Transcutaneous electrical nerve stimulation as an additional treatment for women suffering from therapy-resistant provoked vestibulodynia: a feasibility study.
BACKGROUND
The current approach to women with provoked vestibulodynia (PVD) comprises a multidimensional, multidisciplinary therapeutic protocol. As PVD is considered to be a chronic pain disorder, transcutaneous electrical nerve stimulation (TENS) can be used as an additional therapy for women with otherwise therapy-resistant PVD.


OBJECTIVE
The aims of this study were to evaluate whether TENS has a beneficial effect on vulvar pain, sexual functioning, and sexually-related personal distress in women with therapy-resistant PVD and to assess the effect of TENS on the need for vestibulectomy.


METHODS
A longitudinal prospective follow-up study was performed on women with therapy-resistant PVD who received additional domiciliary TENS. Self-report questionnaires and visual analog scales (VASs) were completed at baseline (T1), post-TENS (T2), and follow-up (T3).


METHODS
Vulvar pain, sexual functioning, and sexually-related personal distress were the main outcome measures.


RESULTS
Thirty-nine women with therapy-resistant PVD were included. Mean age was 27 ± 5.6 years (range: 19 to 41); mean duration between TENS and T3 follow-up was 10.1 ± 10.7 months (range: 2 to 32). Vulvar pain VAS scores directly post-TENS (median 3.4) and at follow-up (median 3.2) were significantly (P < 0.01) lower than at baseline (median 8.0). Post-TENS, sexual functioning scores on the Female Sexual Functioning Index questionnaire had improved significantly (P = 0.2); these scores remained stable at follow-up. Sexually-related personal distress scores had improved significantly post-TENS (P = 0.01). Only 4% of the women who received TENS needed to undergo vestibulectomy vs. 23% in our previous patient population.


CONCLUSIONS
The addition of self-administered TENS to multidimensional treatment significantly reduced the level of vulvar pain and the need for vestibulectomy. The long-term effect was stable. These results not only support our hypothesis that TENS constitutes a feasible and beneficial addition to multidimensional treatment for therapy-resistant PVD, but also the notion that PVD can be considered as a chronic pain syndrome.
Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Marleen S
MS
Vallinga
Symen K
SK
Spoelstra
Inge L M
IL
Hemel
Harry B M
HB
van de Wiel
Willibrord C M
WC
Weijmar Schultz
D000328:Adult; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D010147:Pain Measurement; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D004561:Transcutaneous Electric Nerve Stimulation; D016896:Treatment Outcome; D056650:Vulvodynia / Q000523:psychology / Q000628:therapy*
Dyspareunia; Female Sexual Pain Disorders; Genito-Pelvic Pain/Penetration Disorder; Provoked Vestibulodynia; Transcutaneous Electrical Nerve Stimulation (TENS); Vestibulectomy; Vulvar Pain