Primary and secondary vulvar vestibulitis syndrome: systemic pain perception and psychophysical characteristics.

OBJECTIVE: Women with primary and secondary vulvar vestibulitis syndrome (VVS) report similar vulvar pain symptoms; however, it is not clear whether these subsets have similar pain and psychophysical characteristics. This study evaluated systemic pain perception, cardiovascular measures, and anxiety level in women with primary and secondary VVS. STUDY
DESIGN: Eighty-nine women were enrolled in the study: 44 had primary vulvar vestibulitis, 45 had secondary vulvar vestibulitis. Their anxiety level was first assessed. Then, heat pain stimuli were applied to the forearm, and pain threshold and pain scores for suprathreshold phasic (44 degrees C-48 degrees C) and tonic (46 degrees C) stimuli were assessed by visual analog scale. Finally, blood pressure was recorded using a volume clamp method before, during, and after a tonic stimulus of 1 minute at 46 degrees C.
RESULTS: Women with primary vulvar vestibulitis had higher visual analog scale scores for pain perception at 46 degrees C to 48 degrees C, a higher level of trait anxiety 43.3 +/- 1.5 versus 37.8 +/- 1.5 (P=.010), an increased incidence of dysmenorrhea (chi(2) 8.9, P=.003), and lower resting blood pressure: systolic (108.6 +/- 2.1 vs 118.9 +/- 2.0 mm Hg) (P>.001) and diastolic (59.3 +/- 1.6 vs 64.2 +/- 1.5 mm Hg) (P=.038). Logistic regression revealed that dysmenorrhea and lower systolic blood pressure are associated with primary VVS.
CONCLUSION: Women with primary and secondary VVS differ in their systemic pain perception and psychophysical characteristics. The impact of these findings on treatment modalities should be further evaluated.