Comparing Vestibule Examination Techniques: Light Touch, Serial Forces, and the Lidocaine Test

Area of Science:

• Gynecology
• Pain Medicine
• Dermatology

Background:

• Provoked vestibulodynia (PVD) is a chronic pain condition affecting the vulvar vestibule.
• Accurate assessment of PVD tenderness is crucial for diagnosis and treatment.
• Current assessment methods may not fully differentiate mucosal pain from other pain sources.

Purpose of the Study:

• To compare the cotton swab test and vulvalgesiometer for assessing PVD tenderness.
• To evaluate the efficacy of topical lidocaine in reducing PVD-related pain.
• To correlate pain scores from different scales.

Main Methods:

• A randomized study involving women with PVD at a specialty vulvar clinic.
• Assessment of tenderness using a light rolling cotton swab touch at six sites.
• Assessment of tenderness using a vulvalgesiometer at two sites, measuring pain tolerance thresholds.
• Pain reporting via Numerical Rating Scale (0-10) and Verbal Pain Scale (0-3).
• Application of 4% topical lidocaine followed by repeat testing.

Main Results:

• The cotton swab test effectively identified significant tenderness in PVD.
• Topical lidocaine reduced pain evoked by the swab test to zero or mild levels.
• The pain threshold with the vulvalgesiometer was 25 g; 38% tolerated >100 g without lidocaine.
• The Verbal Pain Scale correlated well with the Numerical Rating Scale.

Conclusions:

• Light cotton swab touch, combined with a verbal pain scale, can effectively map PVD tenderness.
• Lidocaine's ability to extinguish swab-evoked pain supports a mucosal origin for PVD.
• Vulvalgesiometer forces >100-200 g may elicit pain beyond mucosal allodynia.