First, second, and third line medical treatments of vulvodynia are of limited efficacy. Surgical resection, the fourth line treatment of vulvodynia, may have unforgiving sequela. Therefore, acupuncture and electromyographic (EMG) biofeedback could bridge between medical and surgical treatments of vulvodynia. Of note, EMG biofeedback is more frequently recommended in treatment algorithms for vulvodynia than is acupuncture. Trials of acupuncture for unprovoked vulvodynia demonstrate variable efficacy, whereas trials of EMG biofeedback for provoked vulvodynia demonstrate consistent efficacy. Trials of acupuncture for treatment of provoked and unprovoked vulvodynia using identical acupoints, a vulvar algesiometer for objective pain measurement, and standardized, validated, tools for outcome assessment are needed. Such trials may enable comparison of acupuncture to EMG biofeedback for the treatment of provoked and unprovoked vulvodynia. Similarly, trials of EMG biofeedback for treatment of unprovoked vulvodynia would increase the knowledge base of EMG biofeedback for treatment of vulvodynia.
References
[1]
Powell, J. and Wojnarowska, F. (1999) Acupuncture for Vulvodynia. Journal of the Royal Society of Medicine, 9, 579-581.
[2]
Mandal, D., Nunns, D., Byrne, M., Mclelland, J., Rani, R., Cullimore, J., et al. (2010) Guidelines for the Management of Vulvodynia. British Journal of Dermatology, 162, 1180-1185. http://dx.doi.org/10.1111/j.1365-2133.2010.09684.x
[3]
Curran, S., Brotto, L.A., Fisher, H., Knudson, G. and Cohen, T. (2009) The ACTIV Study: Acupuncture Treatment in Provoked Vestibulodynia. The Journal of Sexual Medicine, 7, 981-995. http://dx.doi.org/10.1111/j.1743-6109.2009.01582.x
[4]
Goetsch, M.F. (1991) Vulvar Vestibulitis: Prevalence and Historic Features in a General Gynecologic Practice Population. American Journal of Obstetrics and Gynecology, 164, 1609-1614; discussion, 1614-1616. http://dx.doi.org/10.1016/0002-9378(91)91444-2
[5]
Haefner, H., Collins, M.E., Davis, G.D., Edwards, L., Foster, D.C., Hartmann, E.H., et al. (2005) The Vulvodynia Guideline. Journal of Lower Genital Tract Disease, 9, 40-51. http://dx.doi.org/10.1097/00128360-200501000-00009
[6]
Nunns, D. and Mandal, D. (1997). Psychological and Psychosexual Aspects of Vulvar Vestibulitis. Genitourinary Medicine, 73, 541-544.
[7]
Jantos, M. (2008) Vulvodynia: A Psychophysiological Profile Based on Electromyographic Assessment. Applied Psychophysiology and Biofeedback, 33, 29-38. http://dx.doi.org/10.1007/s10484-008-9049-y
[8]
Bergeron, S., Binik, Y.M., Khalifé, S., Pagidas, K., Glazer, H.I., Meana, M. and Amsel, R. (2001) A Randomized Comparison of Group Cognitive-Behavioral Therapy, Surface Electromyographic Biofeedback, and Vestibulectomy in the Treatment of Dyspareunia Resulting from Vulvar Vestibulitis. Pain, 91, 297-306. http://dx.doi.org/10.1016/S0304-3959(00)00449-8
[9]
McKay, M. (1992) Vulvodynia Diagnostic Patterns. Dermatology Clinics, 10, 423-433.
[10]
Baggish, M.S. and Miklos, J.R. (1995) Vulvar Pain Syndrome: A Review. Obstetrical & Gynecological Survey, 50, 618-627. http://dx.doi.org/10.1097/00006254-199508000-00023
[11]
Haefner, H. (2000) Critique of New Gynecological Surgical Procedures: Surgery for Vulvar Vestibulitis. Clinical Obstetrics & Gynecology, 43, 689-700. http://dx.doi.org/10.1097/00003081-200009000-00028
[12]
Glazer, H.I., Rodke, G., Swencionis, C., Hertz, R. and Young, A.W. (1995) Treatment of Vulvar Vestibulitis Syndrome with Electromyographic Biofeedback of Pelvic Floor Musculature. The Journal of Reproductive Medicine, 40, 283-290.
[13]
Baggish, M.S. and Karram, M.M. (2011) Atlas of Pelvic Anatomy and Gynecologic surgery. 3rd Edition, Elsevier Saunders, Saint Louis.
[14]
Bergeron, S., Binik, Y.M., Khalifé, S. and Pagidas, K. (1997) Vulvar Vestibulitis Syndrome: A Critical Review. The Clinical Journal of Pain, 13, 27-42. http://dx.doi.org/10.1097/00002508-199703000-00006
[15]
What-When-How. (n.d.) The Autonomic Nervous System (Integrative Systems) Part 1. The Crankshaft Publishing. http://what-when-how.com/neuroscience/the-autonomic-nervous-system-integrative-systems-part-1/
[16]
Ustinova, E.E., Fraser, M.O. and Pezzone, M.A. (2010) Cross-Talk and Sensitization of Bladder Afferent Nerves. Neurourology and Urodynamics, 29, 77-81. http://dx.doi.org/10.1002/nau.20817
[17]
Danielsson, I., Sjoberg, I. and Ostman, C. (2001) Acupuncture for the Treatment of Vulvar Vestibulitis: A Pilot Study. Acta Obstetricia et Gynecologica Scandinavica, 80, 437-441. http://dx.doi.org/10.1034/j.1600-0412.2001.080005437.x
[18]
Eva, L.J., Reid, W.M.N., MacLean, A.B. and Morrison, G.D. (1999) Assessment of Response to Treatment in Vulvar Vestibulitis Syndrome by Means of the Vulvar Algesiometer. American Journal of Obstetrics and Gynecology, 181, 99-102. http://dx.doi.org/10.1016/S0002-9378(99)70442-4
[19]
Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsigh, R., et al. (2000) The Female Sexual Function Index (FSFI): Multidimensional Self-report Instrument for the Assessment of Female Sexual Function. Journal of Sex & Marital Therapy, 26, 191-208. http://dx.doi.org/10.1080/009262300278597
[20]
Sullivan, M.J.L., Bishop, S. and Pivik, J. (1995) The Pain Catastrophizing Scale: Development and Validation. Psychological Assessment, 7, 524-532. http://dx.doi.org/10.1037/1040-3590.7.4.524
[21]
McCracken, L. M. (1997) “Attention” to Pain in Persons with Chronic Pain: A Behavioral Approach. Behavior Therapy, 28, 271-284. http://dx.doi.org/10.1016/S0005-7894(97)80047-0
[22]
McKay, E., Kaufman, R. H., Doctor, U., Berkova, Z., Glazer, H. and Redko, V. (2001) Treating Vulvar Vestibulitis with Electromyographic Biofeedback of Pelvic Floor Musculature. The Journal of Reproductive Medicine, 46, 337-342.
[23]
Danielsson, I., Torstensson, T., Brodda-Jansen, G. and Bohm-Starke, N. (2006) EMG Biofeedback versus Topical Lidocaine Gel: A Randomized Study for the Treatment of Women with Vulvar Vestibulitis. Acta Obstetricia et Gynecologica, 85, 1360-1367. http://dx.doi.org/10.1080/00016340600883401
[24]
Schnyer, R., Lao, L., Hammerschiag, R., Wayne, P., Langevin, H.M., Napadow, V., et al. (2008) Society for Acupuncture Research: 2007 Conference Report; The Status and Future of Acupuncture Research: 10 Years Post-NIH Consensus Conference. The Journal of Alternative and Complementary Medicine. 14, 859-860. http://dx.doi.org/10.1089/acm.2008.SAR-2
