Internet-based Treatment for Vulvodynia (EMBLA) - A Randomized Controlled Study.

Acceptance and Commitment Therapy Chronic Pain Coitus Female Humans Internet Surveys and Questionnaires Vulvodynia / therapy
Acceptance and commitment therapy CBT Internet-based treatment Mindfulness Vestibulodynia Vulvodynia

Journal

The journal of sexual medicine
ISSN: 1743-6109
Titre abrégé: J Sex Med
Pays: Netherlands
ID NLM: 101230693

Informations de publication

Date de publication:
02 2022
Historique:
received: 09 04 2021
revised: 22 11 2021
accepted: 29 11 2021
pubmed: 2 1 2022
medline: 1 4 2022
entrez: 1 1 2022
Statut: ppublish

Résumé

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. 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. 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. 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. 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. There is an indication that internet-based treatment could be incorporated into clinical practice as a complement to clinical treatment. 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. 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. Engström AH, Bohm-Starke N, Kullinger M, et al. Internet-based Treatment for Vulvodynia (EMBLA) - A Randomized Controlled Study. J Sex Med 2022;19:319-330.

Sections du résumé

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. Engström AH, Bohm-Starke N, Kullinger M, et al. Internet-based Treatment for Vulvodynia (EMBLA) - A Randomized Controlled Study. J Sex Med 2022;19:319-330.

Identifiants

DOI: 10.1016/j.jsxm.2021.11.019 PMID: 34972640
pubmed: 34972640
pii: S1743-6095(21)00795-5
doi: 10.1016/j.jsxm.2021.11.019
pii:
doi:

Types de publication

Journal Article Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

319-330

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2021 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Auteurs

Andrea Hess Engström (A)

Uppsala University, Center for Clinical Research, Västmanland County Hospital, Västerås, Sweden; Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden. Electronic address: andrea.hess.engstrom@regionvastmanland.se.

Nina Bohm-Starke (N)

Karolinska Institute, Department of Clinical Sciences, Division of Obstetrics and Gynecology, Solna, Sweden; Danderyd Hospital, Stockholm, Sweden.

Merit Kullinger (M)

Uppsala University, Center for Clinical Research, Västmanland County Hospital, Västerås, Sweden; Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden.

Susanne Hesselman (S)

Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden; Uppsala University, Center for Clinical Research, Falun, Sweden.

Ulf Högberg (U)

Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden; Umeå University, Department of Epidemiology and Global Health, Umeå, Sweden.

Monica Buhrman (M)

Uppsala University, Department of Psychology, Division of Clinical Psychology, Uppsala, Sweden.

Alkistis Skalkidou (A)

Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden. Electronic address: https://twitter.com/ASkalkidou.

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Classifications MeSH

questionsmedicales.fr › Disciplines et activités comportementales › Psychothérapie › Thérapie comportementale › Thérapie cognitive › Thérapie d'acceptation et d'engagement › Internet-based Treatment for Vulvodynia...
questionsmedicales.fr › États, signes et symptômes pathologiques › Signes et symptômes › Manifestations neurologiques › Douleur chronique › Internet-based Treatment for Vulvodynia...
questionsmedicales.fr › Phénomènes physiologiques des appareils urinaire et reproducteur › Phénomènes physiologiques de la reproduction › Reproduction › Coït › Internet-based Treatment for Vulvodynia...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Internet-based Treatment for Vulvodynia...
questionsmedicales.fr › Sciences de l'information › Méthodologies informatiques › Systèmes informatiques › Réseaux de communication entre ordinateurs › Internet › Internet-based Treatment for Vulvodynia...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enquêtes et questionnaires › Internet-based Treatment for Vulvodynia...
questionsmedicales.fr › Maladies urogénitales › Maladies génitales › Maladies de l'appareil génital féminin › Maladies de la vulve › Vulvodynie › Internet-based Treatment for Vulvodynia...