Objective: Provoked vulvodynia (PV) is the main cause of vulvar pain and dyspareunia. Although its cause is unknown, it is associated with musculoskeletal dysfunction. The inability of lax uterosacral ligaments (USLs) to support the adjoining T11/L2 and S2-4 nerve plexuses is considered to cause PV. We aimed to determine whether mechanically supporting the USLs would reduce PV. Design: Single-blind, randomized, sham, control, prospective, pilot trial Setting: The Department of Obstetrics and Gynecology, Galilee Medical Center, Israel Population or Sample: Seventeen women Methods: PV patients were randomly assigned to two groups. Subjects in each group were exposed to sham manipulation (inserting a wide swab in the vagina without applying pressure) and trial manipulation (supporting the posterior fornix with a wide swab sufficiently broad to mechanically support the USLs). The manipulation order was alternated. Main Outcome Measures: Using a pain intensity scale, the PV-associated pain level experienced by participants was recorded during each manipulation and the results were compared with baseline levels. Results: The pain level significantly reduced with USL support compared with the baseline value and sham manipulation pain level (P = .003). Pain during sham manipulation was not significantly different from that recorded at baseline. The average reduction in pain with USL support was 18.4% ± 2.2%. The manipulation order did not impact changes in pain level during trial manipulation (P = .512). Conclusions: PV is related to pain originating in the USL and musculoskeletal dysfunction.
