title: Reliability and reproducibility of novel methodology for assessment of pressure pain sensitivity in pelvis.
abstract: Vestibulodynia, the most common type of chronic vulvovaginal pain, impairs the psychological, physical health of nearly 10% of women at some point in their lifetime. The aim of this investigation was to establish reliable standardized methodologies for assessment of pain sensitivity in vulvar mucosa and pelvic musculature. We enrolled 34 women with vestibulodynia and 21 pain-free controls. The participants underwent a nuanced exam that consisted of palpation of precisely located vulvar mucosal and pelvic muscle sites. These measurements remained highly stable when participants were reexamined after 2 weeks, with high within-examiner correlation. Vestibulodynia patients reported greater sensitivity than pain-free controls at the majority of examination sites, particularly at mucosal sites on the lower vestibule. The pain threshold measures at the lower mucosal sites were also associated with the participants' self-reported pain levels during intercourse. These mucosal pain threshold measurements were used to discriminate between vestibulodynia cases and controls with high sensitivity and specificity. This data supports the feasibility of contemporaneous assessment of vulvar mucosa and underlying musculature in the pelvic region, offering the hope of a more precise case definition for vestibulodynia and related disorders.
  
  
  CONCLUSIONS
  This study describes performance characteristics of novel methodologies for assessing pelvic muscle and mucosal sensitivity. These pain sensitivity measures were reproducible and associated with subjective pain reports and vestibulodynia case status and represent an important step toward a more precise case definition for vestibulodynia and related disorders.
authors.affiliation: Department of Obstetrics and Gynecology, Pelvic Pain Research Unit, University of North Carolina, Chapel Hill, North Carolina 27599-7570, USA. denniz_zolnoun@med.unc.edu
authors.forename: Denniz
authors.initials: D
authors.lastname: Zolnoun
authors.forename: Eric
authors.initials: E
authors.lastname: Bair
authors.forename: Greg
authors.initials: G
authors.lastname: Essick
authors.forename: Richard
authors.initials: R
authors.lastname: Gracely
authors.forename: Vinita
authors.initials: V
authors.lastname: Goyal
authors.forename: William
authors.initials: W
authors.lastname: Maixner
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D009092:Mucous Membrane / Q000294:innervation; D018482:Muscle, Skeletal / Q000294:innervation; D010146:Pain / Q000175:diagnosis* / Q000503:physiopathology; D010147:Pain Measurement; D017288:Pain Threshold / Q000502:physiology*; D010388:Pelvis / Q000294:innervation*; D011312:Pressure / Q000009:adverse effects*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D055815:Young Adult