to establish the role of this clinical tool in the evaluation of various treatment outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, Weill Medical College, Cornell University, New York, New York, USA.
authors.forename: L J
authors.initials: LJ
authors.lastname: Romanzi
authors.forename: A
authors.initials: A
authors.lastname: Groutz
authors.forename: F
authors.initials: F
authors.lastname: Feroz
authors.forename: J G
authors.initials: JG
authors.lastname: Blaivas
mesh_terms: D002987:Clitoris / Q000502:physiology; D005260:Female; D006176:Gynecology / Q000295:instrumentation; D006801:Humans; D008875:Middle Aged; D010502:Perineum / Q000502:physiology*; D011312:Pressure; D011446:Prospective Studies; D014110:Touch / Q000502:physiology*; D014844:Vulva / Q000502:physiology*