Pain associated with provoked vestibulodynia (PVD) appears to decrease in time, even in women who are not treated for it, Canadian researchers report. However, psychosexual factors may not improve.
PVD, which causes pain and burning sensations in a woman’s vulvar vestibule, is estimated to affect about 12% of women. The causes of PVD are unclear, but might involve pelvic floor muscle dysfunction or inflammation.
The condition is treated in a variety of ways, including medication, physical therapy, acupuncture, and surgery. However, studies on PVD treatment have not always included a control or placebo condition and follow-ups are typically short. These issues make these results difficult to interpret.
The authors of the present study planned to address these limitations in their research, which covered a two-year period.
They recruited 354 women with PVD to complete a set of questionnaires that evaluated pain intensity, sexual satisfaction, depression symptoms, relationship satisfaction, and sexual behavior. Sexual function was assessed with the Female Sexual Function Index (FSFI).
Two years later, they asked the same women to complete the questionnaires again to assess their progress in that time frame. Two hundred thirty-nine women participated in this second phase.
Of this group, about 41% had tried physical therapy treatment. About 19% had had sex therapy/psychotherapy and almost 19% had had medical management. Other treatments included surgery (7%) and acupuncture (3%). Roughly 8% of the women reported having “other” treatments that were not specified. About a quarter of the women had tried multiple treatments. Forty-one percent of them had had no treatment at all.
The researchers found that pain had decreased for most of the women, including those who had had no treatment.
However, other variables were still problematic for women, even if they had less pain. The number of intercourse attempts did not change significantly. And while the women’s scores on the FSFI improved over two years, the average scores still fell in the dysfunctional category at this point.
“It is tempting to assume that when the pain is reduced, there will be a commensurate improvement in psychosexual variables, but this was often not the case,” the authors wrote.
“Though pain reduction is an important goal in treatment of PVD, once the pain is reduced, further treatment tailored to the individual or couple may be needed to improve other aspects of quality of life,” they added.
It was difficult to determine which treatments were the most beneficial, the authors noted.
“The present findings did not provide clear evidence in support of the superiority of any one treatment and highlight the need for randomized, placebo-controlled trials that compare treatments in the future,” they explained.
The study was published online in September in the Journal of Sexual Medicine.
The Journal of Sexual Medicine
Davis, Seth N.P., PhD, et al.
“Women with Provoked Vestibulodynia Experience Clinically Significant Reductions in Pain Regardless of Treatment: Results from a 2-Year Follow-Up Study”
(Full-text. First published online: September 12, 2013)