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

Abstract

Introduction Classification of vaginal pain within medical or psychiatric diagnostic systems draws mainly on the presumed presence or absence (respectively) of underlying medical etiology. A focus on the experience of pain, rather than etiology, emphasizes common ground in the aims of treatment to improve pain and sexual, emotional, and cognitive experience. Thus, exploring how vaginal pain conditions with varying etiology respond to psychological treatment could cast light on the extent to which they are the same or distinct. Aim To examine the combined and relative efficacy of psychological treatments for vaginal pain conditions. Methods A systematic search of EMBASE, MEDLINE, PsycINFO, and CINAHL was undertaken. Eleven randomized controlled trials were entered into a meta-analysis, and standardized mean differences and odds ratios were calculated. Effect sizes for individual psychological trial arms were also calculated. Main Outcome Measures Main outcome measures were pain and sexual function. Results Equivalent effects were found for psychological and medical treatments. Effect sizes for psychological treatment arms were comparable across vaginal pain conditions. Conclusions Effectiveness was equivalent regardless of presumed medical or psychiatric etiology, indicating that presumed etiology may not be helpful in selecting treatment. Research recommendations and clinical implications are discussed.

Treatment of Female Sexual Pain Disorders: A Systematic Review

“…Our approach is consistent with those of other recent reviews (Flanagan et al, 2014) and with recent changes in the DSM-5 (American Psychiatric Association, 2013) where the categories of Dyspareunia and Vaginismus have been collapsed into one disorder: Genito-Pelvic Pain/Penetration Disorder. For many women who present to physicians with sexual pain, no cause can be easily established and no specific disorder diagnosed.…”

“…Stones et al (2005) reviewed interventions for treating CPP only, and McGuire and Hawton and Melnik et al (2012) reviewed only studies on vaginismus. In 2008, Landry et al conducted a good in-depth critical review of treatments for PVD, and recently Flanagan, Herron, O'Driscoll, and Williams (2014) published a systematic review and meta-analysis of psychological treatments for vaginal pain. All of these reviews, however, have focused on only one type of disorder.…”

“…In 2008, Landry et al conducted a good in-depth critical review of treatments for PVD, and recently Flanagan, Herron, O'Driscoll, and Williams (2014) published a systematic review and meta-analysis of psychological treatments for vaginal pain. The Flanagan et al (2014) review examined three disorders under the heading of vaginal pain (vulvodynia, vaginismus, and dyspareunia), but only reviewed psychological treatments. The Flanagan et al (2014) review examined three disorders under the heading of vaginal pain (vulvodynia, vaginismus, and dyspareunia), but only reviewed psychological treatments.…”

Physiotherapy in Treating Sexual Pain Disorders in Women: A Systematic Review

“…Dyspareunia is as persistent or recurrent pain during vaginal penetration. Women can experience it at the opening of the vagina or deep within the pelvis upon deeper penetration [19].…”

Efficacy of Transcranial Direct-Current Stimulation in Women With Provoked Vestibulodynia

“…This may partially explain the changes observed in both interventions for sexual functioning, sexual distress, catastrophizing, and pain anxiety. Behavioral approaches such as systematic desensitization and attentive listening were respectively found effective for pain management in vaginismus 65 and elderly. 66 A substantial portion of women with PVD is reported to present pain hypersensitivity at both vulvar [5][6][7] and extra-genital regions (i.e.…”