Poster Session

P258. Outcome of medical and psychosexual interventions for Vaginismus: a systematic review and meta-analysis

Elisa Maseroli (IT), Irene Scavello (IT), Giulia Rastrelli (IT), Erika Limoncin (IT), Sarah Cipriani (IT), Emmanuele Jannini (IT), Mario Maggi (IT), Linda Vignozzi (IT)

[Maseroli] Gynecological Endocrinology Research Unit, Department of Experimental, Clinical and Biomedical Sciences “Mario Serio”, University of Florence, Florence, [Scavello] Gynecological Endocrinology Research Unit, Department of Experimental, Clinical and Biomedical Sciences “Mario Serio”, University of Florence, Florence, [Rastrelli] Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences “Mario Serio”, University of Florence, Florence, [Limoncin] Department of Applied Clinical Sciences and Biotechnologies, University of L'Aquila, L'Aquila, [Cipriani] Gynecological Endocrinology Research Unit, Department of Experimental, Clinical and Biomedical Sciences “Mario Serio”, University of Florence, Florence, [Jannini] Department of Systems Medicine, University of Tor Vergata, Rome, [Maggi] Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences “Mario Serio”, University of Florence, Florence,, [Vignozzi] Gynecol

Context: Vaginismus (V) is a condition with great impact on the woman and the couple’s psycho-sexological well-being and reproductive capacity. Various medical and psychosexual interventions have been developed for its treatment, but a very few and poorly designed controlled studies are available on this topic. Objective: The aim of this study is to systematically analyze the results of various interventions for V. Methods: An extensive Medline and Embase search was performed using the word “vaginismus”. All the studies assessing the change in V symptoms upon different therapies were considered. Patients: Overall, 44 studies were included in the meta-analysis, enrolling 1915patients. Interventions: A systematic review and meta-analysis of the above mentioned studies was performed. The patients enrolled in the considered studies mainly underwent the following types of intervention: behavioral therapy, cognitive-behavioral therapy (CBT), pharmacological therapy (botulinum injections) and pelvic floor physiotherapy. Main Outcome Measure: The ability to complete sexual intercourse was the outcome of the meta-analysis. Results: The combination of the results showed that treating V, irrespectively of the therapy used, is associated with the completion of sexual intercourse in in almost 78%of cases. Meta-regression analyses showed that the probability of obtaining V resolution was significantly higher in patients reporting the symptom for a shorter time. We compared the results of each kind of intervention without finding any significant difference. When dividing results according to the study design, no significant differences were found;however, whereas longitudinal observational studies report significant success rates, the results from randomized controlled trials (RCTs) are more variable and overall insignificant. Therefore, the standardized residuals were evaluated and two outlier studies were identified. After removing these two studies, behavioral, CBT and pharmacological therapies demonstrated to be successful approaches, whereas pelvic floor physiotherapy, although showing a trend, failed to fulfill the statistical significance. In addition, no differences in the success rate were found between the different interventions. Conclusions: Available treatments for V are efficacious, allowing the completion of sexual intercourse in 78% of cases. The duration of V, but not the kind of intervention, seems to play as a factor modulating the success of therapy.

 

 

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