Efficacy of a Physiotherapy Treatment in Women Suffering From Provoked Vestibulodynia

• Change in pain during intercourse [ Time Frame: before treatment, after treatment, 6 months after treatment ] [ Designated as safety issue: No ]
  evaluated with a visual analog scale
• Change in global sexual function [ Time Frame: before treatment, after treatment, 6 months after treatment ] [ Designated as safety issue: No ]
  evaluated with the female sexual function index (FSFI)

• Change in pain catastrophizing [ Time Frame: before treatment, after treatment, 6 months after treatment ] [ Designated as safety issue: No ]
  evaluated using the pain catastrophizing scale
• Change in psychologic distress [ Time Frame: before treatment, after treatment, 6 months after treatment ] [ Designated as safety issue: No ]
  evaluated using the State-trait Anxiety Inventory (STAI)
• Change in fear of pain [ Time Frame: before treatment, after treatment, 6 months after treatment ] [ Designated as safety issue: No ]
  evaluated using the Pain Anxiety Symptoms Scale (PASS-20)
• Change in vulvar blood circulation [ Time Frame: before treatment, after treatment, 6 months after treatment ] [ Designated as safety issue: No ]
  evaluated using a doppler laser
• Change in pelvic floor muscles function [ Time Frame: before treatment, after treatment, 6 months after treatment ] [ Designated as safety issue: No ]
  evaluated using transperineal ultrasound and dynamometry
• Change in pain sensitivity (pressure pain) [ Time Frame: before treatment, after treatment, 6 months after treatment ] [ Designated as safety issue: No ]
  evaluated using a vulvagesiometer

Chronic gynaecological pain is a major medical problem that affects 20-30% of women at different moments of their life. This largely neglected issue has a significant impact on the sexual and conjugal life of women suffering from it as well as on their psychological health. Furthermore, this kind of pain is not well understood, often misdiagnosed or even totally ignored. Also, treatment is limited and not extensively studied. This study aims at better understanding and treating gynaecological pain. The focus of the study will be provoked vestibulodynia, pain at the entry of the vagina. The efficacy of specialized pelvic floor physiotherapy will be compared to a topical cream (lidocaine) applied to the vulva. The treatment efficacy will be assessed in 234 women (aged from 18-45 years old) suffering from provoked vestibulodynia recruited in 4 hospitals (CHUS, Jewish General Hospital, Royal-Victoria Hospital, CHUM St-Luc).

This is a randomised controlled trial comparing the impact of multimodal physiotherapy treatments to topical lidocaine in women suffering from provoked vestibulodyina. The first treatment consists of 10 sixty minutes weekly physiotherapy treatments including relaxation techniques, stretching and pelvic floor muscle control exercises. The second treatment is a night time application of lidocaine to the vulva for 10 weeks. Physiotherapists will then evaluate women's pain and sexual function right after the treatment and 6 months later.

• Procedure: Multimodal physiotherapy
  10 weeks of weekly physiotherapy treatments including relaxation techniques, stretching and pelvic floor muscle control exercises.
• Drug: lidocaine
  10 weeks of daily topical 5% lidocaine application
  Other Name: Xylocaine

• Active Comparator: Lidocaine
  10 week treatment of daily application of topical lidocaine
  Intervention: Drug: lidocaine
• Experimental: Multimodal physiotherapy
  10 weeks of weekly multimodal physiotherapy treatments
  Intervention: Procedure: Multimodal physiotherapy

Inclusion Criteria:

• Moderate to severe pain in at least 90% of sexual intercourses.
• Moderate to severe pain during the cotton-swab test at one of more vestibule regions (5/10 minimum pain evaluation on the verbal pain intensity scale).
• Pain limited to the vestibule during vaginal penetrations and during activities applying pressure on the vestibule.
• Provoked vestibulodynia lasting at least 6 months prior to the study and diagnosed by a standardised gynaecologic exam protocol by one of our collaborator.

Exclusion Criteria:

• Major psychiatric condition or pelvic pathology associated with a genital pain problem (e.g.: dyspareunia).
• Use of medication that could influence pain perception.
• Actual or past pregnancy.
• Vulvar or vaginal surgery
• Post-menopausal state
• Unwillingness to restrain from other treatments till the 6 months post-treatment evaluation.
• Urogynaecologic symptoms (urinary/anal incontinence, pelvic organs prolapsus, urinary/vaginal infection active or during the last 3 months).
• Incapacity to have sexual intercourse including vaginal penetration during the last 6 months.
• Physiotherapy treatments or lidocaine application prior to the study

• Canadian Institutes of Health Research (CIHR)
• Fonds de la Recherche en Santé du Québec