Multimodal and Interdisciplinary Interventions for the Treatment of Localized Provoked Vulvodynia: A Scoping Review of the Literature from 2010 to 2023

Abstract

Alex Rains,1 Krisztina Bajzak,2 Michelle E Miller,2 Michelle Swab,3 Gabrielle S Logan,4 Victoria A Jackman,5 Diana L Gustafson6 1Department of Medicine, University of Chicago, Chicago, IL, USA; 2Discipline of Obstetrics and Gynecology, Memorial University, St. John’s, Newfoundland & Labrador, Canada; 3Health Sciences Library, Faculty of Medicine, Memorial University, St. John’s, Newfoundland & Labrador, Canada; 4Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada; 5Faculty of Medicine, Memorial University, St. John’s, Newfoundland & Labrador, Canada; 6Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John’s, Newfoundland & Labrador, CanadaCorrespondence: Alex Rains, Email [email protected]: Localized provoked vulvodynia (LPV) is a chronic condition characterized by pain in the vulvar vestibule, which can be provoked by pressure or touch and which is not tied to a clear underlying cause. Research into the etiology of and most appropriate treatment strategy for LPV is still limited.Methods: Using Arksey and O’Malley’s model for scoping reviews, we evaluated the research question: what is the current evidence regarding the efficacy/effectiveness of multimodal or interdisciplinary interventions for the treatment of LPV? We collated and analyzed articles from 2010 to 2023 to capture the current research landscape.Results: Our review identified 27 studies, which either compared treatments between classes (eg pharmacologic versus psychologic modalities) or described interdisciplinary treatment programs. We identify several trends in the literature. First, outcome measures are inconsistent between studies, often unvalidated, and may not adequately mirror patient concerns. Second, the absence of appropriate comparator groups in many studies restricts providers’ ability to appraise which treatments may be most efficacious. Third, selection bias and demographic homogeneity limit generalizability. Finally, we highlight the need for head-to-head trials of vestibulectomy with other treatments considered first line for vulvodynia management.Conclusion: There is insufficient evidence to suggest the superiority of one treatment modality for LPV relative to others or to recommend a particular interdisciplinary management strategy. Future research should use a head-to-head design where sham control is impossible, incorporate patient-centered outcome measures, and investigate impacts of treatment among diverse samples of LPV patients.Keywords: multidisciplinary, interdisciplinary, multimodal, chronic pain, vulvodynia, dyspareunia

Keywords

• multidisciplinary
• interdisciplinary
• multimodal
• chronic pain
• vulvodynia
• dyspareunia