Treatment of Female Sexual Pain Disorders: A Systematic Review

Abstract

Sexual pain disorders affect women's sexual and reproductive health and are poorly understood. Although many treatments have been evaluated, there is no one “gold standard” treatment. The aim of this systematic review was to investigate what treatments for female sexual pain have been evaluated in clinical studies and their effectiveness. The search strategy resulted in 65 papers included in this review. The articles were divided into the following categories: medical treatments; surgical treatments; physical therapies; psychological therapies; comparative treatment studies; and miscellaneous and combined treatments. Topical and systemic medical treatments have generally been found to lead to improvements in, but not complete relief of, pain, and side effects are quite common. Surgical procedures have demonstrated very high success rates, although there has been variability in complete relief of pain after surgery, which suggests less invasive treatments should be considered first. Physical therapies and psychological therapies have been shown to be promising treatments, supporting a biopsychosocial approach to sexual pain disorders. Although most of the interventions described have been reported as effective, many women still experience pain. A multidisciplinary team with active patient involvement may be needed to optimize treatment outcome.

Notes

The term vulvar vestibulitis is only used here when we discuss earlier studies where researchers employed this term to refer to participant inclusion criteria.

For this review, the term “sexual pain” is used throughout because the focus is on treating pain associated with sexual activity. It is acknowledged that other aspects of pelvic pain/vulvar pain (e.g., daily pain, discomfort, difficulty with daily activities) are also important.

Because of space constraints, the detailed results from application of the Cochrane Risk of Bias criteria are not presented but are available from the authors upon request.

Table 1 Summary of Studies

Figure 1 Flow of papers during the selection process (duplicates were automatically removed from the search results by the database). Records refer to the total number of search results retrieved from the databases.