title: Psychological treatment for vaginal pain: does etiology matter? A systematic review and meta-analysis.
abstract: BACKGROUND
  Classification of vaginal pain within medical or psychiatric diagnostic systems draws mainly on the presumed presence or absence (respectively) of underlying medical etiology. A focus on the experience of pain, rather than etiology, emphasizes common ground in the aims of treatment to improve pain and sexual, emotional, and cognitive experience. Thus, exploring how vaginal pain conditions with varying etiology respond to psychological treatment could cast light on the extent to which they are the same or distinct.
  
  
  OBJECTIVE
  To examine the combined and relative efficacy of psychological treatments for vaginal pain conditions.
  
  
  METHODS
  A systematic search of EMBASE, MEDLINE, PsycINFO, and CINAHL was undertaken. Eleven randomized controlled trials were entered into a meta-analysis, and standardized mean differences and odds ratios were calculated. Effect sizes for individual psychological trial arms were also calculated.
  
  
  METHODS
  Main outcome measures were pain and sexual function.
  
  
  RESULTS
  Equivalent effects were found for psychological and medical treatments. Effect sizes for psychological treatment arms were comparable across vaginal pain conditions.
  
  
  CONCLUSIONS
  Effectiveness was equivalent regardless of presumed medical or psychiatric etiology, indicating that presumed etiology may not be helpful in selecting treatment. Research recommendations and clinical implications are discussed.
authors.affiliation: Research Department of Clinical, Educational & Health Psychology, University College London, London, UK.
authors.forename: Esther
authors.initials: E
authors.lastname: Flanagan
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Herron
authors.forename: Ciarán
authors.initials: C
authors.lastname: O'Driscoll
authors.forename: Amanda C de C
authors.initials: AC
authors.lastname: Williams
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D003075:Coitus / Q000523:psychology; D003131:Combined Modality Therapy; D004644:Emotions; D005260:Female; D006801:Humans; D017063:Outcome Assessment, Health Care; D011613:Psychotherapy; D016032:Randomized Controlled Trials as Topic; D012725:Sexual Behavior; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D020018:Sexual Dysfunctions, Psychological / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D014622:Vaginal Creams, Foams, and Jellies
chemical_list: D014622:Vaginal Creams, Foams, and Jellies
keywords: Dyspareunia; Psychotherapy; Sexual Dysfunction; Vaginismus; Vestibulodynia; Vulvodynia