Long-Term Efficacy of Physical Therapy for Localized Provoked Vulvodynia

Abstract

Purpose The origin of provoked vulvodynia (PV), the main cause of entry dyspareunia, remains unclear, and the treatment is empiric. In this study, we aimed to investigate the long-term effects of physical therapy on PV in subjects using questionnaire concerning PV symptoms immediately after physical therapy and at least 10 years later. Patients and Methods This study included a total of 24 women diagnosed with PV and referred by their primary physicians to Maccabi Physical Therapy Clinic for pelvic floor rehabilitation between 2004 and 2008. Criteria such as pain relief, sexual functioning, and treatment satisfaction were assessed. Results The average pain scores of the 24 participants reduced significantly after therapy, and 42% had no pain between treatment and the time of survey. Eighty-three percent did not undergo additional treatment after the initial physical therapy and reported high or very extremely high levels of pain reduction following treatment. Multiple regression analysis found that onset type of PV and age were not associated with the treatment outcome (p = 1.0). Conclusion Physical therapy is an effective long-term treatment for primary or secondary PV, resulting in pain reduction and improved sexual function.

Individualized multidisciplinary therapy for vulvodynia

“…In a multifaceted and multidisciplinary approach, where there was a predominance of treatments with peripheral action, patients with primary vulvodynia also responded less favorably 18 . However, there were no differences in response between women with different vulvodynia subtypes after eight PFM electromyographic biofeedback sessions, 29 after eight pelvic floor physiotherapy sessions that included biofeedback, 30 and after 10 or more years of completion of pelvic floor rehabilitation 53 . Similarly, no differences were detected after vestibulectomy, 29,73 and therapy with local anesthetics 74 …”

“…18 However, there were no differences in response between women with different vulvodynia subtypes after eight PFM electromyographic biofeedback sessions, 29 after eight pelvic floor physiotherapy sessions that included biofeedback, 30 and after 10 or more years of completion of pelvic floor rehabilitation. 53 Similarly, no differences were detected after vestibulectomy, 29,73 and therapy with local anesthetics. 74 Among the studies included in our review that evaluated the outcomes predictors of centrally acting treatments, 21,22,24,32,41,42,67 three of them 21,24,32 investigated the influence of the vulvodynia subtype but did not detect any impact.…”

“…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.…”

Hypoxia as a potential cause of dyspareunia

“…This pathological distribution of mitochondria may be caused by local hypoxia from low blood flow in tender areas. A feasible alternative cause of hypoxia could be physical inactivity, which produces mitochondrial insufficiency and abnormal levels of critical metabolites for contractile muscle force [ 23 ]. Some authors refer to this phenomenon as deconditioning.…”

Voices of Vulvodynia: Qualitative Analysis of Patient Experiences on Reddit (Preprint)

“…While physical therapy has been shown to have long-term success in the treatment of vulvodynia, vaginal creams such as baclofen and amitriptyline, though effective, are still considered novel remedies. [26][27][28] Surgery (13.0%) and stopping oral contraception pills (OCPs) (9.2%) were also commonly discussed. Although controversial, AUA and ACOG recommend discontinuing hormonal contraceptive treatments, as they may worsen symptoms.…”