Enhancement of the perception of systemic pain in women with vulvar vestibulitis

Objective: The aim of this study was to determine whether the characteristics of systemic pain perception and anxiety differ between women with vulvar vestibulitis and healthy women. Design: Case control study. Setting: Tertiary care hospital. Population: Forty-four women with vulvar vestibulitis and 41 healthy women participated in the study. Methods: First, the women's state and trait anxiety was evaluated. Thereafter, heat pain stimuli were applied to the women's forearm and the pain and unpleasantness thresholds, as well as magnitude estimation of perceived intensity and unpleasantness of suprathreshold stimuli, were assessed. Finally, blood pressure was measured before, during and after a heat stimulus of 46°C. Main outcome measures: Pain threshold and suprathreshold, and anxiety levels of women with vulvar vestibulitis. Results: Women with vulvar vestibulitis had a higher anxiety state (40.0 [12.8] vs 34.1 [10.8], P = 0.044), a higher anxiety trait (42.1 [10.2] vs 35.6 [7.5], P = 0.005), a lower pain threshold (42.2°C [2.5] vs 43.6°C [1.9], P = 0.006), a lower unpleasantness threshold (40.2°C [2.9] vs 41.7°C [2.3], P = 0.023), a higher magnitude estimation of suprathreshold pain at 47°C (88.3 [14.9] vs 70.8 [14.9], P = 0.0001) and at 48°C (96.1 [7.3] vs 84.6 [14.8], P < 0.0001), a higher scoring of tonic pain perception (65.2 [17.3] vs 53.0 [18.6], P = 0.006) and a higher increase in systolic blood pressure during tonic pain stimuli (4.6 [9.6] vs -2.1 [8.7] mmHg, P = 0.005). Conclusion: Women with vulvar vestibulitis have an enhanced systemic pain perception and are more anxious.