Pelvic Floor Myofascia: A New Player Involved in Vulvodynia
Condition: Healthy; Vulvodynia
MeSH terms: Vulvodynia
Study type: Observational

Summary: 
      This study aims to develop novel ultrasound evaluation techniques to characterize the
      different pelvic myofascial tissues and to examine the intra- and inter-rater reliability of
      these techniques (objective 1). Moreover, the potential contribution of the pelvic myofascial
      tissues to the etiology of provoked vestibulodynia will be investigated by comparing the
      ultrasound data of women with provoked vestibulodynia to that of asymptomatic controls
      (objective 2). Women interested in participating in the study will contact the research
      assistant for a screening interview over the phone. Eligible women will then be invited to
      take part in a pelvic floor ultrasound assessment session at the Urogynecology Research
      Laboratory. For the first objective, asymptomatic controls will be evaluated by two
      independent physiotherapists with an expertise in pelvic floor rehabilitation. Intra- and
      inter-rater reliability of ultrasound data will be analyzed. For the second objective,
      asymptomatic controls and women with a diagnosis of provoked vestibulodynia will be evaluated
      by an expert physiotherapist specialized in pelvic floor rehabilitation. Differences in
      ultrasound data between the two groups will be analyzed.
    

Detailed description: 
      Vulvodynia, chronic vulvar pain, is identified as a neglected condition by the World Health
      Organization and the National Institutes of Health. This is explained by a poor understanding
      of the pathology and compromised diagnosis, leading to poor therapeutic management and a lack
      of effective treatment options. Provoked vestibulodynia, characterized by pain at the entry
      of the vagina elicited by pressure and penetration, is the leading subtype of vulvodynia.
      Recent scientific advances have highlighted the importance of the pelvic floor muscles and
      the potential role of the surrounding connective tissues (the fascias). Therefore, a new
      potential contributor is emerging in the etiology of provoked vestibulodynia, namely the
      pelvic myofascial tissues. The first objective of this study is to develop transperineal
      ultrasound evaluation techniques (B-mode and ultrasound elastography/shearwave) to assess the
      morphometry (thickness) and viscoelasticity (shear strain and shear elastic modulus) of the
      pelvic myofascial tissues and to examine the intra- and inter-rater reliability in
      asymptomatic controls. The second objective of this study is to examine the potential
      contribution of the pelvic myofascial tissues to the etiology of provoked vestibulodynia. To
      do this, morphometric (thickness) and viscoelastic (shear strain and shear elastic modulus)
      ultrasound imaging features of the pelvic myofascial structures will be compared in women
      with provoked vestibulodynia and asymptomatic controls. The association between ultrasound
      data and clinical characteristics will also be investigated. The clinical characteristics
      will include self-administered psychosexual questionnaires.
    

Intervention name(s): Ultrasound evaluation
Intervention type(s): Other
Intervention description(s): A single transperineal ultrasound assessment session
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Asymptomatic controls (without any vulvar pain) and women suffering from provoked
        vestibylodynia (moderate to severe pain for at least 90% of the time when engaging in or
        attempting sexual intercourse) are being recruited.
      
Keywords: Fascia; Pelvic floor; Provoked vestibulodynia; Pain; Sexual dysfunctions; Ultrasound