Vulvodynia, a step-wise therapeutic prospective cohort study

Abstract

Vulvodynia is characterised by the presence of vulval allodynia (pain evoked by non-painful stimuli) and vulval dysaesthesias (burning, soreness, rawness, stinging and irritation). We assessed a protocol for the evaluation and management of vulvodynia. The protocol was based on the most recent evidence available. We began a simple evaluation and proceeded to an aggressive one. From the cohort of 74 patients, 69 patients (93.2%) were adherent to the protocol. A total of 25 patients (36.3%) improved after antibiotic therapy: 14 patients (20.4%) had a positive fungal culture and 11 patients (15.9%) had a positive bacterial culture; none with a positive viral culture. Eight patients (11.6%) improved with dietary modification. Ten patients (14.5%) benefitted from tricyclic medications; 13 patients (18.8%) improved after gabapentin therapy; 13 patients (18.8%) did not show improvement of their condition. Some 56 patients (81.2%) manifested an improvement of their symptoms, which allowed them to achieve painless sexual intercourse.

A Systematic Review of the Utility of Anticonvulsant Pharmacotherapy in the Treatment of Vulvodynia Pain

“…A total of nine articles were identified for possible inclusion in the review. The search yielded one open‐label trial ; six nonexperimental studies, i.e., one nonrandomized prospective cohort study of patients receiving sequentially applied treatment protocols including anticonvulsants , three retrospective case series , and two retrospective chart reviews ; and finally, two case reports . There were no randomized controlled trials identified.…”

Treatment of Female Sexual Pain Disorders: A Systematic Review

“…An approach to treating different sexual pain problems may be to follow a "stepwise" individualized treatment protocol, which has the advantage of including a number of treatment modalities and helps eliminate possible etiologies of the problem (Baggish, 2012;Har-Toov et al, 2001;Pagano, 1999;Ventolini et al, 2009). The integration of different treatment modalities is further supported by studies that have shown combined treatments to be effective (Bergeron et al, 2015).…”

“…In another prospective study involving a "stepwise" approach to treatment, Ventolini et al (2009) assessed the effects of several different treatments on 74 women presenting with vulvodynia. Approaches used included antibiotic treatment, dietary modification, tricyclic antidepressants, gabapentin, pelvic floor physical therapy, and psychological counseling.…”

Review of the Literature on the Psychoemotional Reality of Women with Vulvodynia: Difficulties Met and Strategies Developed

“…Des interventions chirurgicales sont offertes en dernier recours aux femmes ayant une vulvodynie. Le taux de succès de ces interventions varie de 50 % à 90 % (3,13,86,87). Toutefois, le soulagement des douleurs à long terme est difficilement prévisible selon certains chercheurs (12,87), des complications sont parfois observées (10) et, dans 10 % des cas, les douleurs s'accentuent après l'opération (13).…”

“…Le taux de succès de ces interventions varie de 50 % à 90 % (3,13,86,87). Toutefois, le soulagement des douleurs à long terme est difficilement prévisible selon certains chercheurs (12,87), des complications sont parfois observées (10) et, dans 10 % des cas, les douleurs s'accentuent après l'opération (13). En outre, ce type de traitement est moins efficace auprès des femmes qui ont une problématique concomitante de vaginisme (10).…”