Electromyography and vaginal pressure of the pelvic floor muscles in women with recurrent vulvovaginal candidiasis and vulvodynia.

OBJECTIVE: To evaluate the electrical potentials and pressure exerted by the pelvic floor muscles in women with recurrent vulvovaginal candidiasis (RVVC) or vulvodynia as compared to control women. STUDY DESIGN: A cross-sectional study performed in the Female Outpatient Clinic of Genital Infections in the Department of Obstetrics and Gynecology of the Universidade Estadual de Campinas analyzed and compared electromyography (EMG) and vaginal pressure of the pelvic floor muscles in 61 women. Of these 61 women, 19 had vulvodynia, 12 had RVVC and 30 women had no disorder (control group). For data collection, the instrument used was the Miotool Uro device and its software Biotrainer (Miotec Ltd., Porto Alegre, Rio Grande do Sul, Brazil). RESULTS: The EMG evaluation of the pelvic floor muscles showed significantly lower values in the vulvodynia group (tonic contractions) and RVVC group (phasic and tonic contractions) when compared to the control group. No significant differences in basal tone EMG and vaginal pressure values at rest or during pelvic floor muscle contractions were found among groups. The maximum time of sustained contraction in patients with RVVC or vulvodynia was significantly lower (p < 0.0001) than in controls. CONCLUSION: Women with vulvodynia and RVVC have more frequent pelvic floor muscle dysfunction than controls when observed by EMG evaluation.

Vulvodinia: un diagnóstico olvidado frente al dolor vulvar / Vulvodynia: unknown etiology of vulvar pain

La vulvodinia es una patología compleja y de difícil tratamiento. Se define como un dolor crónico de la vulva, que puede ser generalizado o localizado. La primera vez que se escribe sobre esta fue en 1889, por Skene. Sin embargo, es sólo hasta 1976, que los miembros de la International Society for Study of Vulvovaginal Diseases, reconocieron el dolor vulvar como una entidad patológica. Se estima una prevalencia de un 15 por ciento, con unas 14 millones de mujeres que lo padecen en EEUU. Generalmente consultan múltiples veces y a diferentes médicos, antes de llegar a un diagnóstico. No existen pruebas específicas, por lo que la clínica y el examen físico son las principales herramientas. Se deben excluir todas aquellas patologías que explican este dolor crónico vulvar. Su etiología es multifactorial, involucrando cambios a nivel de nociceptores, alteraciones de la inervación y la presencia de factores inflamatorios. Sin embargo, no podemos dejar de lado los aspectos psicosexuales, que pueden modular o desencadenar el dolor vulvar, al encontrar un sustrato alterado a nivel de estos tejidos. Basándose en estos aspectos, hoy existen diferentes tratamientos, que son efectivos si los utilizamos asociados y en forma gradual, ya que se potencian entre ellos.

Vulvodynia is a complex pathology and difficult to treat. In 1889 Skene was the first who write about this. However, only until 1976 the members of the International Society for Study of Vulvovaginal Diseases, recognized the vulvar pain as a disease entity. Prevalence estimated at 15 percent with an estimated 14 million women who suffer in the USA. A high number of gynaecologists do not know this diagnosis. For this reason women consult multiple times and to different doctors to reach a diagnosis. There are no specific tests for diagnosis. Finding in the clinical and physical examination are the main tools for this diagnosis. The different pathologies that could explain the presence of a chronic vulvar pain must be excluded. Undoubtedly its aetiology is multifactorial, involving changes in the number of nociceptors and alterations in the innervations, and the presence of inflammatory factors that may be the starting point of this pathology, as it seeks to explain the neuropathic theory. However we can not ignore the psychosomatic theory in explaining the psychosexual disorders as a trigger vulvar pain, in these altered tissues. Based on these aspects there are now treatments that are more or less effective when are gradually associated for better results.