Schonfeld Matan, Petros Peter, Bornstein Jacob
Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
University of Western Australia School of Mechanical and Chemical Engineering, Perth, WA, Australia.
J Pain Res. 2021 May 19;14:1281-1288. doi: 10.2147/JPR.S296613. eCollection 2021.
Provoked vulvodynia (PV) is the most common cause of vulvar pain and dyspareunia. Although its etiology is unknown, it has been associated with musculoskeletal dysfunction. The inability of the lax uterosacral ligaments (USLs) to support the adjoining T11/L2 and S2-4 nerve plexuses is considered to cause PV. This study aimed to determine whether providing mechanical support to the USLs would improve PV.
PV patients were randomly divided into two groups. The participants in each group underwent sham manipulation (inserting a wide swab in the vagina without applying pressure) and trial manipulation (supporting the posterior fornix with a wide swab sufficiently broad to mechanically support the USLs). This was a cross-over trial, and the participants alternated between the sham and trial manipulation. Using a 0-10 visual analog pain scale (VAS), PV-associated pain levels experienced by participants were recorded during each manipulation, and the results were compared with baseline levels.
The pain level significantly reduced with USL support compared with the baseline value and the sham manipulation pain level (P = 0.003). Pain during sham manipulation was not significantly different from that recorded at baseline. The average reduction in pain with USL support was 18.4% ± 2.2%. The manipulation order did not affect changes in the pain level during trial manipulation (P = 0.512).
Applying mechanical support to the posterior fornix temporarily alleviates provoked vulvar pain in some women.
激发性外阴痛（PV）是外阴疼痛和性交困难最常见的原因。尽管其病因不明，但已被认为与肌肉骨骼功能障碍有关。子宫骶韧带（USLs）松弛无法支撑相邻的T11/L2和S2 - 4神经丛被认为是导致PV的原因。本研究旨在确定为子宫骶韧带提供机械支撑是否能改善PV。
PV患者被随机分为两组。每组参与者均接受假操作（在阴道内插入宽拭子但不施加压力）和试验操作（用足够宽的拭子支撑后穹窿以机械支撑子宫骶韧带）。这是一项交叉试验，参与者在假操作和试验操作之间交替。使用0 - 10视觉模拟疼痛量表（VAS），在每次操作过程中记录参与者经历的与PV相关的疼痛水平，并将结果与基线水平进行比较。
与基线值和假操作疼痛水平相比，子宫骶韧带支撑时疼痛水平显著降低（P = 0.003）。假操作期间的疼痛与基线记录的疼痛无显著差异。子宫骶韧带支撑时疼痛平均降低18.4%±2.2%。试验操作期间的操作顺序不影响疼痛水平的变化（P = 0.512）。
对后穹窿施加机械支撑可暂时缓解部分女性的激发性外阴疼痛。
