The Effectiveness of Pelvic Floor Physiotherapy in Women with Provoked Vestibulodynia

Abstract

Provoked vestibulodynia (PVD) is the most common form of vulvodynia affecting 12% of pre-menopausal women in the general population. It is commonly described as a sharp or burning pain at the entrance of the vagina in response to contact or pressure to the vulvar vestibule. PVD has negative impacts on sexual functioning, relationship adjustment, psychological well-being, and overall quality of life. Studies suggest that increased muscle tension in the pelvic floor of women with PVD may play an important role in maintaining and exacerbating their pain. Despite this finding, no prospective studies of pelvic floor physiotherapy (PFP) for PVD have been carried out. The purpose of the current study was to prospectively examine the effectiveness of a comprehensive PFP intervention in treating the physical and psychosexual components of PVD. Thirteen women with PVD completed 8 sessions of PFP. Women were assessed at pre- and post-treatment via gynecological examinations, vestibular pain threshold testing, structured interviews and standardized questionnaires measuring pain variables (pain during intercourse, McGill Pain Questionnaire, Pain Disability Index), cognitive variables (Pain Catastrophizing Scale, Pain Anxiety Symptom Scale-20, coping strategies), and sexual function (frequency of intercourse, Female Sexual Function Index). To-date, ten women have also completed a 3-month follow-up interview. Results indicated that vestibular pain thresholds significantly increased from pre- to post-treatment, indicating reduced pain sensitivity. As compared with pre-treatment, women reported significant reductions in pain intensity during the gynecological examination and during intercourse. Women also significantly improved on measures of negative pain cognitions and various components of sexual function. There were no changes with respect to mental health or quality of life. The treatment was considered to be successful for 10 (77%) of the 13 women and treatment satisfaction was rated very high. Predictors of successful treatment outcome at the follow-up period were a longer period of time in treatment and decreases in pain catastrophizing and pain-related anxiety. Results provide preliminary support for the effectiveness of PFP in treating the physical and psychosexual components of PVD. These findings indicate the need for large-scale, randomized studies of the effectiveness of PFP in comparison and in conjunction with other treatment options.