Exclusive manual perineal rehabilitation with lidocaine 2% gel in the treatment of provoked vestibulodynia: results from a single-arm interventional study

Close, Anne-Françoise; Çulha, Mehmet Gökhan; Albert, Valérie; Valancogne, G.

doi:10.1038/s41443-022-00537-9

Cited by 4 publications

(4 citation statements)

References 42 publications

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“…Among the randomized placebo‐controlled studies (Table 4), the one that evaluated low‐intensity shockwave therapy (LISWT) applied at the introitus showed significant improvement in sexual function 48 . In Table 5, the online ACT program, 17 manual perineal rehabilitation with lidocaine 54 and somatocognitive therapy 56 showed improvements in sexuality. The qualitative study with somatocognitive therapy enabled women to develop a new relationship with their vulvas, so that this body area no longer seems distant or threatening 62 ; positive interference in sexual functioning may be related to this improvement 63 …”

Section: Discussionmentioning

confidence: 99%

“…50 There was no significant reduction in pain after botulinum toxin type A injections. 51,52 Studies presented in Table 5 that examined conservative vulvodynia treatments showed that physical therapy, 53 manual perineal rehabilitation with lidocaine gel, 54 somatocognitive therapy, 55,56 itraconazole treatment, 57 and the online ACT program 17 reduced pain intensity during sexual intercourse and/or during a variety of other activities that cause vulvar pain. Women with vulvodynia refractory to conventional treatment experienced significant improvements in dyspareunia and pain during cotton swab test following botulinum toxin A injections in the m. levator ani.…”

Section: Physical Therapymentioning

confidence: 99%

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Individualized multidisciplinary therapy for vulvodynia

Penteado,

Bonduki,

de Araújo

et al. 2023

J of Obstet and Gynaecol

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ObjectiveThe main objective of this review was to develop strategies for individualizing multidisciplinary therapy for vulvodynia.MethodsWe conducted two literature searches; the first one focused on clinical trials assessing vulvodynia treatments published after the recommendations of the expert committee of the Fourth International Consultation on Sexual Medicine. The second search targeted studies identifying predictive factors and mediators of vulvodynia treatments, published from the earliest date to October 2022.ResultsBased on data from 55 relevant studies, we developed models of individualized multidisciplinary therapy targeting groups of women less responsive to multidisciplinary therapy (characterized by women with higher vulvar pain intensity, impaired sexual functioning, and vulvodynia secondary subtype) and to physical therapy, as an isolated treatment (characterized by women with increased pelvic floor muscle tone and vulvodynia primary subtype). Each individualized multidisciplinary therapy model comprises three components: psychotherapy, medical care, and physical therapy. These components provide distinct therapeutic modalities for distinct subgroups of women with vulvodynia; the women subgroups were identified according to the characteristics of women, the disease, partners, and relationships. Additionally, for women with provoked vestibulodynia who exhibit less benefits from vestibulectomy (such as those with higher levels of erotophobia, greater vulvar pain intensity, and the primary subtype) and encounter resistance to individualized multidisciplinary therapy, we suggest additional conservative treatments before performing vestibulectomy.ConclusionOur study is a pioneer in the development of models that allow the individualization of multidisciplinary therapy for vulvodynia and represents a significant advance in the clinical practice of gynecologists, physiotherapists, and psychologists.

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Section: Discussionmentioning

confidence: 99%

Section: Physical Therapymentioning

confidence: 99%

Individualized multidisciplinary therapy for vulvodynia

Penteado,

Bonduki,

de Araújo

et al. 2023

J of Obstet and Gynaecol

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“…A case series 35 evaluated a combination of pelvic muscle floor therapy (PMFT) and lidocaine 2% gel without a comparator. This study evaluated general wellbeing and health, perceived vulvar pain, sexual function, and pain with vaginal penetration among 45 participants.…”

Section: Descriptive Studies Involving Multiple Interventions/interdi...mentioning

confidence: 99%

Multimodal and Interdisciplinary Interventions for the Treatment of Localized Provoked Vulvodynia: A Scoping Review of the Literature from 2010 to 2023

Rains,

Bajzak,

Miller

et al. 2024

IJWH

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Localized provoked vulvodynia (LPV) is a chronic condition characterized by pain in the vulvar vestibule, which can be provoked by pressure or touch and which is not tied to a clear underlying cause. Research into the etiology of and most appropriate treatment strategy for LPV is still limited. Methods: Using Arksey and O'Malley's model for scoping reviews, we evaluated the research question: what is the current evidence regarding the efficacy/effectiveness of multimodal or interdisciplinary interventions for the treatment of LPV? We collated and analyzed articles from 2010 to 2023 to capture the current research landscape. Results: Our review identified 27 studies, which either compared treatments between classes (eg pharmacologic versus psychologic modalities) or described interdisciplinary treatment programs. We identify several trends in the literature. First, outcome measures are inconsistent between studies, often unvalidated, and may not adequately mirror patient concerns. Second, the absence of appropriate comparator groups in many studies restricts providers' ability to appraise which treatments may be most efficacious. Third, selection bias and demographic homogeneity limit generalizability. Finally, we highlight the need for head-to-head trials of vestibulectomy with other treatments considered first line for vulvodynia management. Conclusion: There is insufficient evidence to suggest the superiority of one treatment modality for LPV relative to others or to recommend a particular interdisciplinary management strategy. Future research should use a head-to-head design where sham control is impossible, incorporate patient-centered outcome measures, and investigate impacts of treatment among diverse samples of LPV patients.

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“…Repeated exposures to topical anesthetic treatment may desensitize the vestibule over time and provide long-term relief in some women (27). Recently, the combination of self-perineal massage plus topical lidocaine 2% improved perceptions of participants general health, vulvar pain, sexual function, and pain with vaginal penetration (28) The nightly application of lidocaine compared to weekly PFPT over 10 weeks each resulted in significant reduction in sexual pain in VBD, however the PFPT effect was greater than nightly lidocaine alone (29). Some clinical limitations of topical lidocaine may be due to the delivery method-lidocaine cream, gel and ointments have a short drug retention time, are associated with messiness and leaking, and have imprecise dosing (16).…”

Section: Film Applicationmentioning

confidence: 99%

Preferred physical characteristics of lidocaine thin film for women with vestibulodynia

Silverstein,

Cromeens,

Rowland

et al. 2023

Front. Pain Res.

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IntroductionVestibulodynia (VBD) is the most common cause of sexual pain in the United States, affecting up to 15% of reproductive-aged women during their lifetime with limited treatment options. The purpose of this study was to describe ideal physical characteristics of a vulvar film designed for insertional sexual pain in sexually active women with VBD.MethodsTwenty women were recruited to participant in one of six, semi-structured 60-minute focus group discussions regarding treatment options for VBD. Heterosexual women, aged 18–51 years old with a diagnosis of vulvodynia, vestibulodynia or insertional dyspareunia fit the inclusion criteria. Those who reported no episodes of vaginal intercourse in the prior 18 months were excluded. A new vulvar film technology loaded with 50 mg of 5% lidocaine was introduced to the group. Participants took part in focus groups on a rolling basis depending on availability. Focus group discussions were audio-recorded and transcribed verbatim. Two study investigators coded the transcripts using inductive coding and merged their respective projects to resolve disagreements. We analyzed data related to each code to develop code clusters and higher-level primary topics regarding device preferences. Data related to each of these primary topics was analyzed to assess the range of participant attitudes and preferences and to identify patterns within each primary topic.ResultsOne hundred and sixteen women were recruited, and twenty women were enrolled. The mean age for the participants was 33.3 years. Most women were educated with at least some college (93%), White (78.6%), married (75%), and had income greater than $100,000 (50%). Analysis of the focus group discussions identified five common topics addressed by participants: desired loaded medication, film size, film shape, film flexibility, and ease and accuracy of use. Concerns across topics included comfort, sexual spontaneity, and efficacy. Interest in loading the device with other acceptable medications or combination with lidocaine was independently noted in 2/6 (33%) of the focus groups.DiscussionMucoadhesive vulvar thin films may be an acceptable drug delivery system for insertional sexual pain for women with VBD.

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Exclusive manual perineal rehabilitation with lidocaine 2% gel in the treatment of provoked vestibulodynia: results from a single-arm interventional study

Cited by 4 publications

References 42 publications

Individualized multidisciplinary therapy for vulvodynia

Individualized multidisciplinary therapy for vulvodynia

Multimodal and Interdisciplinary Interventions for the Treatment of Localized Provoked Vulvodynia: A Scoping Review of the Literature from 2010 to 2023

Preferred physical characteristics of lidocaine thin film for women with vestibulodynia

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