A systematic review on the efficacy of CBT on pain and sexual function of vulvodynia.

Abstract

Vulvodynia is an underdiagnosed pain syndrome with persistent duration, usually without an identifiable organic cause. It negatively affects the quality of life, mental health and romantic relationships and sexual function of women. This review aimed to systematically appraise the available data on the effectiveness of Cognitive Behavioral Therapy on perceived pain and sexual functioning of women with vulvodynia from randomized clinical trials irrespective of their time of publication. The review was performed following the PRISMA guidelines. The literature search was conducted based on specific eligibility criteria in the PubMed, PsycInfo, and Scopus databases using appropriate keywords. The methodological quality of the included studies was assessed with the Jadad Scale. The search resulted in 10 randomized clinical trials that compared the effectiveness of Cognitive Behavioral Therapy compared to other psychotherapeutic approaches and clinical, pharmaceutical, and surgical interventions on 835 women with vulvodynia. The results, which were synthesized narratively based on intervention type and outcomes assessed, revealed the superiority of Cognitive Behavioral Therapy compared to topical treatments with significant improvements in sexual function and pain management, particularly evident at follow-up assessments. Comparisons with other psychotherapeutic approaches (mindfulness-based cognitive therapy, supportive psychotherapy) resulted in similar results. Compared to physiotherapeutic and surgical protocols, Cognitive Behavioral Therapy resulted in more favorable findings, although the improvement regarding sexual function was significant mostly at the 6-month follow-up measurements. Cognitive Behavioral Therapy appeared to help by restructuring dysfunctional beliefs, reducing pain catastrophizing, and developing alternative pain coping strategies. Despite the encouraging evidence, variations with respect to the cognitive-behavioral interventions, comparison groups, and assessment tools used to assess the variables under investigation, direct comparison of the findings was challenging. The results highlighted Cognitive Behavioral Therapy as a promising, non-pharmacological approach to the management of vulvodynia. Education of psychotherapists and clinicians, particularly gynecologists, would contribute to early diagnosis and effective treatment of vulvodynia.