Surgical and behavioral treatments for vestibulodynia: two-and-one-half year follow-up and predictors of outcome.

Abstract

OBJECTIVE:

To estimate whether treatment gains for provoked vestibulodynia participants randomly assigned to vestibulectomy, biofeedback, and cognitive-behavioral therapy in a previous study would be maintained from the last assessment-a 6-month follow-up-to the present 2.5-year follow-up. Although all three treatments yielded significant improvements at 6-month follow-up, vestibulectomy resulted in approximately twice the pain reduction as compared with the two other treatments. A second goal of the present study was to identify predictors of outcome.

METHODS:

In a university hospital, 51 of the 78 women from the original study were reassessed 2.5 years after the end of their treatment. They completed 1) a gynecologic examination involving the cotton-swab test, 2) a structured interview, and 3) validated pain and sexual functioning measures.

RESULTS:

Results from the multivariate analysis of variance conducted on the pain measures showed a significant time main effect (P<.05) and a significant treatment main effect (P<.01), indicating that participants had less pain at the 2.5-year follow-up than at the previous 6-month follow-up. Results from the multivariate analysis of variance conducted on sexual functioning measures showed that participants remained unchanged between the 6-month and 2.5-year follow-up and that there were no group differences. Higher pretreatment pain intensity predicted poorer outcomes at the 2.5-year follow-up for vestibulectomy (P<.01), biofeedback (P<.05), and cognitive-behavioral therapy (P<.01). Erotophobia also predicted a poorer outcome for vestibulectomy (P<.001).

CONCLUSION:

Treatment gains were maintained at the 2.5-year follow-up. Outcome was predicted by pretreatment pain and psychosexual factors.

LEVEL OF EVIDENCE:

II.

• Authors: Sophie Bergeron, Samir Khalifé, Howard I Glazer, Yitzchak M Binik
• Journal: Obstetrics and gynecology (Obstet Gynecol) Vol. 111 Issue 1 Pg. 159-66 (Jan 2008) ISSN: 0029-7844 [Print] United States
• PMID: 18165405 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Biofeedback, Psychology
• Dyspareunia
• Female
• Follow-Up Studies
• Gynecologic Surgical Procedures
• Humans
• Pain Measurement
• Treatment Outcome
• Vulva (surgery)
• Vulvar Vestibulitis (psychology, surgery, therapy)