Meta-analysis of RCTs on the effect of vestibulodynia treatment on female sexual function

Abstract

Vulvodynia and vestibulodynia affect to some 10% of women, tend to be recurrent, and alter sexual function. A large number of treatments have been suggested, although clinical results are controversial. We carried out a systematic review and meta-analysis of randomized clinical trials (RCTs) to assess changes in sexual function with different treatments. Five datafiles were searched without language restriction, for RCTs comparing any clinical intervention as compared to placebo, sham intervention, or no therapy, until October 2018. The authors independently evaluated eligibility based on articles’ titles, abstracts, and full-text articles. A total of 304 unique records were found, and four RCTs provided information about six interventions: (i) Transcranial direct current stimulation (intensity = 2 mA) for 20 minutes, 10 sessions over a two-weeks period, with the anode positioned over the primary motor cortex, and the cathode, over the contralateral supraorbital area; (ii) transcutaneous electrical nerve stimulation twice a week delivered through a vaginal probe, 20 sessions (10 weeks); (iii) 20 units of botulinum toxin A in 0.5 mL injected symmetrically in the muscle bulbospongiosus; (iv) topical lidocaine; (v) oral desimipramine; and (vi) combined topical lidocaine + oral desimipramine. Sexual function assessment was performed with the Female Sexual Function Index (FSFI), the Index of Sexual Satisfaction (ISS), and the Female Sexual Dysfunction (FSD). Random effects meta-analyses with the inverse variance method were used to evaluate the effects of interventions on outcomes. Effects were expressed as mean differences (MD) and their 95% confidence intervals (CI). There were significant increases in FSFI scores (n = 3 interventions; MD = 5.60; 95%CI 0.98 to 10.22; I2 = 57%; p = 0.02); and for the ISS (n = 3 interventions; MD = −5.14; 95%CI −5.14; 95% CI −9.52 to −0.75; I2 = 51%; p = 0.02). There was not significant difference using the FSD (n = 2 interventions; MD = −3. 69: 95%CI = −2.81 to 10.20; I2 = 0%; p = 0.27). Further studies are needed to confirm found trends to identify the appropriate treatment for vestibulodynia.