Provoked Vestibulodynia: Diagnosis, Self-Reported Pain, and Presentation During Gynaecological Examinations.
To explore factors associated with the diagnosis of provoked vestibulodynia (PVD) through (1) self-reported pain characteristics and (2) Friedrich's criteria (vestibular pain during sexual activity/gynaecological examination). We also identified cases in which incorrect diagnoses were assigned and explored group differences in gynaecological examination presentation and associations with self-reported pain.



Data were extracted from nine studies conducted in our research laboratory. Information obtained during a telephone interview and a standardized gynaecological examination was compiled for 106 participants with vulvar pain and 106 pain-free control participants, matched for age, hormonal contraceptive use, and parity.



Cohen's kappa (0.78) indicated substantial agreement (87.3%) between the telephone interview group categorization and diagnosis after the gynaecological examination. A discriminant function analysis yielded one significant function: Friedrich's first two criteria correctly classified 84.2% of cases, accounting for 76.0% of group membership variance. Of note, those in the other genital pain group were most likely to have received an incorrect diagnosis following the telephone interview (P < 0.001). Paired-samples t tests showed that those with pain reported lower pain intensity during the gynaecological examination than during intercourse (P < 0.001) and that intercourse pain was not necessarily related to pain during the examination. However, many participants (72.8%) indicated that the pain elicited during the cotton swab test was similar to the pain they felt with intercourse.



These results support the use of a targeted clinical interview and the evaluation of vestibular pain during sexual activity and the gynaecological examination for diagnosing PVD. Caution should be exercised when a patient presents with genital pain symptoms other than those typically observed in PVD. Furthermore, the cotton swab test may underestimate the degree of pain regularly experienced.
Department of Psychology, Queen's University, Kingston, ON.
Emma E
EE
Dargie
Department of Obstetrics and Gynaecology, Kingston General Hospital, Kingston, ON.
Susan M
SM
Chamberlain
Department of Psychology, Queen's University, Kingston, ON. Electronic address: caroline.pukall@queensu.ca.
Caroline F
CF
Pukall
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D003075:Coitus; D004414:Dyspareunia / Q000175:diagnosis*; D005260:Female; D058869:Gynecological Examination; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D057566:Self Report; D012725:Sexual Behavior; D056650:Vulvodynia / Q000175:diagnosis*; D055815:Young Adult
Symptom assessment; diagnosis; gynaecological examination; vulvodynia