Internet-based Treatment for Vulvodynia (EMBLA) – A Randomized Controlled Study. Issue 2 (28th December 2021)

• Record Type: Journal Article
• Authors: Hess Engström, Andrea; Bohm-Starke, Nina; Kullinger, Merit; Hesselman, Susanne; Högberg, Ulf; Buhrman, Monica; Skalkidou, Alkistis
• Is Part Of: Journal of sexual medicine. Volume 19:Issue 2(2022)
• Page Start: 319
• Page End: 330
• Publication Date: 2021-12-28
• Subjects: Vulvodynia -- Vestibulodynia -- Internet-based treatment -- Acceptance and commitment therapy -- CBT -- Mindfulness; Sexual disorders -- Periodicals; Sex -- Periodicals; Sexual health -- Periodicals; 616.69005
• DOI: 10.1016/j.jsxm.2021.11.019
• Languages: English
• ISSNs: 1743-6095

Abstract

ABSTRACT: Background: Internet-based ACT (Acceptance and commitment therapy) treatment may improve accessibility and reduce stigma related to seeking health care, but there are a lack of studies investigating internet-based treatment using ACT principles for women with vulvodynia. Aim: The aim of this study was to investigate the effects of an internet-based treatment of pain during intercourse for women with provoked vulvodynia compared with no intervention during the waiting period before clinical treatment. Methods: A multicenter randomized controlled trial was conducted during 2016 to 2020, in which 99 participants were included. Participants were randomized to either a 6 week guided internet-based treatment using ACT principles or usual care. Data were collected at baseline, 6 weeks after baseline, and approximately 10 months after baseline. Outcomes: Pain-related (pain during intercourse, tampon test, impact of pain on sexual function) and pain behavior-related outcomes (attempts at intercourse, sexual activities besides intercourse, willingness to perform the tampon test, chronic pain acceptance questionnaire) were used as outcomes. Results: Treatment was efficacious in what concerns pain during intercourse and pain acceptance. Less pain during intercourse among women in the intervention group was observed at both post-treatment (primary endpoint, P = .01, Cohen's d = 1.4, 95% CI = 0.33, 2.4), and follow-up ( P = .04). Absolut mean difference between groups for pain during intercourse at post-treatment was -2.84, (95 % CI = -4.91, -0.78), and -1.58 at follow-up, (95 % CI = -3.17, 0.02), where the intervention group rated less pain than controls. No differences between groups over time were found for tampon test measures or impact of pain on sexual function. There was a significant difference between groups at all timepoints indicating fewer attempts at intercourse among participants in the intervention group. At post-treatment, women who underwent internet-based treatment reported higher pain acceptance and a rise in activity engagement compared with the control group. Clinical Implications: There is an indication that internet-based treatment could be incorporated into clinical practice as a complement to clinical treatment. Strengths & Limitations: Study strengths included using several forms of recruitment and an intervention built by different professions with long experience of treating patients with vulvodynia. High dropout rate was a limitation of this study. Conclusion: Internet-based treatment may have an impact on pain during intercourse and positive effects on pain acceptance. However, conclusions must be drawn with caution due to the small sample size.