Women without vulvodynia can have a positive 'Q-tip test': a cross sectional study

• Published in: Journal of psychosomatic obstetrics and gynaecology 2017-10, Vol.38 (4), p.256-259
• Main Authors: Vieira-Baptista, Pedro, Lima-Silva, Joana, Beires, Jorge, Donders, Gilbert
• Format: Article
• Language: English
• Subjects: Adult; Cross-Sectional Studies; Female; Humans; Middle Aged; pain; Pain - physiopathology; Pain Measurement - methods; Q-tip test; Surveys and Questionnaires; vulva; Vulva - physiopathology; Vulvodynia; Vulvodynia - diagnosis; Vulvodynia - physiopathology
• ISSN: 0167-482X; 1743-8942
• DOI: 10.1080/0167482X.2017.1327519

Background: Vulvodynia is a frequently missed pathology, often confused with vaginismus. The Q-tip test (QTT) is fundamental for the diagnosis; however, there is lack of data about its performance in asymptomatic women. Objective: This study intended to evaluate the QTT for painful vestibular spots in asymptomatic women. Methods: Q-tips were gently pressed at different areas of the vulvar vestibule to obtain a 0-10 score representing the pain felt. This was performed in 267 consecutive patients presenting to the gynecology outpatient clinic for reasons other than vulvovaginal complaints. A questionnaire was done to evaluate the possibility of unrecognized vulvodynia. Results: Out of the 267 women, 18 (6.7%) fitted the diagnosis of vulvodynia and were excluded from the analysis. Of the remaining 249, 41 (16.5%) had a positive QTT. We could not find differences in the sexual activity rate between women with and without a positive QTT. No demographic differences could be found between the two groups. Only depression was more common in women with a positive QTT [31.7% (13/41) versus 10.8% (21/208), p=.001). Conclusions: Asymptomatic women can have painful vestibular spots in the absence of vulvodynia. A positive QTT cannot be considered equivalent to vulvodynia, highlighting the need for extensive workup of these women before that diagnosis can be assumed.