Pharmacological Treatments for Localized Provoked Vulvodynia: A Scoping Review

Bajzak, Krisztina; Rains, Alex; Bishop, Lisa; Swab, Michelle; Miller, Michelle E.; Logan, Gabrielle S.; Jackman, Victoria; Jackman, Liam; Gustafson, Diana L.

doi:10.1080/19317611.2023.2222114

Cited by 3 publications

(10 citation statements)

References 51 publications

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“…This paper focuses on multimodal and interdisciplinary comparisons, while our other manuscripts address pharmacological, physical, and psychological interventions. As was the case in our review of pharmacotherapy, 13 interventions that implied underlying pathology of vulvar pain were excluded, which is consistent with the clinical definition of vulvodynia. 2…”

Section: Strengths and Limitationssupporting

confidence: 76%

“…Several studies also limited participation to individuals reporting dyspareunia during the majority of intercourse attempts. Although scores on CST have been shown to correlate with other pain measures such as dyspareunia, 43 our review of pharmacologic management for LPV 13 demonstrated that improvement in CST did not always coincide with improvement in dyspareunia. Results of this review are consistent with this finding.…”

Section: Discussionmentioning

confidence: 75%

“…Studies focused on a single class of intervention (ie, pharmacological, psychological, and physical modalities) were separated out into multiple publications given the volume of studies and are reported elsewhere. 13 Studies of somatocognitive therapy 14,15 are described in the psychological therapies publication rather than here, as the emphasis of these interventions is on developing conscious bodily awareness and cognitive retraining to change movement and function. Somatocognitive therapy is a unique, psychologically oriented intervention delivered by a group of physiotherapists in Norway.…”

Section: Methodsmentioning

confidence: 99%

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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

Self Cite

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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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Section: Strengths and Limitationssupporting

confidence: 76%

Section: Discussionmentioning

confidence: 75%

Section: Methodsmentioning

confidence: 99%

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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

Self Cite

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“…Since the publication of Andrews' review, 10 no studies have specifically evaluated treatments for LPV with the exception of our review of pharmacological management of LPV. 12 This reveals limited dedicated attention to physical interventions for managing LPV.…”

Section: Introductionmentioning

confidence: 99%

“…Due to the large number of studies and to allow for a thorough discussion of the range of interventions, we divided our findings into four categories to be published separately. 12,13 This paper focuses solely on studies of physical interventions. We highlight interventions that show beneficial effects, discuss gaps in the LPV treatment literature, and provide recommendations for future research.…”

Section: Introductionmentioning

confidence: 99%

Physical Modalities for the Treatment of Localized Provoked Vulvodynia: A Scoping Review of the Literature from 2010 to 2023

Jackman,

Bajzak,

Rains

et al. 2024

IJWH

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Localized provoked vulvodynia (LPV) is a prevalent sexual health condition with significant negative impacts on quality of life. There is a lack of consensus regarding effective management. Methods: We used Arksey and O'Malley's five-step method to identify, collate, and evaluate literature published between 2010 and 2023. The scoping review investigated the efficacy or effectiveness of interventions in the management of LPV. The aim of this paper is to map the literature on the efficacy or effectiveness of physical interventions. Results: The review produced 19 primary studies of physical interventions for LPV. These include acupuncture, laser therapy, physiotherapy, transcutaneous electrical nerve stimulation, low-intensity shockwave therapy, transcranial direct current stimulation, and vestibulectomy. Conclusion:Published studies that investigated a range of physical treatments for LPV showed some positive effects, except for transcranial direct-current stimulation. The remaining modalities demonstrated improved sexual pain and treatment satisfaction, when measured. Findings were mixed for non-sexual pain. There was insufficient evidence to draw conclusions regarding other outcomes. Researchers are encouraged to conduct larger, high-quality studies that sample more diverse patient populations and use patientoriented outcomes to assess effectiveness of physical modalities.

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Psychological modalities for the treatment of localized provoked vulvodynia: a scoping review of literature from 2010 to 2023

Logan,

Gustafson,

Swab

et al. 2024

The Journal of Sexual Medicine

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Introduction Localized provoked vulvodynia is a common sexual health condition for which there is a lack of consensus on effective management, even though it can have a significant negative impact on psychological wellbeing, sexual functioning, and quality of life for women and their partners. Aim To map the research landscape related to the effectiveness/efficacy of psychological treatments for localized provoked vulvodynia, identify gaps, and make recommendations for future research. Methods We used Arksey and O’Malley’s approach to conducting a scoping review to identify, organize, and summarize research published between 2010 and 2023 that investigated the efficacy or effectiveness of interventions in the management of localized provoked vulvodynia. Inclusion and exclusion criteria and the search strategy were developed by subject experts in collaboration with a health sciences librarian. A PubMed search used controlled vocabulary and keyword terms relating to vulvodynia, which were then translated into other databases. Studies not published in English or French were excluded. We did not consider other subsets of vulvodynia. Articles were uploaded to Covidence, duplicates removed, and titles and abstracts screened. The remaining articles were subject to a 2-person, independent full-text review followed by a hand search of eligible articles. All intervention studies were included regardless of the study design. Study details were reported narratively and analyzed. Main Outcome Measures Of the 88 included articles published between January 2010 and March 2023, 15 reported on the efficacy/effectiveness of psychological treatments for localized provoked vulvodynia, including group educational seminars, cognitive behavioral therapy, acceptance and commitment therapy, and somatocognitive therapy. Results Cognitive behavioral therapy was the most common form of psychological treatment studied (n = 7) with interventions for both individuals and couples. Education about the condition and the therapeutic process was a component of many interventions. Psychological therapies may be of some benefit, but only 1 RCT evaluating the efficacy of acceptance and commitment therapy appeared adequately powered to demonstrate improvement in dyspareunia. Studies sampled homogenous patient populations, primarily consisting of White, urban-dwelling, educated, partnered, heterosexual cis-women. Conclusion Evidence of efficacy/effectiveness, drawn mainly from small studies, is promising and highlights opportunities for more robust studies with heterogeneous populations, more research on the role of education in treatment success, and greater attention to assessing patient-driven outcomes in partnered and unpartnered women.

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Pharmacological Treatments for Localized Provoked Vulvodynia: A Scoping Review

Cited by 3 publications

References 51 publications

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

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

Physical Modalities for the Treatment of Localized Provoked Vulvodynia: A Scoping Review of the Literature from 2010 to 2023

Psychological modalities for the treatment of localized provoked vulvodynia: a scoping review of literature from 2010 to 2023

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