(194) ACCURACY OF ONLINE PATIENT SELF-DIAGNOSIS OF VAGINISMUS/GENITO-PELVIC PAIN/PENETRATION DISORDER (GPPPD)

Abstract Introduction Vaginismus, or involuntary vaginal pelvic floor muscle spasm, is currently defined within the broader category of GPPPD. An often-ignored pain condition, vaginismus has been reported in 5-17% of women in the US. These estimates, however, may inaccurately reflect the true prevalence, as many women are reluctant to discuss their symptoms with their healthcare provider (HCP) and training of HCPs in addressing sexual disorders is often inadequate. The use of an internet-based diagnostic tool could provide a potential strategy for reaching women with GPPPD and directing care. Web-based interventions have proven beneficial for diagnosing sexual dysfunction, pain (including vulvodynia), and mental health disorders, but the accuracy of self-diagnosing vaginismus specifically has not yet been evaluated in a clinical trial. Objective To determine the accuracy of self-diagnosis of vaginismus using an internet-based tool as compared to clinical evaluation by a HCP. Methods Women seeking treatment at two U.S. private practice sexual medicine clinics, with no previous diagnosis of vaginismus or GPPPD, were invited to view a website listing the diagnostic criteria of vaginismus and report their symptoms to an interviewer as part of a validation study for self-selection of an over-the-counter vaginal dilation device indicated to help relieve the symptoms associated with vaginismus and painful sex. This was followed by an evaluation with a HCP blinded to the self-diagnosis results. Diagnostic concordance was measured by calculating agreement between self-diagnosis and HCP diagnosis using Cohen’s Kappa coefficients. Results Self-diagnosis of vaginismus was made in 38 of the 50 participants who met inclusion criteria (76%). Among the 50 participants, 7 indicated concomitant vulvovaginal symptoms, like abnormal bleeding or skin changes. All participants were evaluated by a HCP, including a pelvic/vaginal examination. Vaginismus was diagnosed by a HCP in 35 of the 38 (92%) participants with a self-reported diagnosis of vaginismus. Of the three participants with a discordant diagnosis, one was diagnosed by the HCP with genitourinary syndrome of menopause, and two participants did not have significant distress from their symptoms. Of the 12 participants who did not self-diagnose vaginismus, one (17%) was diagnosed with vaginismus by the HCP. There was substantial agreement, κ = 0.79 [95%CI .60-.99], between self-diagnosis of vaginismus and HCP diagnosis of vaginismus. Conclusions Our findings demonstrate that self-diagnosis using a web-based list of symptoms for vaginismus can be accurate relative to the diagnosis made by a HCP during a clinical visit. Despite the demonstrated accuracy of self-diagnosis of vaginismus, thorough evaluation by a HCP is critically important: vaginismus is a non-specific disorder of muscle spasm, the underlying causes of which can be multifactorial and require an approach to therapy that addresses the primary etiology of pain. A web-based self-diagnostic tool for vaginismus could shorten the amount of time that it takes patients to get a diagnosis and lead to sooner treatment for this often-ignored pain condition. Disclosure Yes, this is sponsored by industry/sponsor: Materna Medical. Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: Materna Medical.