Best practice in vulvodynia—an evidence-based literature review
Botta, D1; Tripodi, F1; Rossi, V1
1: Institute of Clinical Sexology, Italy
Objectives: The International Society for the Study of Vulvovaginal Diseases (ISSVD) defines vulvodynia as chronic pain or discomfort involving the vulva for more than 3 months in the absence of an underlying disease. To deal with this condition is a challenge for professionals and although many options have been evaluated, to date a “gold standard” treatment is still not identified. Therefore, the aim of this work was to investigate which are the available treatments and their effectiveness, in order to identify the best practice in vulvodynia cases.
Materials and Methods: A review of PubMed, Medline, EBSCO, Cochrane Library, Schopus and Web of Science databases from 2012 to 2017 was performed. Treatments were divided into the following categories: medical treatments, both topical and systemic; physical therapies, desensitization with dilators, electrical stimulation (TENS), electromyographic biofeedback, radiofrequency and neurostimulation procedures, and combined physical therapy programs; psychological therapies (CBT, RCT); combined treatments; surgical treatments included vestibulectomy, modified vestibulectomy, and laparoscopic surgeries.
Results: Topical and systemic medical treatments have generally been found to lead to an improvement in pain but not to total disappearance. Physical therapies, especially TENS, have produced pain relief and sexual functioning improvement. Psychological therapies, especially CBT, have been shown to be promising treatments, supporting a biopsychosocial approach to sexual pain disorders. Surgical procedures have demonstrated success rates, even if there has been variability in complete pain relief after surgery. However, being surgery an invasive treatment, it has been considered as the last option.
Conclusions: Although most of the interventions described have been reported as effective, no single treatment is successful for all patients; therefore, management must be individualized. Optimal early treatment (soon after diagnosis) may prevent chronic pain and reduce associated sexual, psychological and relationship distress. Treatment plan should be tailored considering the effectiveness for the type of pain and the medical/sexual/psychosocial history of the patient, choosing from the less to the more invasive options. The outcomes should be assessed considering the framework of IMMPACT recommendations for chronic pain clinical trials. Based on the results of our study, the best practice in vulvodynia management should include the combined efforts of several specialties, in the context of a multidisciplinary approach.
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