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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.

Vulvodynia Treated with Acupuncture or Electromyographic Biofeedback