外阴痛患者的盆底检查：VAMP方案与中枢敏化相关性的验证

Pelvic floor examination in vulvodynia: VAMP protocol validation in correlation with central sensitization.

作者信息

Baszak-Radomańska Ewa, Wańczyk-Baszak Jadwiga, Paszkowski Tomasz

机构信息

Terpa Clinic, OB/Gyn Department, Lublin, Poland.

III Chair and Department of Gynecology, Medical University of Lublin, Poland.

出版信息

Womens Health (Lond). 2025 Jan-Dec;21:17455057251338410. doi: 10.1177/17455057251338410. Epub 2025 Jul 1.

DOI:10.1177/17455057251338410

PMID:40590401

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12217571/

Abstract

BACKGROUND

Overactive pelvic floor muscles (PFMs) are a source of pain in patients with vulvodynia. Peripheral sensitization may also lead to central sensitization (CS).

OBJECTIVES

This study aimed to validate the Vulva, Anus, Muscle, and Paraurethra (VAMP) protocol as a diagnostic tool for assessing PFM overactivity in vulvodynia in correlation with the Central Sensitization Inventory (CSI).

DESIGN

This research was the secondary outcome of an ongoing randomized clinical trial reported in accordance with the CONSORT guidelines. Inclusion criteria and research goals were established using the Population Intervention Comparison Outcome model for clinical questions.

METHODS

The VAMP protocol includes the examination of the vulva (V), anus (A) using a cotton swab test and pelvic muscle (M) and paraurethra (P) examinations during the internal exam with pain evaluation. VAMP was validated by comparison with a swab test and correlation with the CSI score.

RESULTS

Of the 152 premenopausal participants, 91.6% suffered from provoked/mixed vulvodynia versus 8.4% spontaneous, and 61.3% had localized versus 38.7% generalized subtypes. Mean VAMP scores were: V = 6.49; A = 0.2; M = 6.57; P = 3.63. The VAMP protocol showed a high degree of internal consistency and test-retest reliability for the V, M, P domains (Spearman's correlation coefficient = 0.916-0.646; < 0.05) and 98.7% of participants fulfilled the VAMP criteria (V, M, P score ⩾ 3) for PFM overactivity. The swab test was negative in 3.9%, a CSI score > 40 was found in 53.7% of participants with a significant correlation for M (Spearman's correlation coefficient = 0.210; < 0.05) and P (Spearman's correlation coefficient = 0.209; < 0.05) in VAMP.

CONCLUSIONS

The VAMP confirmed the presence of a painful vestibule, PFM, and paraurethra under pressure. The VAMP protocol was successfully cross-validated and effective in discriminating women with PFM overactivity, confirmed in almost all patients with vulvodynia. Half of the participants met the criteria for CS. The correlation between CSI and PFM pain on pressure suggests a central pain mechanism. The VAMP is a simple, rapid quantitative diagnostic tool.

REGISTRATION

ClinicalTrials.gov ID NCT05955313 Registered on June 6, 2023.

摘要

背景

盆底肌肉（PFM）过度活跃是外阴痛患者疼痛的一个来源。外周敏化也可能导致中枢敏化（CS）。

目的

本研究旨在验证外阴、肛门、肌肉和尿道旁组织（VAMP）方案作为一种诊断工具，用于评估外阴痛中PFM过度活跃情况，并与中枢敏化量表（CSI）相关联。

设计

本研究是一项正在进行的随机临床试验的次要结果，按照CONSORT指南报告。使用临床问题的人群干预对照结局模型确定纳入标准和研究目标。

方法

VAMP方案包括对外阴（V）、肛门（A）进行棉拭子试验检查，以及在进行内部检查时对盆底肌肉（M）和尿道旁组织（P）进行检查并评估疼痛。通过与棉拭子试验比较以及与CSI评分的相关性来验证VAMP。

结果

在152名绝经前参与者中，91.6%患有激发性/混合性外阴痛，8.4%为自发性，61.3%为局限性亚型，38.7%为广泛性亚型。VAMP平均得分分别为：V = 6.49；A = 0.2；M = 6.57；P = 3.63。VAMP方案在V、M、P领域显示出高度的内部一致性和重测信度（Spearman相关系数 = 0.916 - 0.646；P < 0.05），98.7%的参与者符合PFM过度活跃的VAMP标准（V、M、P评分⩾3）。棉拭子试验阴性率为3.9%，53.7%的参与者CSI评分>40，在VAMP中M（Spearman相关系数 = 0.210；P < 0.05）和P（Spearman相关系数 = 0.209；P < 0.05）有显著相关性。