Division of Surgery, Gynecology Section, Veteran Affairs Medical Center, Orlando, FL, USA; University of Central Florida, Orlando, FL, USA.
Department of Physical Therapy, University of Florida, Gainesville, FL, USA; Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA.
J Sex Med. 2018 May;15(5):705-715. doi: 10.1016/j.jsxm.2018.03.003. Epub 2018 Apr 7.
Vulvodynia is a poorly characterized condition with multiple treatment options that have been described as largely ineffective in research settings.
To describe treatment patterns in women enrolled in the National Vulvodynia Registry and determine if there is an association between selected treatments and patient-reported outcomes such as pain, sexual function, and psychological distress after 6 months of treatment.
Participants completed questionnaires on general medical history and patient-reported outcomes using the short-form McGill Pain Questionnaire, the Female Sexual Function Index, the Short Form-12 quality-of-life questionnaire, the Coping Strategies Questionnaire, and the State-Trait Anxiety Inventory. The evaluation also included pain sensitivity assessment of the vaginal mucosa using a cotton-tipped applicator and the vaginal muscles using a single-digit. In this prospective cohort study, all measurements were collected at baseline and again at 6 months after treatment.
Type of treatment, number of treatments, self-reported pain intensity, dyspareunia, and pain-related psychological distress measures are reported at baseline and 6 months.
Of 344 women enrolled, 282 received treatment; 78 different treatments were identified and categorized by type (eg, topical, oral, physical therapy) and number. The most commonly used treatments were topical (85%, n = 241), physical therapy (52%, n = 147), and oral medications (45%, n = 128). Notably, 73% of participants received ≥2 treatments. There was no association between type or number of treatments and patient characteristics. At 6 months, women reported improvements in general pain (P = .001), pain during intercourse (P = .001), catastrophizing (P = .000), and anxiety (P = .000). The Short Form-12 quality-of-life questionnaire showed improvements in physical limitations (P = .024), emotional limitations (P = .003), well-being (P = .025), and social function (P = .010). However, all domains of the Female Sexual Function Index indicated worsening in sexual function (P = .000) except for pain.
Multi-modal treatments were most commonly used in clinical practice and improvements in patient-reported outcomes such as quality of life, distress, and pain were noted; however, participants who returned at 6 months continued to report poor sexual function.
Strengths include a prospective and long-term study design that evaluated women in clinical settings. Limitations include a high rate of loss to follow-up for certain measures and inability to evaluate efficacy of individual treatments. In a setting where women were receiving highly specialized care, we found wide variation in the type and number of treatments used to treat vulvodynia. Despite this heterogeneity in treatment selection, women reported significant improvements in all study measures except sexual function. Lamvu G, Alappattu M, Witzeman K, et al. Patterns in Vulvodynia Treatments and 6-Month Outcomes for Women Enrolled in the National Vulvodynia Registry-An Exploratory Prospective Study. J Sex Med 2018;15:705-715.
外阴痛是一种特征不明确的疾病，有多种治疗方法，但在研究环境中被描述为大多无效。
描述参与国家外阴痛登记处的女性的治疗模式，并确定在 6 个月的治疗后，选择的治疗方法与患者报告的结果（如疼痛、性功能和心理困扰）之间是否存在关联。
参与者使用短格式麦吉尔疼痛问卷、女性性功能指数、简短形式 12 项健康调查量表、应对策略问卷和状态-特质焦虑量表完成一般病史和患者报告结果的问卷。评估还包括使用棉签评估阴道黏膜的疼痛敏感性和使用单个数字评估阴道肌肉的疼痛敏感性。在这项前瞻性队列研究中，所有测量均在基线时和治疗后 6 个月时进行。
在 344 名入组的女性中，282 名接受了治疗；确定了 78 种不同的治疗方法，并按类型（例如，局部、口服、物理治疗）和数量进行分类。最常用的治疗方法是局部治疗（85%，n=241）、物理治疗（52%，n=147）和口服药物（45%，n=128）。值得注意的是，73%的参与者接受了≥2 种治疗。治疗类型或数量与患者特征之间没有关联。6 个月时，女性报告一般疼痛（P=0.001）、性交疼痛（P=0.001）、灾难化（P=0.000）和焦虑（P=0.000）有所改善。简短形式 12 项健康调查量表显示身体受限（P=0.024）、情绪受限（P=0.003）、幸福感（P=0.025）和社会功能（P=0.010）方面的改善。然而，女性性功能指数的所有领域都表明性功能恶化（P=0.000），除了疼痛。
多模式治疗在临床实践中最常用，患者报告的结果（如生活质量、痛苦和疼痛）有所改善；然而，在 6 个月时返回的参与者继续报告性功能差。
本研究的优势包括前瞻性和长期的研究设计，评估了临床环境中的女性。局限性包括某些措施的随访率较高和无法评估个体治疗的疗效。在女性接受高度专业护理的环境中，我们发现用于治疗外阴痛的治疗类型和数量存在很大差异。尽管在治疗选择上存在这种异质性，但女性报告说，除了性功能外，所有研究指标都有显著改善。
