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Obstetrics & Gynecology 2008;111:159-166
© 2008 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Surgical and Behavioral Treatments for Vestibulodynia

Two-and-One-Half–Year Follow-up and Predictors of Outcome

Sophie Bergeron, PhD1,2, Samir Khalifé, MD3, Howard I. Glazer, PhD4 and Yitzchak M. Binik, PhD1,5

From the Department of Sexology, 1Université du Québec à Montréal, and the Department of Psychology, 2McGill University Health Centre (Royal Victoria Hospital), Montréal, Québec, Canada; 3Department of Obstetrics and Gynecology, Jewish General Hospital, Montréal, Québec, Canada; 4Departments of Obstetrics and Gynecology and Psychiatry, Weill College of Medicine, Cornell University, New York, New York, and New York Presbyterian Hospital, New York, New York; and 5Department of Psychology, McGill University, Montréal, Québec, Canada.

OBJECTIVE: To estimate whether treatment gains for provoked vestibulodynia participants randomly assigned to vestibulectomy, biofeedback, and cognitive–behavioral therapy in a previous study would be maintained from the last assessment—a 6-month follow-up—to the present 2.5-year follow-up. Although all three treatments yielded significant improvements at 6-month follow-up, vestibulectomy resulted in approximately twice the pain reduction as compared with the two other treatments. A second goal of the present study was to identify predictors of outcome.

METHODS: In a university hospital, 51 of the 78 women from the original study were reassessed 2.5 years after the end of their treatment. They completed 1) a gynecologic examination involving the cotton-swab test, 2) a structured interview, and 3) validated pain and sexual functioning measures.

RESULTS: Results from the multivariate analysis of variance conducted on the pain measures showed a significant time main effect (P<.05) and a significant treatment main effect (P<.01), indicating that participants had less pain at the 2.5-year follow-up than at the previous 6-month follow-up. Results from the multivariate analysis of variance conducted on sexual functioning measures showed that participants remained unchanged between the 6-month and 2.5-year follow-up and that there were no group differences. Higher pretreatment pain intensity predicted poorer outcomes at the 2.5-year follow-up for vestibulectomy (P<.01), biofeedback (P<.05), and cognitive–behavioral therapy (P<.01). Erotophobia also predicted a poorer outcome for vestibulectomy (P<.001).

CONCLUSION: Treatment gains were maintained at the 2.5-year follow-up. Outcome was predicted by pretreatment pain and psychosexual factors.

LEVEL OF EVIDENCE: II






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