Conclusions

• It is not possible to estimate the effects of pharmacological treatment for provoked vestibulodynia from scientific studies, as the certainty of evidence is very low. For the same reason, it is not possible to estimate the effects of psychological treatments (various forms of cognitive behavioral therapy and mindfulness) or surgery.
• Multi modal physiotherapy (manual treatment, patient education, pelvic floor treatment and home exercises) may significantly reduce dyspareunia and improve sexual function, compared with topical treatment with lidocaine gel (low certainty of evidence).
• There are no well-conducted studies on diagnostic methods for provoked vestibulodynia.
• There is a need for well-conducted studies on treatment of provoked vestibulodynia. In particular, there is a need for studies on the effect of combined and multi professional treatments. To facilitate evidence synthesis and effect estimates, it is desirable to establish a core outcome set (an agreed set of outcomes that should be measured and reported in all clinical trials).

Several different treatments with diverse mechanisms of action were identified in the review but in most cases only one small or medium-sized study was found. This limited the possibilities to synthesize results and reach reliable conclusions about effects. Lack of evidence does not imply, however, that an intervention lacks effect, but rather that its effect has not been sufficiently researched.

The lack of evidence regarding diagnostic methods is regarded as less problematic, while a patient’s anamnesis in addition to the clinical investigation often is sufficient for an experienced clinician to confirm diagnosis.

Background

Provoked vestibulodynia (localised provoked vulvodynia) is a condition characterised by pain in the vestibular region of the vulva, present in sexual and nonsexual situations. The prevalence is highest among young women. Provoked vestibulodynia has a negative impact on the women’s sexual relations, wellbeing and quality of life.

Aim

The aim was to assess the scientific evidence for methods of diagnosing and treating provoked vestibulodynia through a systematic review. In addition, social and ethical aspects were addressed.

Method

A systematic review was conducted in accordance with the PRISMA statement. The certainty of evidence was assessed with GRADE.

Results

No eligible studies on diagnostic methods with low or moderate risk of bias were identified in the assessment.

Regarding treatment methods, 24 studies with low or moderate risk of bias were identified that investigated 26 unique comparisons of interventions (Table 1).

Table 1

Overview of treatment methods that are included in the assessment. .

Ethical and Social Aspects

The uncertainty regarding the effects of treatments for provoked vestibulodynia makes it difficult to help affected patients. This is unfortunate as the condition not only causes pain but also has psychosocial consequences. According to a previous Swedish report, patients have experienced difficulties in gaining access to investigation and treatment, and they do not always feel that they are taken seriously by the care staff. It is therefore important to improve the knowledge about provoked vulvodynia for healthcare professionals who meet women with the condition.

Conflicts of Interest

In accordance with SBU’s requirements, the experts and scientific reviewers participating in this project have submitted statements about conflicts of interest. These documents are available at SBU’s secretariat. SBU has determined that the conditions described in the submissions are compatible with the experts’ participation in the project.

The full report in Swedish

The full report in Swedish /sv/publikationer/SBU-utvarderar/diagnostik-och-behandling-av-provocerad-vulvodyni/

Flow Chart

Figure 1 Flow Chart

Project group

Characteristics of included studies.pdf

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Search strategies.pdf

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Excluded articles and studies with high risk of bias.pdf

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