On the reliability and validity of physician ratings for vulvodynia and the discriminant validity of its subtypes.

Abstract:  OBJECTIVE: This study aimed to test the reliability and validity of physician ratings in a broadly defined sample of women with vulvodynia and to examine the external validity of the vulvodynia subtypes. DESIGN: Participants were 50 women who were independently diagnosed with vulvodynia by two study gynecologists. Physician ratings corresponding to Friedrich's three criteria for vulvar vestibulitis were taken at the two examinations. Each participant's diagnosis was subtyped as vulvar vestibulitis (VV) or dysesthetic vulvodynia (DV) based upon the physician ratings. Participants completed standardized measures of pain, sexual function, psychological function, and quality of life to examine the discriminant validity of the subtypes. RESULTS: Test-retest reliability for the physician ratings of Friedrich's three criteria was stable for two of the three criteria (i.e., pain on attempted vaginal entry and tenderness to pressure localized within the vulvar vestibule). When these criteria were used to categorize participants as having VV or DV, the subtypes were not statistically different for measures used to examine the discriminant validity of the subtypes. While the distribution of patients changed when premenopausal state was added to the inclusion criteria for VV, the subtypes differed little on the outcome measures. CONCLUSIONS: Findings from the present study suggest that physician ratings for Friedrich's criteria can be operationalized and found to be reliable and valid in a wide range of women with vulvodynia. The absence of differences between subtypes on measures of pain, sexual function, psychological function, and quality of life challenge the clinical significance of these subtypes and support the theory that vulvodynia represents a continuum of chronic vulvar pain rather than two distinct entities.