Abstract Introduction The autonomic nervous system (ANS) is a division of the peripheral nervous system and regulates various involuntary physiological functions, including blood pressure, heart rate, digestion, and sexual arousal. Dysregulation of the ANS may be associated with sexual dysfunction, as vascular dilation, vaginal secretion, and pelvic floor muscle contractions are regulated by the ANS and contribute to normal female sexual functioning. The Composite Autonomic Symptom Score (COMPASS-31) is a validated quantitative measure used to assess autonomic symptoms severity and neurodegenerative system symptoms. COMPASS-31 is composed of six symptom subdomains: orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, and pupillomotor dysfunction. Sexual dysfunction may be measured using two systems, the Female Sexual Function Index (FSFI) and the Sexual Distress Scale (SDS). Objective The objective of this study is to quantify autonomic dysfunction in the context of genito-pelvic pain conditions. Methods New gynecology patients presenting to two vulvar pain clinics between April 2025 and September 2025 (N = 289) completed the COMPASS-31, Female Sexual Function Index (FSFI), and sexual distress scale (SDS). Charts were analyzed after their initial visit for sexual pain and vulvar dermatologic diagnoses. Patients with vulvar dermatoses, those not yet evaluated in a visit, and those under 18 years of age were excluded from the study. Of the remaining 171 patients, all 171 completed the COMPASS-31, 158 completed the SDS, 149 completed the FSFI, and 149 completed the 5-point hypermobility screening questionnaire (5HQ). The average age of the patients was 37.1 ± 13.93. Descriptive statistics were used to compare diagnostic groups. Results All diagnostic groups, excluding vestibulodynia and candidiasis, showed moderate-to-severe autonomic dysfunction, indicated by a mean COMPASS-31 score of greater than or equal to 20: hypertonic pelvic floor dysfunction (HPFD) (20.4 ± 14.19), pudendal neuralgia (22.3 ± 14.95), labral tears (23.92 ± 17.16), lumbar radiculopathy (43.67 ± 15.40), hypermobility (21.9 ± 15.78), hypermobile Ehlers-Danlos syndrome (hEDS) (40.0 ± 16.31), and endometriosis (28.8 ± 17.22) (Fig. 1). Patients with diagnoses of lumbar radiculopathy and hEDS had the highest levels of overall autonomic dysfunction. Differences were observed across diagnostic groups within the orthostatic intolerance, secretomotor dysfunction, and gastrointestinal dysfunction domains, with the highest dysfunction rates seen in lumbar radiculopathy and hEDS (Fig. 2). Conclusions Autonomic dysfunction is relatively common among patients with genito-pelvic pain conditions. The findings suggest there is an association between autonomic dysfunction and vulvovaginal and genito-pelvic pain conditions that should be further explored. Disclosure No.
Hahn et al. (Sun,) studied this question.