PubMed · 11247203
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J Black. Pertinent points.. https://doi.org/10.1080/00926230152051743
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DEFINITION: Vulvodynia includes a group of vulva disorders in patients with a normal clinical presentation. Chronic and spontaneous complaints are observed, sometimes aggravated by sexual intercourse. Most patients complain of a burning vulva. MANAGEMENT: The diagnostic and therapeutic approach to vulvodynia is long and difficult. Complementary explorations may be useful initially but should not be repeated too often. They are helpful in ruling out vulvovaginal infections (candidiasis, sexually transmitted diseases) and vulva dermatosis. Vulvodynia can then be classed as cyclic vulvo-dynia, vestibulitis or essential (dysesthesic vulvodynia). MULTIDISCIPLINARY CARE: Each different type of vulvodynia requires specific care. In all cases, the psychosomatic aspect must be considered. Multidisciplinary care may involve the primary care physician, the gynecologist, the dermatologist, the pain specialist, the psychologist, the psychiatrist, and the physical therapy specialist.
BACKGROUND: Proponents of therapeutic ultrasound suggest it can decrease pain by resolution of inflammation processes and reducing the pressure on pain sensitive structures by haematoma and oedema. OBJECTIVES: The objective of this review was to assess the effects of therapeutic ultrasound for treating acute perineal pain, persistent perineal pain and/or dyspareunia, following childbirth. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register, Embase, Cinahl (to May 1996), Physiotherapy Index (1985 to May 1996) and World Congress of Physical Therapy 1994 Conference Proceedings. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing active therapeutic ultrasound with no treatment, placebo ultrasound, or any other 'standard' or active treatment for women with acute or persistent perineal pain and/or dyspareunia following childbirth. DATA COLLECTION AND ANALYSIS: One reviewer assessed trial quality and extracted data. MAIN RESULTS: Four trials involving 659 women were included. The trials were of variable quality. Based on two placebo controlled trials, women treated with active ultrasound for acute perineal pain were more likely to report improvement in pain with treatment (odds ratio 0.37, 95% confidence interval 0.19 to 0.69). No other outcome reached significance. In one trial comparing pulsed electromagnetic energy with ultrasound for acute perineal pain, women treated with ultrasound were more likely to have bruising at 10 days (odds ratio 1.64, 95% confidence interval 1.04 to 2.60). However those treated with ultrasound were less likely to have experienced perineal pain at 10 days (odds ratio 0.56, 95% confidence interval 0.34 to 0.92) and three months (odds ratio 0.43, 95% confidence interval 0.22 to 0.84). No other outcome reached significance. Based on one trial, women treated with ultrasound for persistent perineal pain and/or dyspareunia were less likely to report pain with sexual intercourse compared with the placebo group (odds ratio 0.31, 95% confidence interval 0.11 to 0.84). None of the other outcomes measured reached significance. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the use of ultrasound in treating perineal pain and/or dyspareunia following childbirth.