ABSTRACT

Vulvodynia is a functional chronic pain disorder. The etiology is unclear, although pelvic floor muscle (PFM) dysfunction is suspected as one of the main causes of vulvar discomfort. There are no standardized techniques for the quantification of pain arising from PFM overactivity. The severity of pain can be ascertained by examining four anatomical regions. The two external regions are examined using the cotton swab test, first around the vestibule of the vulva (V), and the second around the anus (A). The two internal regions, both of which are examined bilaterally using digital palpation, include the levator ani muscles (M) and the paraurethral area (P). For simplicity, only one maximum pain score was recorded for each given area, using the numerical rating scale (NRS). The four scores are then recorded under the VAMP acronym. Three of the regions (VMP) may be painful on application of pressure in vulvodynia women. Based on these findings a physical examination schedule is proposed for women presenting with vulvodynia. Confirmation of PFMs dysfunction is essential for conservative management of pain involving pelvic floor physical therapy, general myofascial therapy and biofeedback. The introduction of the VAMP protocol for vulvodynia cases is outlined on the basis of recent literature.