The Vaginal Penetration Skills Scale (VPSS): a paradigm shift in genito-pelvic pain/penetration disorder screening, assessment, and stratification

Background: Receptive vaginal penetration skills have been implicated in the etiology, explanatory models, and treatment of genito-pelvic pain penetration disorder (GPPPD). However, there are no psychometric skills measures designed to screen, assess, and stratify GPPPD. Aim: We aimed to develop and psychometrically evaluate a new scale-the Vaginal Penetration Skills Scale (VPSS)-to screen, assess, and stratify GPPPD. Methods: This study included 148 Brazilian females with GPPPD symptoms (113 lifelong and 35 acquired) and 251 Brazilian females without sexual complaints. We conducted factor analyses considering all participants (n =399). Then, we conducted latent class analysis within the GPPPD group to identify clusters of individuals with similar VPSS profiles. We assessed convergent validity through intercorrelation with the Brazilian versions of the Female Genital Self-Image Scale (FGSIS) and the 6-item Female Sexual Function Index (FSFI-6). Outcomes: We developed complete and short-form versions of the VPSS (VPSS-29 and VPSS-SF11, respectively), each with 3 dimensions, to screen, assess, and stratify GPPPD. Results: Factor analysis yielded a 3-factor VPSS model with the "Nonsexual Genital Self-Exploration," "Nonsexual Vaginal Penetration Skills," and "Sexual Vaginal Penetration Skills" dimensions for both VPSS versions. The reliability was excellent for the VPSS-29 (omega =0.981, alpha =0.981) and the VPSS-SF11 (omega =0.959, alpha =0.961). All 3 dimensions could detect significant differences between patients with GPPPD and healthy females. They also differentiated the patients with GPPPD, distinguishing gradient levels. For convergent validity, we found moderate to strong correlations (rho=0.715-0.745) between the VPSS, FGSIS, and FSFI-6. Clinical Implications: The VPSS can be applied easily in both clinical and research settings. Strengths and Limitations: The VPSS provides a concise and thorough evaluation of receptive vaginal penetration skills in both sexual and nonsexual contexts among patients with GPPPD. The sample had limited diversity regarding gender and sexual orientation; therefore, it is important to validate the use of this scale in populations beyond the cisgender heterosexual female population to ensure its applicability in diverse settings. Conclusion: These results support the reliability and psychometric validity of the VPSS as a self-report measure to screen, assess, and stratify GPPPD symptoms.