Skip to main content
Top
Published in: International Urogynecology Journal 12/2018

01-12-2018 | Original Article

Test–retest reliability of internal pudendal artery blood flow using color Doppler ultrasound in healthy women

Authors: Joanie Mercier, An Tang, Mélanie Morin, Marie-Claude Lemieux, Samir Khalifé, Barbara Reichetzer, Chantale Dumoulin

Published in: International Urogynecology Journal | Issue 12/2018

Login to get access

Abstract

Introduction and hypothesis

The internal pudendal artery (IPA) is one of the main arteries supplying the pelvic floor muscles (PFMs) and vulvo-vaginal tissues. Its assessment with color Doppler ultrasound has been documented previously, but the reliability of IPA measurements has never been assessed. This study evaluates the test–retest reliability of IPA blood flow parameters measured by color Doppler ultrasound under two conditions: at rest and after a PFM contraction task.

Methods

Twenty healthy women participated in this study. One observer performed two measurement sessions using a clinical ultrasound system with a curved-array probe on the participant’s gluteal area. IPA measurements were repeated: at rest and after a PFM contraction task. Peak systolic velocity (PSV), time-averaged maximum velocity (TAMX), end-diastolic velocity (EDV), pulsatility index (PI), and resistance index (RI) were measured. Test–retest reliability was assessed using a paired t test, intraclass correlation coefficient (ICC), and Bland and Altman plots.

Results

There was no significant difference for all IPA blood flow measurements between the two repeated sessions. At rest, reliability was excellent for PSV and TAMX and the variability between measurements, as per Bland and Altman plots, was small. After PFM contractions, reliability was excellent for PSV and TAMX and fair to good for PI. The variability between measurements was small for PSV and acceptable for TAMX and PI. EDV and RI parameters did not perform as well.

Conclusion

The assessment of IPA blood flow with color Doppler ultrasound to evaluate vascular change in women is reliable.
Literature
2.
go back to reference Kovacs P, Gruber H, Piegger J, Bodner G. New, simple, ultrasound-guided infiltration of the pudendal nerve. Dis Colon Rectum. 2001;44(9):1381–5.CrossRef Kovacs P, Gruber H, Piegger J, Bodner G. New, simple, ultrasound-guided infiltration of the pudendal nerve. Dis Colon Rectum. 2001;44(9):1381–5.CrossRef
3.
go back to reference Rofaeel A, Peng P, Louis I, Chan V. Feasibility of real-time ultrasound for pudendal nerve block in patients with chronic perineal pain. Reg Anesth Pain Med. 2008;33(2):139–45.CrossRef Rofaeel A, Peng P, Louis I, Chan V. Feasibility of real-time ultrasound for pudendal nerve block in patients with chronic perineal pain. Reg Anesth Pain Med. 2008;33(2):139–45.CrossRef
4.
go back to reference Portman DJ, Gass MLS. Vulvovaginal atrophy terminology consensus conference P. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's sexual health and the North American Menopause Society. J Sex Med. 2014;11(12):2865–72.CrossRef Portman DJ, Gass MLS. Vulvovaginal atrophy terminology consensus conference P. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's sexual health and the North American Menopause Society. J Sex Med. 2014;11(12):2865–72.CrossRef
5.
go back to reference Palmer AR, Likis FE. Lactational atrophic vaginitis. J Midwifery Womens Health. 2003;48(4):282–4.CrossRef Palmer AR, Likis FE. Lactational atrophic vaginitis. J Midwifery Womens Health. 2003;48(4):282–4.CrossRef
6.
go back to reference Mollo M, Bautrant E, Rossi-Seignert A-K, Collet S, Boyer R, Thiers-Bautrant D. Evaluation of diagnostic accuracy of colour duplex scanning, compared to electroneuromyography, diagnostic score and surgical outcomes, in pudendal neuralgia by entrapment: a prospective study on 96 patients. Pain. 2009;142(1):159–63.CrossRef Mollo M, Bautrant E, Rossi-Seignert A-K, Collet S, Boyer R, Thiers-Bautrant D. Evaluation of diagnostic accuracy of colour duplex scanning, compared to electroneuromyography, diagnostic score and surgical outcomes, in pudendal neuralgia by entrapment: a prospective study on 96 patients. Pain. 2009;142(1):159–63.CrossRef
7.
go back to reference Erol B, Tefekli A, Ozbey I, Salman F, Dincag N, Kadioglu A, et al. Sexual dysfunction in type II diabetic females: a comparative study. J Sex Marital Ther. 2002;28(S1):55–62.CrossRef Erol B, Tefekli A, Ozbey I, Salman F, Dincag N, Kadioglu A, et al. Sexual dysfunction in type II diabetic females: a comparative study. J Sex Marital Ther. 2002;28(S1):55–62.CrossRef
8.
go back to reference Graziottin A, Lukasiewicz M, Serafini A. Sexual rehabilitation after gynaecological cancers. In: Reisman Y, Gianotten WL, editors. Cancer, intimacy and sexuality. Heidelberg: Springer; 2017. p. 205–22.CrossRef Graziottin A, Lukasiewicz M, Serafini A. Sexual rehabilitation after gynaecological cancers. In: Reisman Y, Gianotten WL, editors. Cancer, intimacy and sexuality. Heidelberg: Springer; 2017. p. 205–22.CrossRef
9.
go back to reference Goldstein I, Berman J. Vasculogenic female sexual dysfunction: vaginal engorgement and clitoral erectile insufficiency syndromes. Int J Impot Res. 1998;10:S84–90. discussion S98–101.PubMed Goldstein I, Berman J. Vasculogenic female sexual dysfunction: vaginal engorgement and clitoral erectile insufficiency syndromes. Int J Impot Res. 1998;10:S84–90. discussion S98–101.PubMed
10.
go back to reference Pieterse Q, Ter Kuile M, Deruiter M, Trimbos J, Kenter G, Maas C. Vaginal blood flow after radical hysterectomy with and without nerve sparing. A preliminary report. Int J Gynecol Cancer. 2008;18(3):576–83.CrossRef Pieterse Q, Ter Kuile M, Deruiter M, Trimbos J, Kenter G, Maas C. Vaginal blood flow after radical hysterectomy with and without nerve sparing. A preliminary report. Int J Gynecol Cancer. 2008;18(3):576–83.CrossRef
11.
go back to reference North American Menopause Society. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013;20(9):888–902.CrossRef North American Menopause Society. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013;20(9):888–902.CrossRef
12.
go back to reference Gambacciani M, Palacios S. Laser therapy for the restoration of vaginal function. Maturitas. 2017;99:10–5.CrossRef Gambacciani M, Palacios S. Laser therapy for the restoration of vaginal function. Maturitas. 2017;99:10–5.CrossRef
13.
go back to reference Moore DJ, Gonzales JU, Tucker SH, Elavsky S, Proctor DN. Exercise-induced vasodilation is associated with menopause stage in healthy middle-aged women. Appl Physiol Nutr Metab. 2012;37(3):418–24.CrossRef Moore DJ, Gonzales JU, Tucker SH, Elavsky S, Proctor DN. Exercise-induced vasodilation is associated with menopause stage in healthy middle-aged women. Appl Physiol Nutr Metab. 2012;37(3):418–24.CrossRef
14.
go back to reference Parker BA, Smithmyer SL, Ridout SJ, Ray CA, Proctor DN. Age and microvascular responses to knee extensor exercise in women. Eur J Appl Physiol. 2008;103(3):343–51.CrossRef Parker BA, Smithmyer SL, Ridout SJ, Ray CA, Proctor DN. Age and microvascular responses to knee extensor exercise in women. Eur J Appl Physiol. 2008;103(3):343–51.CrossRef
15.
go back to reference Egginton S. Invited review: activity-induced angiogenesis. Pflugers Arch. 2008;457(5):963–77.CrossRef Egginton S. Invited review: activity-induced angiogenesis. Pflugers Arch. 2008;457(5):963–77.CrossRef
16.
go back to reference Battaglia C, Nappi RE, Mancini F, Cianciosi A, Persico N, Busacchi P, et al. Menstrual cycle-related morphometric and vascular modifications of the clitoris. J Sex Med. 2008;5(12):2853–61.CrossRef Battaglia C, Nappi RE, Mancini F, Cianciosi A, Persico N, Busacchi P, et al. Menstrual cycle-related morphometric and vascular modifications of the clitoris. J Sex Med. 2008;5(12):2853–61.CrossRef
17.
go back to reference Daniels JW, Molé PA, Shaffrath JD, Stebbins CL. Effects of caffeine on blood pressure, heart rate, and forearm blood flow during dynamic leg exercise. J Appl Physiol. 1998;85(1):154–9.CrossRef Daniels JW, Molé PA, Shaffrath JD, Stebbins CL. Effects of caffeine on blood pressure, heart rate, and forearm blood flow during dynamic leg exercise. J Appl Physiol. 1998;85(1):154–9.CrossRef
18.
go back to reference Sørensen LT, Jørgensen S, Petersen LJ, Hemmingsen U, Bülow J, Loft S, et al. Acute effects of nicotine and smoking on blood flow, tissue oxygen, and aerobe metabolism of the skin and subcutis. J Surg Res. 2009;152(2):224–30.CrossRef Sørensen LT, Jørgensen S, Petersen LJ, Hemmingsen U, Bülow J, Loft S, et al. Acute effects of nicotine and smoking on blood flow, tissue oxygen, and aerobe metabolism of the skin and subcutis. J Surg Res. 2009;152(2):224–30.CrossRef
19.
go back to reference Hoffman MD, Sheldahl LM, Kraemer WJ. Therapeutic exercise. In: DeLisa JA, Gans BM, Walsh NE, Bockenek WL, Frontera WR, Geiringer SR, et al., editors. Physical medicine & rehabilitation: principles and practice. 1. 4th edition. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 389–432. Hoffman MD, Sheldahl LM, Kraemer WJ. Therapeutic exercise. In: DeLisa JA, Gans BM, Walsh NE, Bockenek WL, Frontera WR, Geiringer SR, et al., editors. Physical medicine & rehabilitation: principles and practice. 1. 4th edition. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 389–432.
20.
go back to reference Berman J, Berman L, Werbin T, Flaherty E, Leahy N, Goldstein I. Clinical evaluation of female sexual function: effects of age and estrogen status on subjective and physiologic sexual responses. Int J Impot Res. 1999;11(Suppl 1):S31–S8.CrossRef Berman J, Berman L, Werbin T, Flaherty E, Leahy N, Goldstein I. Clinical evaluation of female sexual function: effects of age and estrogen status on subjective and physiologic sexual responses. Int J Impot Res. 1999;11(Suppl 1):S31–S8.CrossRef
21.
go back to reference Birk G, Dawson E, Batterham A, Atkinson G, Cable T, Thijssen D, et al. Effects of exercise intensity on flow mediated dilation in healthy humans. Int J Sports Med. 2013;34(5):409–14.PubMed Birk G, Dawson E, Batterham A, Atkinson G, Cable T, Thijssen D, et al. Effects of exercise intensity on flow mediated dilation in healthy humans. Int J Sports Med. 2013;34(5):409–14.PubMed
22.
go back to reference Johnson BD, Wallace JP. A comparison of postexercise shear rate patterns following different intensities and durations of running in healthy men. Clin Physiol Funct Imaging. 2012;32(3):234–40.CrossRef Johnson BD, Wallace JP. A comparison of postexercise shear rate patterns following different intensities and durations of running in healthy men. Clin Physiol Funct Imaging. 2012;32(3):234–40.CrossRef
23.
go back to reference Currie KD, McKelvie RS, MacDonald MJ. Flow-mediated dilation is acutely improved after high-intensity interval exercise. Med Sci Sports Exerc. 2012;44(11):2057–64.CrossRef Currie KD, McKelvie RS, MacDonald MJ. Flow-mediated dilation is acutely improved after high-intensity interval exercise. Med Sci Sports Exerc. 2012;44(11):2057–64.CrossRef
24.
go back to reference De Vet HCW, Terwee CB, Knol DL, Bouter LM. When to use agreement versus reliability measures. J Clin Epidemiol. 2006;59(10):1033–9. De Vet HCW, Terwee CB, Knol DL, Bouter LM. When to use agreement versus reliability measures. J Clin Epidemiol. 2006;59(10):1033–9.
25.
go back to reference Fleiss JL. The design and analysis of clinical experiments. New York: Wiley; 1986. Fleiss JL. The design and analysis of clinical experiments. New York: Wiley; 1986.
26.
go back to reference Bland JM, Altman D. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;327(8476):307–10.CrossRef Bland JM, Altman D. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;327(8476):307–10.CrossRef
27.
go back to reference Currier DP. Elements of research in physical therapy. Baltimore: Williams & Wilkins; 1984. Currier DP. Elements of research in physical therapy. Baltimore: Williams & Wilkins; 1984.
28.
go back to reference Dumoulin C, Moore K. Adult Conservative Management In: Paul A, Linda C, Saad K, Alan W, editors. Incontinence, 5th International Consultation on Incontinence, Paris; 2013. p. 1103–073. Dumoulin C, Moore K. Adult Conservative Management In: Paul A, Linda C, Saad K, Alan W, editors. Incontinence, 5th International Consultation on Incontinence, Paris; 2013. p. 1103–073.
29.
go back to reference Green DJ, Spence A, Halliwill JR, Cable NT, Thijssen DHJ. Exercise and vascular adaptation in asymptomatic humans. Exp Physiol. 2011;96(2):57–70.CrossRef Green DJ, Spence A, Halliwill JR, Cable NT, Thijssen DHJ. Exercise and vascular adaptation in asymptomatic humans. Exp Physiol. 2011;96(2):57–70.CrossRef
30.
go back to reference Prior BM, Yang HT, Terjung RL. What makes vessels grow with exercise training? J Appl Physiol. 2004;97(3):1119–28.CrossRef Prior BM, Yang HT, Terjung RL. What makes vessels grow with exercise training? J Appl Physiol. 2004;97(3):1119–28.CrossRef
Metadata
Title
Test–retest reliability of internal pudendal artery blood flow using color Doppler ultrasound in healthy women
Authors
Joanie Mercier
An Tang
Mélanie Morin
Marie-Claude Lemieux
Samir Khalifé
Barbara Reichetzer
Chantale Dumoulin
Publication date
01-12-2018
Publisher
Springer London
Published in
International Urogynecology Journal / Issue 12/2018
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-018-3615-5

Other articles of this Issue 12/2018

International Urogynecology Journal 12/2018 Go to the issue