Long-Term Results of an Individualized, Multifaceted, and Multidisciplinary Therapeutic Approach to Provoked Vestibulodynia

Abstract

Introduction Although it is highly recommended to use a multifaceted approach to treat provoked vestibulodynia (PVD), the large majority of treatment studies on PVD used a one-dimensional approach. Aim To evaluate the long-term treatment outcome of a multifaceted approach to vulvar pain, sexual functioning, sexually related personal distress, and relational sexual satisfaction in women with PVD. Methods Retrospective questionnaire survey 3–7 years after treatment. Main Outcome Measures Sexual functioning, sexually related personal distress, and relational sexual satisfaction were measured using the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale (FSDS), and the Dutch Relationship Questionnaire (NRV), respectively. An additional questionnaire assessed socio-demographic variables, intercourse resumption, and the level to which the women would recommend the treatment to other women with PVD. Post-treatment vulvar pain scores were obtained using a visual analog scale (VAS). Pretreatment scores were reported in retrospect on a separate VAS. Results The questionnaires were completed by 64 out of 70 women (91%). Mean follow-up was 5 years (range 3–7). Comparison of the mean pretreatment and post-treatment VAS scores showed a significant reduction in vulvar pain. Pain reduction was reported by 52 women (81%), whereas no change and pain increase were reported by 7 women (11%) and 5 women (8%), respectively. Post-treatment, 80% of the women had resumed intercourse. Only 5 women (8%) reported completely pain-free intercourse. Comparisons with age-related FSFI and FSDS Dutch norm data showed that scores for sexual functioning in the study group were significantly lower, while scores for sexually related personal distress were significantly higher. There were no significant differences in relational sexual satisfaction ratings between the study group and the NRV Dutch norm data. Conclusion These retrospective data on long-term treatment outcome support the hypothesis that a multifaceted approach to PVD can lead to substantial improvements in vulvar pain and the resumption of intercourse.

Female Sexual Pain Disorders: a Review of the Literature on Etiology and Treatment

“…Indeed, recent standard operating procedures call for biopsychosocial and multidisciplinary approaches to the assessment and treatment of female sexual pain conditions [120]. To date, a small number of quantitative [121][122][123][124] and qualitative studies [125,126] have examined the impact of treatment programs for women's sexual pain that integrate medical, physical, and psychological therapies. For example, in an uncontrolled, prospective study, Backman and colleagues found that 6 months after completing a program of concurrent sex therapy and pelvic floor physical therapy, women reported significant reductions in dyspareunia, greater frequency of intercourse, and improvements in sexual functioning [123].…”

“…Despite these encouraging results, this small body of literature contends with methodological concerns such as small sample sizes [124,123], retrospective designs [124], and a lack of randomization or control groups [121][122][123][124], which confounds treatment effects with potential placebo responses.…”

Psychosexual aspects of vulvovaginal pain

“…Using a retrospective questionnaire survey 3-7 years post-treatment, Spoelstra, Dijkstra, van Driel & Weijmar Schultz [57] showed that 80% of women had resumed intercourse and 81% reported pain reduction, although only 8% reported completely pain-free intercourse. These findings are encouraging and suggest the need for more empirical work aimed at assessing the efficacy of an integrated approach to care.…”

Management of Female Sexual Pain Disorders

“…There is currently no standardized protocol for the use of pelvic floor muscle exercises in the treatment of sexual pain disorders, and they have not been investigated as a unidimensional treatment. Nevertheless, studies demonstrating the effectiveness of comprehensive pelvic floor rehabilitation programs [48,75,119] and multidisciplinary approaches [121,122] to the treatment of PVD have included this component.…”

“…A retrospective study investigated the effectiveness of pelvic floor rehabilitation combined with surgical, topical and/or psychological intervention, with 81% of women reporting significant pain reductions following treatment [121]. In a prospective, uncontrolled study, Backman et al [122] demonstrated the effectiveness of combining pelvic floor rehabilitation and psychosexual counseling in the treatment of PVD, with all the participants reporting some degree of improvement.…”