The diagnosis and treatment of vulvovaginal pain disorders are progressing through the advancement of intravaginal surface electromyography (SEMG). In a new article published in the latest Biofeedback, these developments are discussed by Howard I. Glazer, a clinical associate professor of Psychology in Psychiatry at Weill College of Medicine at Cornell University and New York Presbyterian Hospital. Glazer has contributed substantial research in the field.
Vulvodynia is a descriptive term covering a wide range of disorders in which there is pain in the vulvar area. Vulvovaginal discomfort includes vaginal infections, hormonal changes, dermatomes, venereal disease, oncological disease, and trauma. Discomfort comes from irritants, including soaps, detergents, and topical vulvar preparations used to treat some of the above conditions.
Vulvodynia can be diagnosed by exclusion of identifiable organic pathology.
With this limited overview of the sources of irritative symptoms, it is necessary to have a complete diagnostic workup with medical treatment before any biofeedback intervention is considered.
“In no other area of biofeedback practice is it more important to rule out all organic causes for the symptoms prior to commencing treatment and to treat patients only under referral from a specialty physician, not on self-referral,” Glazer said.
In treatment, patients have the option of using the “Glazer” protocol for pelvic floor muscle evaluation, which is a five-segment evaluation sequence integrated with SEMG. Glazer first published his research of the protocol in 1995. In the study, there was more than a 50 percent cure rate with an average self-reported improvement of 83 percent. Eighty percent of sexually abstinent patients resumed regular intercourse.
Subsequent studies followed. In 2000, Glazer found that 3 to 5 years after successful treatment, 100 percent of those studied remained completely asymptomatic with no reports of either vulvar dysesthesia or introital dyspareunia. Unexpectedly however, measures of sexual interest, frequency, and satisfaction did not fully return to presymptomatic levels. It was concluded that full treatment must include not only pain relief, but also psychosexual rehabilitation.
The collected research has shown that free-form observations of SEMG-with or without direct pelvic muscle palpation-do not comprise an adequate evaluation. Replicable protocols that are applied to the patient over time are necessary to assess progress.
Revision date: June 21, 2011
Last revised: by Jorge P. Ribeiro, MD