Abstract
The objective of this study was to explore the relationship between psychological and physiological processes and how these interact in the case of vulvodynia. The study design consisted of a retrospective review of predominantly premenopausal women presenting with vulvodynia via analyses of questionnaires, psychometric tests, sexual history, surface electromyographic (sEMG) assessments, and clinical notes. Five hundred and twenty-nine patients with vulvodynia (mean age 27.7 years) were studied. The average age of symptom onset was 22.8 years and the average duration of symptoms was 5.0 years. Patients scored higher than the comparison group on global dimensions of the Symptom Checklist—90 Revised (SCL-90R), with anxiety and depression scores showing a significant but modest correlation with severity of pain. sEMG data confirmed an association with pelvic muscle dysfunction but there was no correlation with severity of vulvar pain. A negative correlation between sEMG readings and duration of pain was noted and may be due to progressive time-related quieting of electrical activity in muscle tissues, which is commonly associated with the development of a functional muscle contracture. In conclusion, it is important to view chronic pain syndromes like vulvodynia from a psychophysiological perspective which recognizes the potential contribution of psychological and physiological variables in the aetiology of chronic vulvar pain.
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APA. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: American Psychiatric Association.
Arnold, L. D., Backmann, G. A., Rosen, R., et al. (2006). Vulvodynia: Characteristics and associations with comorbidities and quality of life. Obstetrics and Gynecology, 107, 617–624.
Bachmann, G. A., Rosen, R., Pinn, V. W., et al. (2006). Vulvodynia: A state-of-the-art consensus on definitions, diagnosis and management. The Journal of Reproductive Medicine, 51, 447–456.
Bergeron, S., Binik, Y. M., Khalife, S., et al. (2001). Vulvar vestibulitis syndrome: Reliability of diagnosis and validity of current diagnostic criteria. Obstetrics and Gynecology, 98, 45–51.
Bernstein, A. M., Philips, H. C., Linden, W., et al. (1992). A psychophysiological evaluation of female urethral syndrome: Evidence for a muscular abnormality. Journal of Behavioral Medicine, 15, 299–312.
Binik, Y. M., Meana, M., Berkley, K., et al. (1999). The sexual pain disorders: Is the pain sexual or is the sex painful? Annual Review of Sex Research, 10, 210–235.
Boersma, K., & Linton, S. J. (2006). Psychological processes underlying the development of a chronic pain problem: A prospective study of the relationship between profiles of psychological variables in the fear-avoidance model and disability. Journal of Clinical Pain, 22, 160–166.
Bohm-Stark, N., Hillinges, M., Brodda-Jansen, G., et al. (1998). Increased intraepithelial innervation in women with vulvar vestibulitis syndrome. Gynecologic and Obstetric Investigation, 46, 256–260.
Bohm-Stark, N., Hillinges, M., Brodda-Jansen, G., et al. (2001). Psychophysical evidence of nociceptor sensitization in vulvar vestibulitis syndrome. Pain, 94, 177–183.
Bohm-Stark, N., Hillinges, M., Falconer, C., et al. (1999). Neurochemical characterization of the vestibular nerves in women with culcar vestibulitis syndrome. Gynecologic and Obstetric Investigation, 48, 270–275.
Brookoff, D., & Bennet, D. S. (2006). Neuromodulation in intractable interstitial cystitis and related pelvic pain syndromes. Pain Medicine, 7, 166–184.
Brotto, L. A., Basson, R., & Gehring, D. (2003). Psychological profiles among women with vulvar vestibulitis syndrome: A chart review. Journal of Psychosomatic Obstetrics and Gynaecology, 24, 195–203.
Burton, R. J. (1996). Musculoskeletal pain. In P. P. Raj (Ed.), Pain medicine: A comprehensive review (pp. 418–429). St. Louis: Mosby.
Cailliet, R. (1996). Soft tissue pain and disability (3rd ed.). Philidelphia: F.A. Davis.
Coghill, R. C., Sang, C. N., Maisog, J. M., et al. (1999). Pain intensity processing within the human brain: A bilateral, distributed mechanism. Journal of Neurophysiology, 82, 1934–1943.
Cram, J. R., Kasman, G. S., & Holtz, J. (1998). Introduction to surface electromyography. Gaithersburg: Aspen Publishers Inc.
Derogatis, L. R. (1994). Symptom checklist-90-R: Administration, scoring, and procedures manual (3rd ed.). Minneapolis: National Computer Systems.
Devoe, L. D. (2006). A note from the editor-in-chief. The Journal of Reproductive Medicine, 51, 445–446.
Fitzgerald, M. P., & Kotarinos, R. (2003a). Rehabilitation of the short pelvic floor. I: Background and patient evaluation. International Urogynecology Journal and Pelvic Floor Dysfunction, 14, 261–268.
Fitzgerald, M. P., & Kotarinos, R. (2003b). Rehabilitation of the short pelvic floor. II: Treatment of the patient with the short pelvic floor. International Urogynecology Journal and Pelvic Floor Dysfunction, 14, 269–275.
Flor, H., Birbaumer, N., Schugens, M., et al. (1992a). Symptom-specific psychophysiological responses in chronic pain patients. Psychophysiology, 29, 452–460.
Flor, H., Miltner, W., & Birbaumer, N. (1992b). Psychophysiological recording methods. In D. C. Turk & R. Melzack (Eds.), Handbook of pain assessment (pp. 169–190). New York: Guilford Press.
Foster, D. C., Sazenski, T. M., & Stodgell, C. J. (2004). Impact of genetic variation in interleukin-1 receptor antagonist and Melanocortin-1 receptor genes on vulvar vestibulitis syndrome. The Journal of Reproductive Medicine, 49, 503–509.
Gevirtz, R. N., Hubbard, D. R., & Harpin, R. E. (1996). Psychological treatment of chronic lower back pain. Professional Psychology Research and Practice, 27, 561–566.
Glazer, H. I., Jantos, M., Hartmann, E. H., et al. (1998). Electromyographic comparisons of pelvic floor in women with dysesthetic vulvodynia and asymptomatic women. The Journal of Reproductive Medicine, 43, 959–962.
Glazer, H. I., Rodke, G., Swencionis, C., et al. (1995). Treatment of vulvar vestibulitis syndrome with electromyographic biofeedback of pelvic floor musculature. The Journal of Reproductive Medicine, 40, 283–290.
Granot, M., Friedman, M., Yarnitsky, D., et al. (2002). Enhancement of the perception of systemic pain in women with vulvar vestibulitis. British Journal of Obstetrics and Gynaecology, 109, 863–866.
Haefner, H., Collins, M. E., Davis, G. C., et al. (2005). The vulvodynia guidelines. Journal of Lower Genital Tract Disease, 9, 40–51.
Hawthorn, J., & Redmond, K. (1998). The physiology of pain. In J. Hawthorn & K. Redmond (Eds.), Pain: Causes and management (pp. 7–28). Oxford: Blackwell Science.
Hoehn-Saric, R., & Mcleod, D. R. (2000). Anxiety and arousal: Physiological changes and their perception. Journal of Affective Disorders, 61, 217–224.
Hofbauer, R. K., Olausson, H. W., & Bushnell, M. C. (2006). Thermal and tactile sensory deficits and allodynia in a nerve-injured patient: A multimodal psychophysical and functional magnetic resonance imaging study. Clinical Journal of Pain, 22, 104–108.
Hubbard, D. R. (1996). Chronic and recurrent muscle pain: Pathophysiology and treatment, and review of pharmacologic studies. Journal of Musculoskeletal Pain, 4, 123–143.
Hubbard, D. R. (1998). Persistent muscular pain: Approaches to relieving trigger points. Journal of Musculoskeletal Medicine, 15, 16–26.
Jantos, M., & Burns, N. R. (2007). Vulvodynia: Development of a psychosexual profile. The Journal of Reproductive Medicine, 52, 63–71.
Jantos, M., & White, G. (1997). The vestibulitis syndrome: Medical and psychosexual assessment of a cohort of patients. The Journal of Reproductive Medicine, 42, 145–151.
Jensen, M. P., & Karoly, P. (1992). Self-report scales and procedures for assessing pain in adults. In D. C. Turk & R. Melzack (Eds.), Handbook of pain assessment (pp. 135–151). New York: Guilford Press.
Keefe, F. J., Rumble, M. E., & Scipio, C. D. (2004). Psychological aspects of persistent pain: Current state of science. Pain, 5, 195–211.
Kendall, S. A., Elert, J., Ekselius, L., et al. (2002). Are perceived muscle tension, electromyographic hyperactivity and personality traits correlated in the fibromyalgia syndrome? Journal of Rehabilitation Medicine, 34, 73–79.
Lowenstein, L., Vardi, Y., Deutsch, M., et al. (2004). Vulvar vestibulitis severity – assessment by sensory and pain testing modalities. Pain, 107, 47–53.
Malleson, J. (1954). Sex problems in marriage with particular reference to coital discomfort and the unconsummated marriage. Practitioner, 172, 389–396.
Masheb, R. M., Nash, J. M., & Brondolo, E. (2000). Vulvodynia: An introduction and critical review of a chronic pain condition. Pain, 86, 3–10.
Masheb, R. M., Wang, E., Lozano, C., et al. (2005). Prevalence and correlates of depression in treatment-seeking women with vulvodynia. Journal of Obstetrics and Gynaecology, 25, 786–791.
McKenna, K. E. (2002). The neurophysiology of female sexual function. World Journal of Urology, 20, 93–100.
McNulty, W. H., Gevirtz, R. N., Hubbard, D. R., et al. (1994). Needle electromyographic evaluation of trigger pint response to a psychological stressor. Psychophysiology, 31, 313–316.
Meana, M., Binik, Y. M., Khalife, S., & Cohen, D. (1997). Dyspareunia: Sexual dysfunction or pain syndrome? Journal of Nervous and Mental Diseases, 185, 561–569.
Merskey, H., & Bogduck, N. (1994). Classification of chronic pain (2nd ed.). Washington: IASP Press.
Miller, T. M., & Layzer, R. B. (2005). Muscle cramps. Muscle Nerve, 32, 431–442.
Moyal-Barracco, M., & Lynch, P. J. (2004). 2003 ISSVD terminology and classification of vulvodynia: A historical perspective. The Journal of Reproductive Medicine, 49, 772–777.
Oemler, M., Grabhorn, R., Vahlensieck, W., et al. (2006). Psychosocial aspects of interstitial cystitis: do biographical factors have a relevant impact on the disease course? Der Urologe A, 45, (Translated abstract).
Pukall, C. F., Payne, K. A., Binik, Y., et al. (2003). Pain measurement in vulvodynia. Journal of Sex & Marital Therapy, 29, 111–120.
Pukall, C. F., Reissing, E. D., Binik, Y. M., et al. (2000). New clinical research perspectives on the sexual pain disorders. Journal of Sex Education and Therapy, 25, 36–44.
Reissing, E. D., Binik, Y. M., Khalife, S., et al. (2003). Etiological correlates of vaginismus: Sexual and physical abuse, sexual knowledge, sexual self-schema and relationship adjustment. Journal of Sex & Marital Therapy, 29, 47–59.
Samwel, H. J. A., Evers, A. W. M., Crul, B. J. P., et al. (2006). The role of helplessness, fear of pain, and passive pain-coping in chroming pain patients. Clinical Journal of Pain, 22, 245–251.
Severeijns, R., Vlaeyen, J. W. S., van den Hout, M. A., et al. (2005). Pain catastrophizing and consequences of musculoskeletal pain: A prospective study in the Dutch community. Journal of Pain, 6, 125–132.
Simons, D. G., Travell, J. G., & Simons, L. S. (1999). Myofascial pain and dysfunction: The trigger point manual (2nd ed., Vol. 1: Upper Half of Body). Baltimore: Williams & Wilkins.
Steege, J. F. (1998). Basic philosophy of the intergrated approach: Overcoming the mind-body split. In J. F. Steege, D. A. Metzger, & B. S. Levy (Eds.), Chronic pelvic pain: An intergrated approach (pp. 6–12). Philadelphia: W.B. Saunders.
Stewart, E. G., & Berger, B. M. (1997). Parallel pathologies? Vulvar vestibulitis and interstitial cystitis. The Journal of Reproductive Medicine, 42, 131–134.
Sullivan, M. J. L., Lynch, M. E., & Clark, A. J. (2005). Dimensions of catastrophic thinking associated with pain experience and disability in patients with neuropathic pain conditions. Pain, 113, 310–315.
Sullivan, M. J. L., Thorn, B., Haythornthwaite, J. A., et al. (2001). Theoretical perspectives on the relation between catastrophizing and pain. Clinical Journal of Pain, 17, 52–64.
Turk, D. C., & Melzack, R. (1992). The measure of pain and the assessment of people experiencing pain. In D. C. Turk & R. Melzack (Eds.), Handbook of pain assessment (pp. 3–12). New York: Guilford Press.
Turner, J. A., & Aaron, A. L. (2001). Pain-related catastrophizing: What is it? Clinical Journal of Pain, 17, 65–71.
Vardi, Y., Gruenwald, I., Sprecher, E., et al. (2000). Normative values for female genital sensation. Urology, 56, 1035–1040.
Weiss, J. M. (2001). Pelvic floor myofascial trigger points: Manual therapy for interstitial cystitis and the urgency-frequency syndrome. Journal of Urology, 166, 2226–2231.
White, G., Jantos, M., & Glazer, H. I. (1997). Establishing the diagnosis of vulvar vestibulitis. The Journal of Reproductive Medicine, 45, 157–160.
Wylie, K., Hallem-Jones, R., & Harrington, C. (2004). Psychological difficulties within a group of patients with vulvodynia. Journal of Psychosomatic Obstetrics and Gynaecology, 25, 257–265.
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Jantos, M. Vulvodynia: A Psychophysiological Profile Based on Electromyographic Assessment. Appl Psychophysiol Biofeedback 33, 29–38 (2008). https://doi.org/10.1007/s10484-008-9049-y
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DOI: https://doi.org/10.1007/s10484-008-9049-y