title: Mucosal versus muscle pain sensitivity in provoked vestibulodynia.
abstract: BACKGROUND
  An estimated 8.3%-16% of women experience vulvovaginal discomfort during their lifetime. Frequently these patients report provoked pain on contact or with attempted intercourse, commonly referred to as provoked vestibulodynia (PVD). Despite the burden of this condition, little is known about its potential etiologies including pelvic floor muscular dysfunction and mucosal components. This knowledge would be beneficial in developing targeted therapies including physical therapy.
  
  
  OBJECTIVE
  To explore the relative contribution of mucosal versus muscle pain sensitivity on pain report from intercourse among women with PVD.
  
  
  METHODS
  In this proof of concept study, 54 women with PVD underwent a structured examination assessing mucosal and pelvic muscle sensitivity.
  
  
  METHODS
  We examined three mucosal sites in the upper and lower vestibule. Patients were asked to rate their pain on cotton swab palpation of the mucosa using a 10-point visual analog scale. Muscle pain was assessed using transvaginal application of pressure on right and left puborectalis, and the perineal muscle complex. The Gracely pain scale (0-100) was used to assess the severity of pain with intercourse, with women rating the lowest, average, and highest pain levels; a 100 rating the highest level of pain.
  
  
  RESULTS
  The lower vestibule's mucosa 5.81 (standard deviation =2.83) was significantly more sensitive than the upper vestibule 2.52 (standard deviation =2.6) (P<0.01) on exam. However, mucosal sensitivity was not associated with intercourse pain, while muscle sensitivity was moderately associated with both average and highest intensity of intercourse pain (r=-0.46, P=0.01 and r=-0.42, P=0.02), respectively.
  
  
  CONCLUSIONS
  This preliminary study suggests that mucosal measures alone may not sufficiently capture the spectrum of clinical pain report in women with PVD, which is consistent with the empirical success of physical therapy in this population.
authors: Department of Obstetrics and Gynecology, Denver Health Medical Center, Denver, CO, USA.
authors: Kathryn
authors: K
authors: Witzeman
authors: Division of Epidemiology and Community health, University of Minnesota, Minneapolis, MN, USA.
authors: Ruby Hn
authors: RH
authors: Nguyen
authors: Pelvic Pain Research Unit, Division of Advanced Laparoscopy and Pelvic Pain, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
authors: Alisa
authors: A
authors: Eanes
authors: Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, University of Michigan, Ann Arbor, MI, USA.
authors: Sawsan
authors: S
authors: As-Sanie
authors: Department of Obstetrics and Gynecology and Center for Neurosensory Disorders, University of North Carolina, Chapel Hill, NC, USA.
authors: Denniz
authors: D
authors: Zolnoun
keywords: dyspareunia; pain sensitivity; pelvic floor muscle pain; pressure pain threshold; provoked vestibulodynia; vulvar pain; vulvodynia