Vulvar vestibulitis syndrome: Reliability of diagnosis and evaluation of current diagnostic criteria

Objective: To assess the reliability of the diagnosis of vulvar vestibuliti s as defined by Friedrich and to evaluate the usefulness of Friedrich's cri teria in the diagnostic process. Methods: In a university hospital, 146 women with dyspareunia had two sets of gynecologic examinations involving vulvar pain ratings, took part in str uctured interviews, and completed the McGill-Melzack Pain Questionnaire. Results: Kappa values for the vulvar vestibulitis diagnosis ranged from 0.6 6 to 0.68 for inter-rater agreement and from 0.49 to 0.54 for test-retest r eliability. Mean vestibular pain ratings ranged from 2.45 at the 12 o'clock site to 7.58 at the 9-12 o'clock site; ratings for all sites correlated si gnificantly between gynecologists. Pain in the labia majora and labia minor a was minimal for both sets of examinations, with mean participant pain rat ings ranging from 0 to 1.49. Gynecologists' erythema ratings did not correl ate significantly with respect to either inter-rater agreement or test-rete st reliability. Of Friedrich's three diagnostic criteria, only tenderness t o pressure within the vulvar vestibule differentiated dyspareunia patients with and without vulvar vestibulitis. In reference to their coital pain, 88 .1% of women with vulvar vestibulitis chose adjectives from the McGill-Melz ack Pain Questionnaire describing a thermal quality, and 86.6% chose adject ives describing an incisive pressure sensation. Conclusion: Vulvar vestibulitis can be reliably diagnosed in women with dys pareunia. Pain is limited to the vulvar vestibule and can be rated and desc ribed in a consistent fashion by these women. Erythema does not appear to b e a useful diagnostic criterion. (C) 2001 by the American College of Obstet ricians and Gynecologists.