Establishing the diagnosis of vulvar vestibulitis.

OBJECTIVE: To study the pelvic floor electromyographic (EMG) responses of a cohort of patients diagnosed with vulvar vestibulitis. STUDY
DESIGN: Following full medical and laboratory workup, patients with vestibulitis were given pelvic floor EMG. Results were compared with the collated data, termed the "nonmorbid EMG pelvic floor response," derived from a study control group of 50 symptomless subjects. Six aspects of the EMG response were examined: resting baseline, contractile potential, resting standard deviation, recruitment, recruitment recovery and power spectral analysis.
RESULTS: As compared to the study control group, the cohort demonstrated elevated resting baseline above 2.0 microV) in 23 (71%); poor contractile potential, < 17 microV, in 20 (65%); elevated resting standard deviation, > 0.20, in 30 (93%); slow to poor recruitment recovery after contraction, > or = 0.2 seconds in 27 (86%) and low frequency, < 115 Hz in 22 (69%).
CONCLUSION: The study confirmed that of vestibulitis patients, 88% will show at least three of the above altered criteria and that the diagnosis can be confirmed by: (1) the instability of muscle, (2) poor muscle recovery after contraction, and (3) elevated resting baseline plus one other optional criterion, either (4) reduced frequency or (5) reduced muscle contraction strength.