Logan Gabrielle S, Gustafson Diana L, Swab Michelle, Rains Alex, Miller Michelle E, Jackman Victoria A, Bajzak Krisztina
Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, Harry Medovy House, Winnipeg, MB, R3E 0Z2, Canada.
Division of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, NL, A1B 3V6, Canada.
J Sex Med. 2025 Jan 3;22(1):132-155. doi: 10.1093/jsxmed/qdae163.
Localized provoked vulvodynia is a common sexual health condition for which there is a lack of consensus on effective management, even though it can have a significant negative impact on psychological wellbeing, sexual functioning, and quality of life for women and their partners.
To map the research landscape related to the effectiveness/efficacy of psychological treatments for localized provoked vulvodynia, identify gaps, and make recommendations for future research.
We used Arksey and O'Malley's approach to conducting a scoping review to identify, organize, and summarize research published between 2010 and 2023 that investigated the efficacy or effectiveness of interventions in the management of localized provoked vulvodynia. Inclusion and exclusion criteria and the search strategy were developed by subject experts in collaboration with a health sciences librarian. A PubMed search used controlled vocabulary and keyword terms relating to vulvodynia, which were then translated into other databases. Studies not published in English or French were excluded. We did not consider other subsets of vulvodynia.Articles were uploaded to Covidence, duplicates removed, and titles and abstracts screened. The remaining articles were subject to a 2-person, independent full-text review followed by a hand search of eligible articles. All intervention studies were included regardless of the study design. Study details were reported narratively and analyzed.
Of the 88 included articles published between January 2010 and March 2023, 15 reported on the efficacy/effectiveness of psychological treatments for localized provoked vulvodynia, including group educational seminars, cognitive behavioral therapy, acceptance and commitment therapy, and somatocognitive therapy.
Cognitive behavioral therapy was the most common form of psychological treatment studied (n = 7) with interventions for both individuals and couples. Education about the condition and the therapeutic process was a component of many interventions. Psychological therapies may be of some benefit, but only 1 RCT evaluating the efficacy of acceptance and commitment therapy appeared adequately powered to demonstrate improvement in dyspareunia. Studies sampled homogenous patient populations, primarily consisting of White, urban-dwelling, educated, partnered, heterosexual cis-women.
Evidence of efficacy/effectiveness, drawn mainly from small studies, is promising and highlights opportunities for more robust studies with heterogeneous populations, more research on the role of education in treatment success, and greater attention to assessing patient-driven outcomes in partnered and unpartnered women.
局限性激发性外阴痛是一种常见的性健康状况，尽管它会对女性及其伴侣的心理健康、性功能和生活质量产生重大负面影响，但在有效管理方面仍缺乏共识。
梳理与局限性激发性外阴痛心理治疗的有效性相关的研究情况，找出差距，并为未来研究提出建议。
我们采用阿克西和奥马利的方法进行范围综述，以识别、整理和总结2010年至2023年间发表的研究，这些研究调查了干预措施在局限性激发性外阴痛管理中的疗效或有效性。纳入和排除标准以及检索策略由主题专家与健康科学图书馆员合作制定。在PubMed上进行检索时使用了与外阴痛相关的控制词汇和关键词，然后将其翻译成其他数据库。未以英文或法文发表的研究被排除。我们未考虑外阴痛的其他亚类。文章上传至Covidence，去除重复项，并筛选标题和摘要。其余文章由两人独立进行全文评审，随后对符合条件的文章进行手工检索。所有干预研究均被纳入，无论其研究设计如何。研究细节以叙述方式报告并进行分析。
在2010年1月至2023年3月发表的88篇纳入文章中，15篇报告了局限性激发性外阴痛心理治疗的疗效，包括团体教育研讨会、认知行为疗法、接受与承诺疗法和躯体认知疗法。
认知行为疗法是研究最多的心理治疗形式（n = 7），包括针对个体和夫妻的干预措施。对病情和治疗过程的教育是许多干预措施的一个组成部分。心理治疗可能有一定益处，但只有1项评估接受与承诺疗法疗效的随机对照试验似乎有足够的效力证明性交困难有所改善。研究的患者群体同质化，主要由白人、居住在城市、受过教育、有伴侣的异性恋顺性别女性组成。
主要来自小型研究的疗效证据很有前景，并凸显了开展针对异质人群的更有力研究、更多关于教育在治疗成功中的作用的研究以及更加关注评估有伴侣和无伴侣女性中患者驱动的结果的机会。
