Vestibular Anesthesia Test: Assessment of Localized Provoked Vestibulodynia

S Ponce, V Chauhan, M Davide, J Conrado, C Doshi, R Rubin, J Yih

Vulvodynia, Female Sexual Dysfunction, Vestibulodynia, Clinical Evaluation

Description of video (249/300 words): The vestibular anesthesia test helps clinicians differentiate the etiology of vestibulodynia. A positive result supports a clinical diagnosis of localized provoked vestibulodynia.1,2 This test builds on the cotton-swab test, a simple diagnostic tool used to identify and diagnose vestibulodynia. Vestibulodynia can be localized to specific clock-face regions of the vestibule, where 12:00 o’clock is just inferior to the clitoral frenulum and 6:00 o'clock is just superior to the posterior fourchette. The vestibule is bordered by Hart's line and lies external to the mesodermal vagina. A moist cotton swab is lightly brushed against each clock-face region while the patient reports pain severity on a scale from 0 to 10. Posterior pain at the 4:00, 6:00, and 8:00 o'clock regions may indicate referred pain due to hypertonic pelvic floor muscles. Pain in the anterior region, with or without posterior pain, suggests a diagnosis of localized provoked vestibulodynia. To conduct the vestibular anesthesia test, a topical anaesthetic is applied to the entire vestibule. The recommended formulation is benzocaine-lidocaine-tetracaine to maximize mucosal absorption. The cotton-swab test is then repeated. If pain scores decrease in a clinically significant manner, a diagnosis of localized provoked vestibulodynia may be made. Hormonal serology should also be performed to rule out hormonally mediated vestibulodynia.3 For perimenopausal patients, vaginal estrogen and DHEA may be given empirically to assess for Genitourinary Syndrome of Menopause.4,5

None.

The authors have nothing to disclose

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