A randomized clinical trial for women with vulvodynia: Cognitive-behavioral therapy vs. supportive psychotherapy

TLDR

Current vulvodynia treatments rely largely on expert opinion rather than evidence. The study compared the efficacy of cognitive‑behavioral therapy versus supportive psychotherapy in women with vulvodynia. Mixed‑effects modeling analyzed all available data. Among 50 participants, 84 % completed treatment and 94 % completed one‑year follow‑up; pain severity decreased significantly (p < 0.001), with 42 % achieving clinical improvement, and CBT produced greater reductions in examination pain (p = 0.014), improved sexual function (p = 0.034), higher satisfaction and credibility than SPT, with effects maintained at one year.

Abstract

Many treatments used for women with vulvodynia are based solely upon expert opinion. This randomized trial aimed to test the relative efficacy of cognitive-behavioral therapy (CBT) and supportive psychotherapy (SPT) in women with vulvodynia. Of the 50 participants, 42 (84%) completed 10-week treatments and 47 (94%) completed one-year follow-up assessments. Mixed effects modeling was used to make use of all available data. Participants had statistically significant decreases in pain severity (p's<0.001) with 42% of the overall sample achieving clinical improvement. CBT, relative to SPT, resulted in significantly greater improvement in pain severity during physician examination (p=0.014), and greater improvement in sexual function (p=0.034), from pre- to post-treatment. Treatment effects were well maintained at one-year follow-up in both groups. Participants in the CBT condition reported significantly greater treatment improvement, satisfaction and credibility than participants in the SPT condition (p's<0.05). Findings from the present study suggest that psychosocial treatments for vulvodynia are effective. CBT, a directed treatment approach that involves learning and practice of specific pain-relevant coping and self-management skills, yielded better outcomes and greater patient satisfaction than a less directive approach.