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Vulvodynia—An Evidence‐Based Literature Review and Proposed Treatment Algorithm
Author(s) -
De Andres Jose,
SanchisLopez Nerea,
AsensioSamper Juan Marcos,
FabregatCid Gustavo,
VillanuevaPerez Vicente L.,
Monsalve Dolz Vicente,
Minguez Ana
Publication year - 2016
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/papr.12274
Subject(s) - vulvodynia , medicine , etiology , grading (engineering) , multidisciplinary approach , evidence based medicine , dermatology , pelvic pain , surgery , alternative medicine , pathology , social science , sociology , engineering , civil engineering
Objective We searched the medical literature from the last 15 years (1998 to 2013) relating to the etiology, diagnosis, and treatment of vulvodynia. The evidence was reviewed supporting the therapeutic proposals currently in use and propose the incorporation of novel, minimally invasive, interventional therapies, within the context of a multidisciplinary approach. Methods This was a systematic review of all relevant studies with no language restrictions. Studies were identified through M edline/ P ub M ed (1998 to M arch 2013), the C ochrane L ibrary (2001 to 2013), and conference records and book chapters. The keywords used included “chronic pelvic pain,” “vulvodynia,” “vestibulodynia,” and search terms “etiology,” “diagnosis,” and “treatment” were added. The levels of evidence were assessed using grading system for “ T herapy/ P revention/ E tiology/ H arm” developed by the C entre for E vidence‐ B ased M edicine ( CEBM ). The grading system assists in clinical decision‐making, and we decided to use “The G rading of R ecommendations A ssessment, D evelopment, and E valuation ( GRADE ).” Results A total of 391 papers were assessed. Of these, 215 were analyzed and 175 were excluded, as they pertained to areas not directly related to the disease under review. Conclusion The optimal therapy for vulvar pain syndrome remains elusive, with low percentages of therapeutic success, using either local or systemic pharmacological approaches. Surgery involving invasive and often irreversible therapeutic procedures has resulted in success for certain subtypes of vulvodynia. We present a multidisciplinary approach whereby pain treatment units may provide an intermediate level of care between standard medical and surgical treatments.