{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T17:39:56Z","timestamp":1757612396355,"version":"3.44.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2025,7,20]],"date-time":"2025-07-20T00:00:00Z","timestamp":1752969600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Generalitat Valenciana in Programa para la promoci\u00f3n de I\u2009+\u2009D\u2009+\u2009i","award":["ACIF\/2021\/012","AICO\/2021\/126"],"award-info":[{"award-number":["ACIF\/2021\/012","AICO\/2021\/126"]}]},{"name":"Merz Pharma GmbH & Co"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Findings on vulvodynia-associated alterations in the pelvic floor muscles\u2019 (PFMs\u2019) myoelectrical activity are contradictory, and no study has yet assessed whether they influence treatment outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>To characterize vulvodynia-associated alterations in PFM activity and assess its potential to predict the response to botulinum toxin type A (BoNT\/A) treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This prospective, non-masked, and non-randomized study recruited 35 vulvodynia patients who underwent BoNT\/A injections and 35 healthy women. Their left and right PFM activity was monitored by surface electromyography (sEMG) with 2 recording modalities (intravaginal probe and external electrodes) during PFM contractions and rest and compared across groups at baseline. Clinical information was also collected from their medical history, pelvic physical examination, and self-informed clinical questionnaires. Both sEMG and clinical features were used to predict the patient\u2019s response to treatment using multiple binary logistic regression models.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcomes<\/jats:title>\n                  <jats:p>sEMG signals\u2019 root mean square (RMS), median frequency (MDF), sample entropy (SampEn), intramuscular and intermuscular magnitude-squared coherence (mscoh) and imaginary part of their coherency (iCOH), and clinical outcomes (sociodemographic, obstetric, gynecological, urological, and other general clinical characteristics; painful comorbidities; pelvic and vulvar pain sensitivity; Patient\u2019s Global Impression of Improvement).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Vulvodynia patients exhibited significantly lower intensity during contractions (&amp;lt;RMS, P\u00a0=\u2009.003) and altered intramuscular coupling (&amp;gt;mscoh) during contractions (P\u00a0=\u2009.004) and rest (P\u00a0=\u2009.006) in the myoelectrical activity of their left superficial PFM (sEMG from external electrodes) and altered intermuscular coupling during contractions (&amp;gt;mscoh, P\u00a0=\u2009.004) in their deep PFM (sEMG from intravaginal probe) than healthy women. Furthermore, intramuscular coupling at rest was significantly associated with response to treatment (P\u00a0&amp;lt;\u2009.01) and predicted it accurately when combined with clinical information (AUC\u2009=\u20090.95).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Implications<\/jats:title>\n                  <jats:p>PFM sEMG can provide valuable insights into vulvodynia pathophysiology and help optimize treatment selection, potentially reducing the economic and psychological impact of ineffective treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Strengths and Limitations<\/jats:title>\n                  <jats:p>This study provides a reliable and comprehensive description of PFM myoelectrical activity alterations in vulvodynia conditions, demonstrating for the first time that sEMG information can improve the prediction of treatment response. It is limited by a small sample size of intravaginal probe recordings due to pain elicited by probes during their insertion and signal quality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Vulvodynia is associated with decreased activity intensity in the superficial PFM and altered electrical coupling, as shown by sEMG, which can enhance the precision of BoNT\/A treatment response prediction and thus reduce the economic and psychological burden of ineffective treatment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jsxmed\/qdaf171","type":"journal-article","created":{"date-parts":[[2025,7,20]],"date-time":"2025-07-20T05:32:18Z","timestamp":1752989538000},"page":"1594-1603","source":"Crossref","is-referenced-by-count":0,"title":["Novel insights of vulvodynia pathophysiology from reliable and comprehensive pelvic floor muscle surface electromyography characterization: can it help predict response to botulinum toxin treatment?"],"prefix":"10.1093","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2099-4626","authenticated-orcid":false,"given":"Monica","family":"Albaladejo-Belmonte","sequence":"first","affiliation":[{"name":"Centro de Investigaci\u00f3n e Innovaci\u00f3n en Bioingenier\u00eda, Universitat Polit\u00e8cnica de Val\u00e8ncia , 46022 Valencia ,","place":["Spain"]},{"name":"Escuela Politecnica Superior, Universidad San Pablo-CEU, CEU Universities , 28668, Alcorcon, Madrid ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paula","family":"Villa-Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Servicio de Obstetricia y Ginecolog\u00eda, Hospital Universitario y Polit\u00e9cnico La Fe de Valencia , 46026 Valencia ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco Jose","family":"Nohales-Alfonso","sequence":"additional","affiliation":[{"name":"Servicio de Obstetricia y Ginecolog\u00eda, Hospital Universitario y Polit\u00e9cnico La Fe de Valencia , 46026 Valencia ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Blanca","family":"Novillo-Del \u00c1lamo","sequence":"additional","affiliation":[{"name":"Servicio de Obstetricia y Ginecolog\u00eda, Hospital Universitario y Polit\u00e9cnico La Fe de Valencia , 46026 Valencia ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose","family":"Alberola-Rubio","sequence":"additional","affiliation":[{"name":"Sonda Devices S.L. , IVIRMA Global Research Alliance, 46004, Valencia ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1410-2721","authenticated-orcid":false,"given":"Javier","family":"Garcia-Casado","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n e Innovaci\u00f3n en Bioingenier\u00eda, Universitat Polit\u00e8cnica de Val\u00e8ncia , 46022 Valencia ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,7,20]]},"reference":[{"issue":"2","key":"2025090408013636600_ref1","doi-asserted-by":"publisher","first-page":"328","DOI":"10.3390\/life13020328","article-title":"Chronic vulvar pain and health-related quality of life in women with vulvodynia","volume":"13","author":"Patla","year":"2023","journal-title":"Life"},{"issue":"4","key":"2025090408013636600_ref2","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1185\/03007995.2012.666963","article-title":"Economic burden and quality of life of vulvodynia in the United States","volume":"28","author":"Xie","year":"2012","journal-title":"Curr Med Res Opin"},{"key":"2025090408013636600_ref3","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1016\/j.jad.2023.10.025","article-title":"Assessment of anxiety, depression and somatization in women with vulvodynia: a systematic review and META-analysis","volume":"344","author":"Dagostin Ferraz","year":"2024","journal-title":"J Affect Disord"},{"issue":"4","key":"2025090408013636600_ref4","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1016\/J.JSXM.2016.02.167","article-title":"2015 ISSVD, ISSWSH, and IPPS consensus terminology and classification of persistent vulvar pain and vulvodynia","volume":"13","author":"Bornstein","year":"2016","journal-title":"J Sex Med"},{"issue":"12","key":"2025090408013636600_ref5","doi-asserted-by":"crossref","first-page":"6639","DOI":"10.3390\/ijerph18126639","article-title":"Vulvodynia\u2014it is time to accept a new understanding from a neurobiological perspective","volume":"18","author":"Torres-Cueco","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2025090408013636600_ref6","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","author":"American Psychiatric Association","year":"2013","edition":"5th"},{"key":"2025090408013636600_ref7","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1002\/9781119755173.ch36","volume-title":"Vulvodynia \u2013 Pathophysiology and Clinical Features","author":"Bohm-Starke","year":"2022"},{"key":"2025090408013636600_ref8","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1007\/978-3-030-40862-6_75","volume-title":"Pelvic Floor Disorders: A Multidisciplinary Textbook","author":"Jantos","year":"2020"},{"issue":"3","key":"2025090408013636600_ref9","first-page":"157","article-title":"Establishing the diagnosis of vulvar vestibulitis","volume":"42","author":"White","year":"1997","journal-title":"J Reprod Med"},{"issue":"11","key":"2025090408013636600_ref10","first-page":"959","article-title":"Electromyographic comparisons of the pelvic floor in women with dysesthetic vulvodynia and asymptomatic women","volume":"43","author":"Glazer","year":"1998","journal-title":"J Reprod Med"},{"issue":"2","key":"2025090408013636600_ref11","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1080\/01443610400023106","article-title":"Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome","volume":"26","author":"Reissing","year":"2005","journal-title":"J Psychosom Obstet Gynecol"},{"issue":"3-4","key":"2025090408013636600_ref12","first-page":"141","article-title":"Electromyography and vaginal pressure of the pelvic floor muscles in women with recurrent vulvovaginal candidiasis and vulvodynia","volume":"57","author":"Polpeta","year":"2012","journal-title":"J Reprod Med"},{"issue":"10","key":"2025090408013636600_ref13","doi-asserted-by":"publisher","first-page":"1467","DOI":"10.1007\/s00192-015-2660-6","article-title":"Pelvic floor muscle function in women with provoked vestibulodynia and asymptomatic controls","volume":"26","author":"N\u00e6ss","year":"2015","journal-title":"Int Urogynecol J"},{"issue":"4","key":"2025090408013636600_ref14","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1016\/j.jsxm.2017.02.012","article-title":"Heightened pelvic floor muscle tone and altered contractility in women with provoked Vestibulodynia","volume":"14","author":"Morin","year":"2017","journal-title":"J Sex Med"},{"issue":"2 Pt 2","key":"2025090408013636600_ref15","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.1111\/J.1743-6109.2009.01642.X","article-title":"Pelvic floor muscle assessment outcomes in women with and without provoked vestibulodynia and the impact of a physical therapy program","volume":"7","author":"Gentilcore-Saulnier","year":"2010","journal-title":"J Sex Med"},{"issue":"6","key":"2025090408013636600_ref16","doi-asserted-by":"publisher","first-page":"2225","DOI":"10.3390\/S21062225","article-title":"Characterization of pelvic floor activity in healthy subjects and with chronic pelvic pain: diagnostic potential of surface electromyography","volume":"21","author":"Albaladejo-Belmonte","year":"2021","journal-title":"Sensors"},{"key":"2025090408013636600_ref17","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000003554","article-title":"Gamma-band intermuscular connectivity is associated with increased neural drive to pelvic floor muscles in women with interstitial cystitis\/bladder pain syndrome","author":"Houston","year":"2023","journal-title":"J Urol"},{"issue":"1","key":"2025090408013636600_ref18","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1111\/jmwh.13456","article-title":"Evaluation and treatment of vulvodynia: state of the science","volume":"68","author":"Schlaeger","year":"2023","journal-title":"J Midwifery Womens Health"},{"issue":"1","key":"2025090408013636600_ref19","doi-asserted-by":"publisher","first-page":"44","DOI":"10.5114\/pm.2020.95337","article-title":"Aetiology, diagnosis, and clinical management of vulvodynia","volume":"19","author":"Vasileva","year":"2020","journal-title":"Menopausal Rev"},{"issue":"2","key":"2025090408013636600_ref20","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1111\/jog.15829","article-title":"Individualized multidisciplinary therapy for vulvodynia","volume":"50","author":"Penteado","year":"2024","journal-title":"J Obstet Gynaecol Res"},{"issue":"8","key":"2025090408013636600_ref21","doi-asserted-by":"publisher","first-page":"476","DOI":"10.3390\/toxins15080476","article-title":"Treatment of Vestibulodynia with submucosal injections of IncobotulinumtoxinA into targeted painful points: an open-label exploratory study","volume":"15","author":"Villa-Mu\u00f1oz","year":"2023","journal-title":"Toxins (Basel)"},{"issue":"14","key":"2025090408013636600_ref22","doi-asserted-by":"publisher","first-page":"4668","DOI":"10.3390\/S21144668","article-title":"Effect of BoNT\/a in the surface electromyographic characteristics of the pelvic floor muscles for the treatment of chronic pelvic pain","volume":"21","author":"Albaladejo-Belmonte","year":"2021","journal-title":"Sensors"},{"issue":"1","key":"2025090408013636600_ref23","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1080\/25765299.2020.1862985","article-title":"Evaluation of performance fatigability through surface EMG in health and muscle disease: state of the art","volume":"28","author":"Beretta-Piccoli","year":"2021","journal-title":"Arab J Basic Appl Sci"},{"issue":"10","key":"2025090408013636600_ref24","doi-asserted-by":"publisher","first-page":"2046","DOI":"10.1113\/EP089711","article-title":"Physiological complexity: influence of ageing, disease and neuromuscular fatigue on muscle force and torque fluctuations","volume":"106","author":"Pethick","year":"2021","journal-title":"Exp Physiol"},{"key":"2025090408013636600_ref25","doi-asserted-by":"publisher","first-page":"102940","DOI":"10.1016\/j.jelekin.2024.102940","article-title":"Pelvic floor muscle electrical coupling in chronic pelvic pain: insights into pathophysiology and botulinum toxin treatment effects","volume":"79","author":"Albaladejo-Belmonte","year":"2024","journal-title":"J Electromyogr Kinesiol"},{"issue":"1","key":"2025090408013636600_ref26","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1186\/s12884-022-04952-0","article-title":"Risk factors of pelvic floor muscle strength in south Chinese women: a retrospective study","volume":"22","author":"Fang","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"issue":"6","key":"2025090408013636600_ref27","doi-asserted-by":"publisher","first-page":"1511","DOI":"10.1007\/s00192-021-04789-9","article-title":"Surface electromyography of the pelvic floor at 6\u20138 weeks following delivery: a comparison of different modes of delivery","volume":"33","author":"Guo","year":"2022","journal-title":"Int Urogynecol J"},{"issue":"1","key":"2025090408013636600_ref28","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1093\/jsxmed\/qdac002","article-title":"Is there a difference in pelvic floor muscle tone between women with and without pelvic pain? A systematic review and meta-analysis","volume":"20","author":"Kadah","year":"2023","journal-title":"J Sex Med"},{"issue":"1","key":"2025090408013636600_ref29","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.sxmr.2020.04.002","article-title":"The overactive pelvic floor (OPF) and sexual dysfunction. Part 2: evaluation and treatment of sexual dysfunction in OPF patients","volume":"9","author":"Padoa","year":"2021","journal-title":"Sex Med Rev"},{"issue":"2","key":"2025090408013636600_ref30","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1002\/NAU.22529","article-title":"State of the art review: intravaginal probes for recording electromyography from the pelvic floor muscles","volume":"34","author":"Keshwani","year":"2015","journal-title":"Neurourol Urodyn"},{"key":"2025090408013636600_ref31","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3389\/fnhum.2018.00207","article-title":"Coherence of the surface EMG and common synaptic input to motor neurons","author":"Dideriksen","year":"2018","journal-title":"Front Hum Neurosci"},{"issue":"23","key":"2025090408013636600_ref32","doi-asserted-by":"publisher","first-page":"7417","DOI":"10.3390\/s24237417","article-title":"Does muscle pain induce alterations in the pelvic floor motor unit activity properties in interstitial cystitis\/bladder pain syndrome? A high-density sEMG-based study","volume":"24","author":"Albaladejo-Belmonte","year":"2024","journal-title":"Sensors"},{"key":"2025090408013636600_ref33","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1016\/j.nicl.2015.05.013","article-title":"Altered resting state neuromotor connectivity in men with chronic prostatitis\/chronic pelvic pain syndrome: a MAPP","volume":"8","author":"Kutch","year":"2015","journal-title":"Neuroimage Clin"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/22\/9\/1594\/63803360\/qdaf171.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/22\/9\/1594\/63803360\/qdaf171.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T12:01:51Z","timestamp":1756987311000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/22\/9\/1594\/8208280"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,20]]},"references-count":33,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,7,20]]},"published-print":{"date-parts":[[2025,9,4]]}},"URL":"https:\/\/doi.org\/10.1093\/jsxmed\/qdaf171","relation":{},"ISSN":["1743-6095","1743-6109"],"issn-type":[{"type":"print","value":"1743-6095"},{"type":"electronic","value":"1743-6109"}],"subject":[],"published-other":{"date-parts":[[2025,9]]},"published":{"date-parts":[[2025,7,20]]}}}