Vulvodynia—Younger Age and Combined Therapies Associate With Significant Reduction in Self-Reported Pain

Aalto, Anu; Vuoristo, Silja; Tuomaala, Heidi; Niemi, Riikka Johanna; Staff, Synnöve; Mäenpää, Johanna

doi:10.1097/lgt.0000000000000318

Cited by 8 publications

(12 citation statements)

References 20 publications

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“…The preliminary search yielded 2,189 results, of which 999 remained following deduplication. From the remaining studies, the selection process yielded four papers for inclusion in this review ( Figure 1 ) ( 27 , 33 , 35 , 36 ). All studies were observational and retrospective in nature.…”

Section: Resultsmentioning

confidence: 99%

“…If the authors disagreed, a third author (AL) was consulted to reach a decision through discussion. The Newcastle-Ottawa Scale was used to assess the quality of the retrospective cohort study by Aalto et al ( Appendix 1 ) ( 33 , 34 ) The scale is an eight-item assessment tool composed of three domains: selection, comparability, and outcome of the assessed study. There is a maximum of nine stars/points across the three domains: maximum of four for selection, two for comparability and three for outcome.…”

Section: Methodsmentioning

confidence: 99%

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Effectiveness of topical gabapentin in the treatment of vulvodynia: a narrative synthesis

Ergisi,

Law,

Chaudhari

et al. 2023

Front. Pain Res.

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Vulvodynia is a leading cause of dyspareunia in premenopausal women, causing considerable morbidity and sexual dysfunction. A multimodal approach is used to treat vulvodynia. Alongside psychosocial interventions and physiotherapy, pharmacological treatment such as oral gabapentin are used in the treatment of vulvodynia. Topical formulations of gabapentin have shown promise in animal models and case reports investigating its use in other pain conditions. The topical route also avoids the systemic complications of gabapentin such as somnolence, dizziness, and peripheral edema. This study aimed to perform a narrative synthesis of studies investigating the use of topical gabapentin in the treatment of vulvodynia. The primary outcome was a change in pain score following treatment with topical gabapentin. A broad literature search was performed, which identified four studies for inclusion. The included studies reported improved pain measures following treatment; however, conclusions cannot be made due to methodological heterogeneity and inherent limitations. These include lack of control arms, small sample sizes, lack of patient randomization, and use of combination treatments. Due to the paucity of evidence, this review supports the future implementation of double-blind randomized controlled trials to further investigate the efficacy of topical gabapentin in the treatment of vulvodynia.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Effectiveness of topical gabapentin in the treatment of vulvodynia: a narrative synthesis

Ergisi,

Law,

Chaudhari

et al. 2023

Front. Pain Res.

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show abstract

“…Studies evaluating multidisciplinary therapy demonstrated significant improvements in pain, sexual function, and quality of life for women living with vulvodynia. 7,11,13,18,20 However, studies that identified the predictive factors of this therapy outcomes have shown greater pain reduction in patients with primary vulvodynia, 11 T A B L E 2 Prospective and retrospective studies identifying the predictors and moderators of vulvodynia treatment outcomes. women with lower baseline dispareunia, 11 in those with higher baseline sexual functioning, 11 and in women with higher baseline levels of sexual desire.…”

Section: Discussionmentioning

confidence: 99%

“…4,7,15,16 An interesting study investigating an intervention based on Acceptance and Commitment Therapy (ACT) in women living with vulvodynia highlighted the individual variability in participants' responses; no one improved on all outcomes, but each participant improved on different subsets of outcomes. 17 Studies have identified predictive factors and moderators of vulvodynia multidisciplinary treatment outcomes, 7,11,[18][19][20] as well as for the treatments that are part of multidisciplinary therapy. 16,[21][22][23][24][25][26][27][28][29][30][31][32][33] Predictive factors of vestibulectomy outcomes have also been evaluated.…”

Section: Introductionmentioning

confidence: 99%

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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“…Patients treated by a multidisciplinary team are usually offered physiotherapy (including transcutaneous electrical nerve stimulation), sexual counseling and therapy, and psychotherapy. Although a multidisciplinary approach to LPV is recommended, 8,9 it is actually not evidence based. 10 Surgery (vestibulectomy) for LPV is recommended as the ultimate treatment option, if conservative treatments fail or are insufficient in terms of pain reduction.…”

Section: Introductionmentioning

confidence: 99%

Combination of Treatments With or Without Surgery in Localized Provoked Vulvodynia: Outcomes After Three Years of Follow-Up

Aalto

Huhtala

Mäenpää

et al. 2019

BioResearch Open Access

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Most vulvodynia patients receive combinations of several treatment modalities for their chronic painful condition. If conservative treatments fail, vestibulectomy is considered to be the ultimate treatment option for localized provoked vulvodynia (LPV). The aim of this descriptive study was to analyze relief of pain, quality of life (QoL), and complications associated with combining surgery with conservative treatments among LPV patients, both in short term and after 3 years of follow-up.The study population consisted of a retrospective patient cohort of surgically (n = 16) and only conservatively (n = 50) treated LPV patients. QoL data were assessed by a validated questionnaire (RAND-36). Data were collected by reviewing patient records and by aid of postal questionnaires. Efficacy of treatments in relief of pain was measured by numerical rating scale (NRS). Two months after surgery, the NRS scores assessed by a physician were lower in the surgery group than in patients treated only conservatively (p = 0.008). However, after a median of 36 months of follow-up, self-reported NRS scores and QoL showed no difference between the two patient cohorts. Complication rate after vestibulectomy was 18.8%. The findings suggest that combining surgery with conservative treatments may result in a more effective short-term reduction of pain. However, the effect seemed to be only temporary, as no long-term benefit was achieved.

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Vulvodynia—Younger Age and Combined Therapies Associate With Significant Reduction in Self-Reported Pain

Cited by 8 publications

References 20 publications

Effectiveness of topical gabapentin in the treatment of vulvodynia: a narrative synthesis

Effectiveness of topical gabapentin in the treatment of vulvodynia: a narrative synthesis

Individualized multidisciplinary therapy for vulvodynia

Combination of Treatments With or Without Surgery in Localized Provoked Vulvodynia: Outcomes After Three Years of Follow-Up

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