Pelvic Floor muscle function in women with provoked vestibulodynia and asymptomatic controls

Naes I, Bo K. Int Urogynecol J (2015) 26:1467-1473.

 

Pelvic PT Distance Journal Club February 3, 2015
Beth Shelly

Vulovodynia in GYN practice - 12 to 16%

Dx by pt history, Q - Tip test, and inspection of intriotus, and is thought to be related to PFM overactivity, lack of PFM strength, and restricted vaginal opening.  PG 1468 describes difficulty with objective measures currently used.  The authors went to great lengths to use the most reliable equipment available for this study.

Assessor masked comparison of 35 women with provoked vestibulodynia (PVD) and 35 asymptomatic controls. It is unclear who did the measuring - Looks like author IN did explanation and vaginal exam for PFM contraction. Then she also did all the measurements with the person behind a screen.

 ·         Q-Tip test with device that measures pressure placed on vestibule at 4:00, 6:00, and 8:00

o   PVD pts tolerated lower pressures than controls

·         Balloon catheter to measure resting pressure and pressure during 10 sec hold

o   PVD pts had higher resting pressure

o   No difference was seen in 10 second hold or pressure generated

·         EMG using an anal probe vaginally (due to worry about pain) to measure resting PFM activity and during 10 sec hold

o   PVD pts had sig lower 10 second hold

o   No significant difference was seen in resting pressure

Many contradictory results

·         Vaginal Balloon resting pressure higher in PVD but resting EMG no different

·         EMG 10 second hold lower but no difference in balloon 10 second hold

 Possible problems with study

·         No measure of PFM vaginal palpation pain

·         Could have assessed EMG de-recruitment time or resting tone between contractions

·         Does the anal probe used vaginally really give the best contact on the vaginal skin