School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke; Research Center, Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada.
Faculty of Medicine and Health Sciences, Université de Sherbrooke; Research Center, Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada.
Sex Med Rev. 2017 Jul;5(3):295-322. doi: 10.1016/j.sxmr.2017.02.003. Epub 2017 Mar 28.
Pelvic floor muscle physical therapy is recommended in clinical guidelines for women with provoked vestibulodynia (PVD). Including isolated or combined treatment modalities, physical therapy is viewed as an effective first-line intervention, yet no systematic review concerning the effectiveness of physical therapy has been conducted.
To systematically appraise the current literature on the effectiveness of physical therapy modalities for decreasing pain during intercourse and improving sexual function in women with PVD.
A systematic literature search using PubMed, Scopus, CINHAL, and PEDro was conducted until October 2016. Moreover, a manual search from reference lists of included articles was performed. Ongoing trials also were reviewed using clinicaltrial.gov and ISRCTNregistry. Randomized controlled trials, prospective and retrospective cohorts, and case reports evaluating the effect of isolated or combined physical therapy modalities in women with PVD were included in the review.
Main outcome measures were pain during intercourse, sexual function, and patient's perceived improvement.
The literature search resulted in 43 eligible studies including 7 randomized controlled trials, 20 prospective studies, 5 retrospective studies, 6 case reports, and 6 study protocols. Most studies had a high risk of bias mainly associated with the lack of a comparison group. Another common bias was related to insufficient sample size, non-validated outcomes, non-standardized intervention, and use of other ongoing treatment. The vast majority of studies showed that physical therapy modalities such as biofeedback, dilators, electrical stimulation, education, multimodal physical therapy, and multidisciplinary approaches were effective for decreasing pain during intercourse and improving sexual function.
The positive findings for the effectiveness of physical therapy modalities in women with PVD should be investigated further in robust and well-designed randomized controlled trials. Morin M, Carroll M-S, Bergeron S. Systematic Review of the Effectiveness of Physical Therapy Modalities in Women With Provoked Vestibulodynia. Sex Med Rev 2017;5:295-322.
临床指南推荐对患有唤起性外阴痛（PVD）的女性采用盆底肌物理治疗。物理治疗包括单独或联合治疗方式，被视为有效的一线干预措施，但尚未对其进行过关于有效性的系统评价。
系统评价物理治疗方式对减轻患有 PVD 的女性性交疼痛和改善性功能的有效性。
对 PubMed、Scopus、CINHAL 和 PEDro 进行了系统的文献检索，检索时间截至 2016 年 10 月。此外，还对纳入文献的参考文献列表进行了手工检索。通过 clinicaltrial.gov 和 ISRCTNregistry 对正在进行的试验也进行了审查。本综述纳入了评估单独或联合物理治疗方式对患有 PVD 的女性影响的随机对照试验、前瞻性和回顾性队列研究以及病例报告。
主要观察指标为性交疼痛、性功能和患者感知的改善。
文献检索共得到 43 项符合条件的研究，包括 7 项随机对照试验、20 项前瞻性研究、5 项回顾性研究、6 项病例报告和 6 项研究方案。大多数研究存在较高的偏倚风险，主要与缺乏对照组有关。另一个常见的偏倚与样本量不足、未验证的结局、非标准化干预和其他正在进行的治疗有关。绝大多数研究表明，生物反馈、扩张器、电刺激、教育、多模式物理治疗和多学科方法等物理治疗方式可有效减轻性交疼痛和改善性功能。
应在设计良好的随机对照试验中进一步研究物理治疗方式对患有 PVD 的女性的有效性。
