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

Abstract

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.

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

“…Most vestibulectomy studies did not specify details of preceding treatments. While the case series discussed in this paper had globally positive results for dyspareunia, studies comparing vestibulectomy with conservative management, discussed in our companion paper, 13 generally reported that dyspareunia outcomes were comparable to multimodal/interdisciplinary therapies, underscoring the importance of comparator groups for this intervention. Lack of comparator groups may have inflated treatment response due to possible spontaneous improvements over time.…”

“…Studies that compared physical interventions with pharmacological or psychological interventions were categorized as multidisciplinary/multimodal and are reported elsewhere. 12,13 Laser Therapy…”

“…The lack of convincing quantitative evidence for acupuncture is consistent with previous reviews and the Vulvodynia Guidelines. 8,10,13,41 Study results of laser therapies were encouraging, though there were some methodological limitations. The fractional CO2 laser RCT 21 found favourable results for pain and sexual function measures.…”

“…Study designs were limited to a case series, a small quasi-experimental study, and a cross-sectional survey. While no RCT of PT compared to other physical interventions was identified, our companion publication 13 explores treatment versus treatment trials of PT relative to other treatment categories (eg, psychologic, pharmacologic). PT often combines various interventions for pelvic floor muscle dysfunction, including pelvic floor muscle assessment, manual therapy, biofeedback, vaginal dilators, and TENS.…”

“…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.…”