A randomized comparison of group cognitive–behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis

TLDR

The study compared a 12‑week group cognitive‑behavioral therapy, a 12‑week surface electromyographic biofeedback program, and vestibulectomy for dyspareunia caused by vulvar vestibulitis. Eighty‑two women were randomized to one of the three treatments and evaluated before, after, and six months post‑treatment using gynecological exams, structured interviews, and validated questionnaires on pain, sexual function, and psychological adjustment. All groups showed significant reductions in pain, improvements in sexual function and psychological adjustment at post‑treatment and six‑month follow‑up, with vestibulectomy yielding the greatest pain relief—though its superiority should be interpreted cautiously due to seven non‑completers—demonstrating benefits of both medical and behavioral interventions.

Abstract

This study compared group cognitive-behavioral therapy (12-week trial), surface electromyographic biofeedback (12-week trial), and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Subjects were 78 women randomly assigned to one of three treatment conditions and assessed at pretreatment, posttreatment and 6-month follow-up via gynecological examinations, structured interviews and standard questionnaires pertaining to pain (Pain Rating Index and Sensory scale of the McGill Pain Questionnaire, vestibular pain index, pain during intercourse), sexual function (Sexual History Form, frequency of intercourse, Information subscale of the Derogatis Sexual Functioning Inventory), and psychological adjustment (Brief Symptom Inventory). As compared with pretreatment, study completers of all treatment groups reported statistically significant reductions on pain measures at posttreatment and 6-month follow-up, although the vestibulectomy group was significantly more successful than the two other groups. However, the apparent superiority of vestibulectomy needs to be interpreted with caution since seven women who had been assigned to this condition did not go ahead with the intervention. All three groups significantly improved on measures of psychological adjustment and sexual function from pretreatment to 6-month follow-up. Intent-to-treat analysis supported the general pattern of results of analysis by-treatment-received. Findings suggest that women with dyspareunia can benefit from both medical and behavioral interventions.