Behavioral approach with or without surgical intervention to the vulvar vestibulitis syndrome: a prospective randomized and non-randomized study

Abstract

This article describes the outcome of a behavioral approach with or without preceding surgical intervention in 48 women with the vulvar vestibulitis syndrome. In the first part of the study, 14 women with the vulvar vestibulitis syndrome were randomly assigned to one of two treatment programs: either a behavioral approach or a behavioral approach preceded by surgery. In the second part of the study, 34 women and their partners were given a choice of treatment. Follow-up data were gathered a mean of 3 and 2 1/2 years after treatment, respectively. In the randomized patient population, the intervention had a positive effect on all of them: the complaints disappeared, diminished or did not change but formed less of a problem. The difference in outcome between the two different treatments, a behavioral approach with or without preceding surgery, was not statistically significant. In the second non-randomized part of the study, 28 out of the 34 women (82%) chose the behavioral approach without preceding surgery. The difference in outcome between the two treatments was not statistically significant. Two out of the 28 women who chose behavioral treatment without preceding surgery had to be referred for psychiatric consultation because of serious psycho-sexual problems. In one woman, psychiatric treatment was successful. Three other women, whose behavioral treatment failed, underwent additional surgery, which clearly helped them to overcome the deadlock in the behavioral approach. The behavioral approach should be the first choice of treatment for the vulvar vestibulitis syndrome. Surgical intervention should be considered as an additional form of treatment in some cases with the vulvar vestibulitis syndrome to facilitate breaking the vicious circle of irritation, pelvic floor muscle hypertonia and sexual maladaptive behavior.

Psychological Treatment for Vaginal Pain: Does Etiology Matter? A Systematic Review and Meta-Analysis

“…Of the 12 studies that met inclusion criteria, one did not include sufficient data in the original publication, and the author no longer had the data [47]. Data from 11 studies were included in the meta‐analysis: six presented sufficient data in original publications [35,41,44,46,48], one of which was a follow‐up study [42]; two included limited categorical data, which allowed for the use of odds ratios [45,51]; and three were supplemented by descriptive statistics [43] and raw datasets [49,50] from authors.…”

“…While it is frequently the case that different psychological therapies have equal effectiveness, which is hypothesized to be due to common therapeutic factors rather than specific therapeutic methods [76], it is less usual to find equivalence of psychological and medical treatments. One small, low‐quality trial in the review combined psychological and medical treatments for vestibulodynia [51], comparing placebo and real surgery, both in combination with behavior therapy, and found similar symptom reduction in the two treatment arms. This cannot be further dismantled to identify effects.…”

“…Applying a biopsychological understanding of pain and allowing patients a choice of treatments could also help to improve outcomes. While a multidisciplinary approach may be recognized as the ideal in clinical practice, this was not reflected in the evidence; only one trial attempted to evaluate a combined medical and psychological approach [51].…”

A randomized clinical trial for women with vulvodynia: Cognitive-behavioral therapy vs. supportive psychotherapy

“…Significant reductions in pain severity, disability and affective distress, as well as significant reductions in healthcare use have been repeatedly documented in randomized controlled clinical trials [27]. Support for the efficacy of CBT for the treatment of vulvodynia has been investigated in two uncontrolled [1, 32] and one well-controlled, randomized study [5]. When group CBT was provided to women with vulvar vestibulitis, a 21–38% decrease in pain severity was reported [5].…”

Measuring Treatment Outcomes in Women With Vulvodynia

“…Ter Kuile et al found in a prospective, open-trial study that a reduction in dyspareunia was related to a general improvement in sexual functional level as well as increased control of the muscles of the pelvis [17]. Weijmar Schultz et al have shown in a prospective, randomized study that CBT is comparable with surgery [18]. Bergeron and colleagues found in a small randomized, controlled study among 28 women who had been allocated for CBT, electromyographic biofeedback or vestibulecttomy, that surgery primarily led to a reduction in dyspareunia.…”