title: The treatment of provoked vestibulodynia: a critical review.
abstract: OBJECTIVE
  To carry out a critical review of published studies concerning the treatment of provoked vestibulodynia.
  
  
  METHODS
  MEDLINE, PsycINFO, and Cochrane were used to identify treatment studies published between January 1996 and December 2006. All studies published in English that dealt specifically with the treatment of provoked vestibulodynia were included in the review regardless of their methodological quality. Thirty-eight treatment studies were thus examined in the present paper.
  
  
  RESULTS
  Since 1996, surgical treatment has received somewhat less empirical attention. Nevertheless, it still boasts the best success rates, which range from 61% to 94%. More studies have focused on medical treatments, yielding success rates varying between 13% and 67%. Behavioral treatments have been the least studied, although 35% to 83% of patients benefit from them. Despite these interesting results, only 5 of the 38 treatment studies reviewed are randomized clinical trials. Furthermore, the majority of studies have several methodological weaknesses, such as the absence of (1) control or placebo group, (2) double-blind evaluation, (3) pretreatment pain evaluation, and (4) validated measures of pain and sexual functioning.
  
  
  CONCLUSIONS
  On the basis of the results of the reviewed prospective studies and the randomized clinical trials, vestibulectomy is the most efficacious treatment to date. Though some medical treatments seem little effective, others appear promising and should be investigated further, as is the case with behavioral treatments. Additional randomized clinical trials are necessary to confirm the efficacy of surgery and validate nonsurgical treatments for provoked vestibulodynia.
authors.affiliation: Department of Sexology, Université du Québec à Montréal, Montreal, Canada. landry.tina@courrier.uqam.ca
authors.forename: Tina
authors.initials: T
authors.lastname: Landry
authors.forename: Sophie
authors.initials: S
authors.lastname: Bergeron
authors.forename: Marie-Josée
authors.initials: MJ
authors.lastname: Dupuis
authors.forename: Geneviève
authors.initials: G
authors.lastname: Desrochers
mesh_terms: D000700:Analgesics / Q000008:administration & dosage; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D002986:Clinical Trials as Topic / Q000592:standards / Q000706:statistics & numerical data; D015928:Cognitive Behavioral Therapy / Q000706:statistics & numerical data; D004414:Dyspareunia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D010148:Intractable Pain / Q000503:physiopathology / Q000628:therapy*; D014844:Vulva / Q000294:innervation / Q000503:physiopathology*; D054515:Vulvar Vestibulitis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*
chemical_list: D000700:Analgesics; D000929:Antidepressive Agents, Tricyclic; D000935:Antifungal Agents