Pukall Caroline F, Binik Yitzchak M, Khalifé Samir, Amsel Rhonda, Abbott Frances V
Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal, Canada.
Pain. 2002 Mar;96(1-2):163-75. doi: 10.1016/s0304-3959(01)00442-0.
Vulvar vestibulitis syndrome (VVS) is a common cause of dyspareunia in pre-menopausal women. Little is known about sensory function in the vulvar vestibule, despite Kinsey's assertion that it is important for sexual sensation. We examined punctate tactile and pain thresholds to modified von Frey filaments in the genital region of women with VVS and age- and contraceptive-matched pain-free controls. Women with VVS had lower tactile and pain thresholds around the vulvar vestibule and on the labium minus than controls, and these results were reliable over time. Women with VVS also had lower tactile, punctate pain, and pressure-pain tolerance over the deltoid muscle on the upper arm, suggesting that generalized systemic hypersensitivity may contribute to VVS in some women. In testing tactile thresholds, 20% of trials were blank, and there was no group difference in the false positive rate, indicating that response bias cannot account for the lower thresholds. Women with VVS reported significantly more catastrophizing thoughts related to intercourse pain, but there was no difference between groups in catastrophizing for unrelated pains. Pain intensity ratings for stimuli above the pain threshold increased in a parallel fashion with log stimulus intensity in both groups, but the ratings of distress were substantially greater in the VVS group than in controls at equivalent levels of pain intensity. The data imply that VVS may reflect a specific pathological process in the vestibular region, superimposed on systemic hypersensitivity to tactile and pain stimuli.
外阴前庭炎综合征（VVS）是绝经前女性性交困难的常见原因。尽管金赛断言其对性感觉很重要，但对外阴前庭的感觉功能却知之甚少。我们检测了患有VVS的女性以及年龄和避孕方式匹配的无痛对照组女性生殖器区域对改良von Frey细丝的点状触觉和疼痛阈值。患有VVS的女性在外阴前庭周围和小阴唇处的触觉和疼痛阈值低于对照组，并且这些结果随时间推移是可靠的。患有VVS的女性在上臂三角肌上的触觉、点状疼痛和压痛耐受性也较低，这表明全身性超敏反应可能在某些女性的VVS中起作用。在测试触觉阈值时，20%的试验为空白，且两组的假阳性率无差异，这表明反应偏差不能解释较低的阈值。患有VVS的女性报告与性交疼痛相关的灾难化思维明显更多，但两组在与性交无关的疼痛的灾难化方面无差异。两组中高于疼痛阈值的刺激的疼痛强度评分均随对数刺激强度呈平行增加，但在同等疼痛强度水平下，VVS组的痛苦评分明显高于对照组。数据表明，VVS可能反映了前庭区域的特定病理过程，叠加在对触觉和疼痛刺激的全身性超敏反应之上。
