Hess Engström Andrea, Bohm-Starke Nina, Kullinger Merit, Hesselman Susanne, Högberg Ulf, Buhrman Monica, Skalkidou Alkistis
Uppsala University, Center for Clinical Research, Västmanland County Hospital, Västerås, Sweden; Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden.
Karolinska Institute, Department of Clinical Sciences, Division of Obstetrics and Gynecology, Solna, Sweden; Danderyd Hospital, Stockholm, Sweden.
J Sex Med. 2022 Feb;19(2):319-330. doi: 10.1016/j.jsxm.2021.11.019. Epub 2021 Dec 28.
Internet-based ACT (Acceptance and commitment therapy) treatment may improve accessibility and reduce stigma related to seeking health care, but there are a lack of studies investigating internet-based treatment using ACT principles for women with vulvodynia.
The aim of this study was to investigate the effects of an internet-based treatment of pain during intercourse for women with provoked vulvodynia compared with no intervention during the waiting period before clinical treatment.
A multicenter randomized controlled trial was conducted during 2016 to 2020, in which 99 participants were included. Participants were randomized to either a 6 week guided internet-based treatment using ACT principles or usual care. Data were collected at baseline, 6 weeks after baseline, and approximately 10 months after baseline.
Pain-related (pain during intercourse, tampon test, impact of pain on sexual function) and pain behavior-related outcomes (attempts at intercourse, sexual activities besides intercourse, willingness to perform the tampon test, chronic pain acceptance questionnaire) were used as outcomes.
Treatment was efficacious in what concerns pain during intercourse and pain acceptance. Less pain during intercourse among women in the intervention group was observed at both post-treatment (primary endpoint, P = .01, Cohen's d = 1.4, 95% CI = 0.33, 2.4), and follow-up (P = .04). Absolut mean difference between groups for pain during intercourse at post-treatment was -2.84, (95 % CI = -4.91, -0.78), and -1.58 at follow-up, (95 % CI = -3.17, 0.02), where the intervention group rated less pain than controls. No differences between groups over time were found for tampon test measures or impact of pain on sexual function. There was a significant difference between groups at all timepoints indicating fewer attempts at intercourse among participants in the intervention group. At post-treatment, women who underwent internet-based treatment reported higher pain acceptance and a rise in activity engagement compared with the control group.
There is an indication that internet-based treatment could be incorporated into clinical practice as a complement to clinical treatment.
STRENGTHS & LIMITATIONS: Study strengths included using several forms of recruitment and an intervention built by different professions with long experience of treating patients with vulvodynia. High dropout rate was a limitation of this study.
Internet-based treatment may have an impact on pain during intercourse and positive effects on pain acceptance. However, conclusions must be drawn with caution due to the small sample size. Engström AH, Bohm-Starke N, Kullinger M, et al. Internet-based Treatment for Vulvodynia (EMBLA) - A Randomized Controlled Study. J Sex Med 2022;19:319-330.
基于互联网的接受与承诺疗法（ACT）治疗可能会提高医疗服务的可及性，并减少与寻求医疗保健相关的耻辱感，但缺乏针对患有外阴痛的女性使用基于ACT原则的互联网治疗的研究。
本研究的目的是调查与临床治疗前等待期不进行干预相比，基于互联网的治疗对患有激发性外阴痛的女性性交疼痛的影响。
在2016年至2020年期间进行了一项多中心随机对照试验，纳入了99名参与者。参与者被随机分为接受为期6周的使用ACT原则的基于互联网的指导治疗或常规护理。在基线、基线后6周和基线后约10个月收集数据。
与性交疼痛和疼痛接受度相关的结果被用作指标。与性交疼痛相关的指标（性交时疼痛、棉塞试验、疼痛对性功能的影响）和与疼痛行为相关的指标（性交尝试、性交以外的性活动、进行棉塞试验的意愿、慢性疼痛接受问卷）。
在性交疼痛和疼痛接受方面，治疗是有效的。在治疗后（主要终点，P = .01，科恩d值 = 1.4，95%置信区间 = 0.33，2.4）和随访时（P = .04），均观察到干预组女性性交时疼痛减轻。治疗后两组性交疼痛的绝对平均差异为-2.84，（95%置信区间 = -4.91，-0.78），随访时为-1.58，（95%置信区间 = -3.17，0.02），其中干预组的疼痛评分低于对照组。在棉塞试验指标或疼痛对性功能的影响方面，未发现两组随时间的差异。在所有时间点，两组之间存在显著差异，表明干预组参与者的性交尝试次数较少。在治疗后，接受基于互联网治疗的女性与对照组相比，报告了更高的疼痛接受度和活动参与度的提高。
有迹象表明，基于互联网的治疗可以作为临床治疗的补充纳入临床实践。
研究的优点包括使用多种招募形式以及由不同专业人员构建的干预措施，这些专业人员在治疗外阴痛患者方面有长期经验。高失访率是本研究的一个局限性因素。
基于互联网的治疗可能会对性交疼痛产生影响，并对疼痛接受度产生积极影响。然而，由于样本量较小，必须谨慎得出结论。Engström AH、Bohm-Starke N、Kullinger M等。外阴痛的基于互联网治疗（EMBLA）-一项随机对照研究。《性医学杂志》2022；19：319 - 330。
