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The Result of Treatment on Vestibular and General Pain Thresholds in Women With Provoked Vestibulodynia

Bohm-Starke, Nina MD, PhD* †; Brodda-Jansen, Gunilla MD, PhD* ‡ §; Linder, Jürgen MD, PhD; Danielsson, Ingela MD, PhD

doi: 10.1097/AJP.0b013e318122d1fc
Original Articles

Objective: To correlate changes in vestibular pain thresholds to general pain thresholds in a subgroup of women with provoked vestibulodynia taking part in a treatment study.

Methods: Thirty-five women with provoked vestibulodynia were randomized to 4 months' treatment with either electromyographic biofeedback (n=17) or topical lidocaine (n=18). Vestibular and general pressure pain thresholds (PPTs) were measured and the health survey Short Form-36 (SF-36) was filled out before treatment and at a 6-month follow-up. Subjective treatment outcome and bodily pain were analyzed. Thirty healthy women of the same age served as controls for general PPTs and SF-36.

Results: No differences in outcome measures were observed between the 2 treatments. Vestibular pain thresholds increased from median 30 g before to 70 g after treatment in the anterior vestibule (P<0.001) and from median 20 to 30 g in the posterior vestibule (P<0.001). PPTs on the leg and arm were lower in the patients as compared with controls both before and at the 6-month follow-up. Patients reporting total cure were 3/35; 25/35 were improved. The number of patients who frequently reported of other bodily pain was reduced after the treatment. The patients had lower scores for SF-36 (General Health, Vitality) before treatment, which was restored at the 6-month follow-up.

Discussion: Treating provoked vestibulodynia by either topical lidocaine or electromyographic biofeedback increased vestibular pain thresholds, reduced dyspareunia, and improved bodily pain. The patients showed a general hypersensitivity to pressure pain compared with controls and in this study the hypersensitivity did not seem to be affected by treating the superficial dyspareunia.

*Department of Clinical Sciences, Karolinska Institutet

Division of Obstetrics and Gynecology

Division of Rehabilitation Medicine, Danderyd Hospital

§Rehabilitation and Research Centre for Torture Victims, Copenhagen, Denmark

Department of Clinical Neuroscience, Diagnostic Centre, Karolinska Institutet, Karolinska University Hospital, Stockholm

Department of Obstetrics and Gynecology, Sundsvall Hospital, Sundsvall, Sweden

Supported by grants from EXPO 2003, project number 0378, and from the Mid-Sweden Research and Development Centre.

Reprints: Nina Bohm-Starke, MD, PhD, Department of Clinical Sciences, Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital, 182 88 Stockholm, Sweden (e-mail: nina.bohm-starke@ds.se).

Received for publication February 5, 2007; revised May 5, 2007; accepted May 18, 2007

© 2007 Lippincott Williams & Wilkins, Inc.