Association between quantitative sensory testing, treatment choice, and subsequent pain reduction in vulvar vestibulitis syndrome

The chronic pain syndrome of vulvar vestibulitis is a major cause of sexual dysfunction, and complete cure is not always achieved. The aim of the study was to determine whether the psychophysical characteristics of systemic pain perception predict treatment choice and outcome. Ninety women with vulvar vestibulitis syndrome were evaluated by using quantitative sensory testing with heat pain threshold measurements and pain scores for suprathreshold stimuli applied to the forearm, blood pressure measurements, and an assessment of the number of other pain disorders. Women were free to choose a surgical procedure (ie, vestibulectomy), one of the possible nonsurgical treatments (eg, biofeedback, cognitive-behavioral therapy, or hypoallergic agents), or to avoid treatment entirely. Eight, months later, women reported the success of the treatment on the basis of reduction in the level of vulvar pain. Vestibulectomy demonstrated the best therapeutic effectiveness (chi(2), 26.4; P < .0001). Women who chose this type of treatment had lower pain scores (P = .038) and fewer pain syndromes other than the vulvar pain (P = .025). Logistic regression analysis, controlling for the effect of vestibulectomy, indicated that lower experimental pain scores (P = .044), fewer pain disorders (P = .023), and higher systolic blood pressure (P = .039) are predictive variables for reduction of vulvar pain. An assessment of systemic pain perception might be helpful in choosing the optimal treatment and in predicting its success. Perspective: The present study suggests that pain perception variables might be of value in the prediction of treatment choice and outcome among women with vulvar vestibulitis. (C) 2004 by the American Pain Society.