Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald

CiteScore 2017: 0.84

SCImago Journal Rank (SJR) 2017: 0.401
Source Normalized Impact per Paper (SNIP) 2017: 0.452

See all formats and pricing
More options …
Volume 18, Issue 2


Pain, psychological distress and motor pattern in women with provoked vestibulodynia (PVD) – symptom characteristics and therapy suggestions

Gro Killi Haugstad
  • Department of Physiotherapy, Faculty of Health Sciences, OsloMet – Oslo Metropolitan University, Oslo, Norway
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Slawomir Wojniusz
  • Department of Physiotherapy, Faculty of Health Sciences, OsloMet – Oslo Metropolitan University, Oslo, Norway
  • Cognitive Health in Trauma and Disease Research Group, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Unni Merete Kirste / Rolf Steinar Kirschner / Ingvild Lilleheie
  • Department of Physiotherapy, Faculty of Health Sciences, OsloMet – Oslo Metropolitan University, Oslo, Norway
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Tor Sigbjørn Haugstad
Published Online: 2018-03-28 | DOI: https://doi.org/10.1515/sjpain-2017-0173


Background and aims:

Provoked vestibulodynia (PVD) represent a longstanding pain syndrome that affects large numbers of women worldwide. However, no standardized guidelines for PVD treatment exist. In a cross-sectional pilot study we examined 30 PVD patients on multidimensional parameters including pain, psychological distress and quality of movement, in order to obtain a broader understanding of the somatic and psychological symptoms in PVD, and for the future to develop better interventions. Additionally, we compare the findings to previously published results regarding the same parameters in women with chronic pelvic pain (CPP).


Thirty women with PVD recruited from a tertiary care university clinic of gynecology were assessed for demographic data, pain intensity (VAS), psychological distress (GHQ-30 and Tampa scale of Kinesophobia) and quality of movement (standardized Mensendieck test, SMT).


Average age of the PVD women was 24.7±3.60 years, 60% of them were in permanent relationships, all were nulliparous, none had been subjected to surgical procedures, 100% were working full or part time and 90% were educated to at least undergraduate level. Mean VAS score was 7.77±1.97 (mean±SD), kinesiophobia 24.4±3.95 and anxiety domain of GHQ-30 9.73±4.06. SMT scores were particularly low for the domains of respiration and gait (less than 50% of optimal scores).


PVD women display reduced quality of movement, especially for gait and respiration patterns, increased level of anxiety and high average pain scores. These findings are similar to what we have previously reported in CPP patients. However, in contrast to CPP group, PVD women are on average younger, have higher work participation, higher education level and have not been subjected to surgical procedures.


Since PVD women display similar, although somewhat less severe, symptom profile than CPP, we suggest that a multidimensional approach to treatment, such as “somatocognitive therapy” should be investigated in this group as it has previously been shown to be promising in treatment of CPP.

Keywords: provoked vestibulodynia; chronic pelvic pain; standardized Mensendieck test; psychological distress; somatocognitive therapy


  • [1]

    Engeler DS, Baranowski AP, Dinis-Oliveira P, Elneil S, Hughe J, Messelink EJ, van Ophoven A, Williams AC, European Association of Urology. EAU guidelines on chronic pelvic pain: is management of chronic pelvic pain a habit, a philosophy, or a science? 10 years of development. Eur Urol 2013;64:431–9.CrossrefGoogle Scholar

  • [2]

    Bornstein J, Goldstein AT, Stockdale CK, Bergeron S, Pukall C, Zolnoun C, Deborah C. 2015 ISSVD, ISSWSH and IPPS consensus terminology and classification of persistent vulvar pain and vulvodynia. J Low Genit Tract Dis 2016;20:126–30.Web of ScienceGoogle Scholar

  • [3]

    Mathias SD, Kupperman M, Liberman RF, Steege JF. Chronic pelvic pain, prevalence health-related quality of life, and economic correlates. Obstet Gynecol 1996;87:332–7.Google Scholar

  • [4]

    Latthe P, Latthe M, Say L, Gulmezoglu, Khan KS. WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health 2006;6:177–89.CrossrefPubMedGoogle Scholar

  • [5]

    Zondervan KT. The community prevalence of chronic pelvic pain in women and associated illness behavior. Br J Gen Pract 2001;51:541–7.PubMedGoogle Scholar

  • [6]

    Ahangari A. Prevalence of chronic pelvic pain among women: an updated review. Pain Physician 2014;17:141–7.Google Scholar

  • [7]

    Howard FM. Chronic pelvic pain. Obstet Gynecol 2003; 101:594–611.PubMedGoogle Scholar

  • [8]

    Loving S, Thomsen T, Jasczak P, Nordling J. Pelvic floor muscle dysfunctions are prevalent in female chronic pelvic pain: a cross-sectional population-based study. Eur J Pain 2014;18:1259–70.CrossrefPubMedWeb of ScienceGoogle Scholar

  • [9]

    Babula O, Danielsson I, Sjoberg I, Ledger W, Witkin J, Steven S. Altered distribution of mannose-binding lectin alleles at exon I codon 54 in women with vulvar vestibulitis syndrome. Am J Obstet Gynecol 2004;191:762–6.PubMedCrossrefGoogle Scholar

  • [10]

    Harlow BL, Vitonis AF, Stewart EG. Influence of oral contraceptive use on the risk of adult-onset vulvodynia. J Reprod Med 2008;53:102–10.PubMedGoogle Scholar

  • [11]

    Falsetta ML, Foster DC, Bonham AD, Phipps RP. A review of the available clinical therapies for vulvodynia management and new data implicating proinflammatory mediators in pain elicitation. Br J Obstet Gynaecol 2017;124:210–8.CrossrefGoogle Scholar

  • [12]

    Morin M, Bergeron S, Khalifé S, Mayrand MH, Binik YM. Morphometry of the pelvic floor muscles in women with and without provoked vestibulodynia using 4D ultrasound. J Sex Med 2014;11:776–85.Web of ScienceCrossrefPubMedGoogle Scholar

  • [13]

    Bohm-Starke N, Hilliges M, Brodda-Jansen G, Rylander E, Torebjork E. Psychophysical evidence of nociceptor sensitization in vulvar vestibulitis syndrome. Pain 2001;94:177–83.CrossrefPubMedGoogle Scholar

  • [14]

    Desrochers G, Bergeron S, Landry T, Jodion M. Do psychosexual factors play a role in the etiology of provoked vestibulodynia? A critical review. J Sex Marital Ther 2008;34:198–226.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [15]

    Petros P, Bornstein R. Vulvar vestibulitis may be a referred pain arising from laxity in the uterosacral ligaments: a hypothesis based on three prospective case reports. Aust N Z J Obstet Gynaecol 2004;44:484–5.CrossrefPubMedGoogle Scholar

  • [16]

    Haugstad GK, Haugstad TS, Leganger S, Kirste UM, Klemmetsen I, Hammel B, Malt UF. Reliability and validity of a standardized Mensendieck physiotherapy test (SMT). J Physiother Theory Pract 2006;22:189–205.CrossrefGoogle Scholar

  • [17]

    Haugstad GK, Haugstad TS, Kirste UM, Leganger S, Wojniusz S, Klemmetsen I, Malt UF. Continuing improvement of chronic pelvic pain in women after short-term Mensendieck somatocognitive therapy. Results of a 1-year follow-up study. Am J Obstet Gynecol 2008;199:615.e1–8.CrossrefWeb of ScienceGoogle Scholar

  • [18]

    Friedreich EG. Vulvar vestibulitis syndrome. J Reprod Med 1987;32:110–4.PubMedGoogle Scholar

  • [19]

    Breivik H, Borchgrevink PC, Allen SM, Rosseland L, Romundstad L, Breivik EK, Kvarstein G, Stubhaug S. Assessment of pain. Br J Anaesth 2008;101:17–24.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [20]

    Roelofs J, van Breukelen G, Sluiter J, Frings-Dresen MHW, Goossens M, Thibault P, Boerma K, Vlayen JWS. Norming of the Tampa Scale for Kinesiophobia across pain diagnoses and various countries. Pain 2011;152:1090–5.Web of SciencePubMedCrossrefGoogle Scholar

  • [21]

    Goldberg D, Williams P. A user’s guide to the General Health Questionnaire. Windsor: NFER-Nelson, 1988.Google Scholar

  • [22]

    Neblett R, Hartzell MM, Mayer TG, Bradford EM, Gatchel RJ. Establishing clinically meaningful severity levels for the Tampa Scale for Kinesiophobia (TSK-13). Eur J Pain 2016;20:701–10.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [23]

    Groven KS, Råheim M, Håkonsen E, Haugstad GK. “Will I ever be a True Woman.” An exploration of the experiences of woman with vestibulodynia. Health Care Women Int 2015;16:1–18.Web of ScienceGoogle Scholar

  • [24]

    Roelofs J, Goubert L, Peters ML, Vlaeyen JW, Crombez G. The Tampa Scale for Kinesiophobia: further examination of psychometric properties in patients with chronic low back pain and fibromyalgia. Eur J Pain 2004;8:495–502.CrossrefPubMedGoogle Scholar

  • [25]

    Feleus A, van Dalen T, Bierma-Zeinstra SMA, Roos-Bernsen S, Verhaar JAN, Koes BW, Miedema HS. Kinesiophobia in patients with non-traumatic arm, neck and shoulder complaints: a prospective cohort study in general practice. BMC Musculoskelet Disord 2007;8:117.Web of SciencePubMedCrossrefGoogle Scholar

  • [26]

    Stockdale CK, Lawson HW. Vulvodynia Guideline update. J Low Genit Tract Dis 2014;18:93–100.Web of SciencePubMedCrossrefGoogle Scholar

  • [27]

    Weijenborg PTM, ter Kuile MM, Gopie JP, Spinhoven P. Predictors of outcome in a cohort of women with chronic pelvic pain – a follow-up study. Eur J Pain 2009;3:768–77.Web of ScienceGoogle Scholar

  • [28]

    Haugstad GK, Haugstad TS, Kirste UM, Leganger S, Klemmetsen I, Malt U. Mensendieck somatocognitive therapy as treatment approach to chronic pelvic pain: results of a randomized controlled intervention study. Am J Obstet Gynecol 2006;194:1303–10.CrossrefPubMedGoogle Scholar

  • [29]

    Haugstad GK, Kirschner R, Fougner M, Lilleheie I, Harttfjord Kvæl L, Kirste UM, Haugstad TS. Vulvodynia treated with somatocognitive therapy in a student outpatient clinic – a preliminary report. Poster and Oral Abstract Presentation 2015 Norwegian Pain Association NOSF Annual Conference, Oslo: Oslo University Hospital.Google Scholar

  • [30]

    Danielsen KG, Dahl-Michelsen T, Håkonsen E, Haugstad GK. Recovering from provoked vestibulodynia: experiences from encounters with somatocognitive therapy. J Physiother Theory Pract 2018 (in press).Web of ScienceGoogle Scholar

About the article

Received: 2017-11-27

Revised: 2018-02-19

Accepted: 2018-02-24

Published Online: 2018-03-28

Published in Print: 2018-04-25

Authors’ statements

Research funding: No specific funding.

Conflict of interest: No conflicts of interest for any of the authors.

Informed consent: Obtained for all participants according to the requirements of the Norwegian Regional Ethics Committee.

Ethical approval: The study has been approved by the Norwegian Regional Ethics Committee (2010-15/1546).

Citation Information: Scandinavian Journal of Pain, Volume 18, Issue 2, Pages 221–227, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1515/sjpain-2017-0173.

Export Citation

©2018 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved..Get Permission

Comments (0)

Please log in or register to comment.
Log in