A Morpho-Functional Assessment of the Vulvar Vestibule in Patients With Vestibulodynia: A Case-Control Study

Objective: The aim of the study was to investigate the morpho-functional characteristics of the vulvar vestibule in women with provoked vestibulodynia (PVD), comparing clinical, structural, and sensory parameters with healthy controls. Materials and methods: This was a case-control study including 30 women diagnosed with PVD and 30 healthy controls. The following morpho-functional characteristics were considered: (i) vestibular trophism, (ii) vestibular epithelial thickness, (iii) pelvic floor muscle hypertonia, and (iv) vestibular current perception threshold evaluation, at 3 frequencies (2000 Hz, 250 Hz, and 5 Hz). Fisher's exact test and Mann-Whitney U test were used to compare parameters between PVD cases and healthy controls, while Pearson's correlation coefficient was calculated to assess vestibular trophism and epithelial thickness with neurosensitization. Results: PVD patients compared to healthy controls showed higher vestibular trophism health score (6.5 vs 3.0, p < .001), lower epithelial thickness (987.0 vs 1159.0 μm, p < .001), more frequently hypertonia of pelvic floor muscle (p < .001), and lower thresholds at neurosensitization at all three frequencies. A linear negative correlation emerged between vestibular trophism health score and current perception threshold at 5 Hz (r = -0.53, p = .003) and 250 Hz (r = -0.45, p = .013) in PVD cases. No significant correlation emerged for controls and for both groups for current perception threshold at 2000 Hz. Conclusions: This study identified substantial organic differences between PVD patients and healthy controls in critical parameters, such as vestibular trophism, epithelial thickness, pelvic floor muscle hypertonia, and neurosensitization. These findings enhance understanding of the complex and multifactorial mechanisms underlying PVD and highlight potential therapeutic targets for intervention.