Journal of Pain Research (May 2021)
Mechanically Supporting Uterosacral Ligaments for the Relief of Provoked Vulvodynia: A Randomized Pilot Trial
Abstract
Matan Schonfeld,1 Peter Petros,2 Jacob Bornstein1,3 1Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel; 2University of Western Australia School of Mechanical and Chemical Engineering, Perth, WA, Australia; 3Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, IsraelCorrespondence: Jacob BornsteinDepartment of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, IsraelTel +972-4-9107720Fax +972-4-9001890Email [email protected]: 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.Patients and Methods: 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.Results: 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).Conclusion: Applying mechanical support to the posterior fornix temporarily alleviates provoked vulvar pain in some women.Keywords: vestibulodynia, support structures, referred pain, dyspareunia, vulvar pain, pelvic floor dysfunction
