Vulvodínia: fatores psicossociais e abordagens psicoterapêuticas

Abstract

Introduction: Vulvodynia, vulvar pain, is a common gynecological condition with an estimated global prevalence of approximately 8% of the world population, typically affecting women between the ages of 20 and 40. As it is a multifactorial disease, it can be triggered by hormonal changes, recurrent infections or inflammation in the vulvar region, trauma to the genital area, genetic predisposition and psychosocial factors. Women with vulvodynia present symptoms of sexual dysfunction, in addition to high levels of anxiety and depression, favoring a decrease in quality of life. Considering the psychological component involved in the prognosis of vulvodynia, psychotherapy and psychotherapeutic techniques can offer clinically practical and resolute treatment options for vulvar pain. Objectives: To evaluate the psychosocial factors and psychotherapeutic techniques in the management of vulvodynia. Materials and methods: Two systematic reviews were conducted, one of which included meta-analysis. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) recommendations were followed. In article 1, a search strategy was used for observational studies (case-control and cohort) that investigated the psychosocial factors associated with vulvodynia, its effects on sexuality, mental health and quality of life, evaluating vulvar pain as the primary outcome, in the following databases: PubMed, LILACS, Embase, CINAHL, Web of Science, Scopus and PsycINFO. The risk of bias was assessed using the Newcastle-Ottawa Scale. In article 2, a search strategy was used for randomized clinical trials that used psychotherapy and psychotherapeutic techniques for vulvodynia, with vulvar pain intensity as the primary outcome, in the following databases: PubMed, Embase, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, PsycInfo, and Clinical Trial Databases. The risk of bias was assessed using the Cochrane Risk of Bias (RoB 2.0) tool, and RevMan 5.4 was used for data synthesis (meta-analysis). In both articles, two authors independently selected and extracted data from the articles, and the Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE) approach was used to classify the strength of the evidence. Results: In article 1, a total of 3,182 articles were identified, of which 22 studies met the eligibility criteria and were included in the review, comprising 2,624 patients. An association between psychosocial factors and vulvodynia was observed, in which women with vulvar pain had more symptoms of anxiety and depression. Regarding sexual function, the most frequent results were dyspareunia and dysfunction. For quality of life, women with chronic vulvar pain had greater difficulty performing physical activities and experienced negative moods and feelings. The risk of bias of the studies ranged from good (6) to excellent (7). The high heterogeneity of the studies made it impossible to perform the meta-analysis. In article 2, a total of 1,884 articles were identified, of which 10 studies met the eligibility criteria and were included in the systematic review, comprising 951 participants. Two studies were included in the meta-analysis, these with 143 participants. When comparing Acceptance and Commitment Therapy (ACT) with the control group, the mean difference (MD) in the pooled analysis for the Chronic Pain Acceptance Questionnaire did not differ significantly between ACT and other therapies, for post-treatment assessment (MD = 0.77; 95% CI -3.45, 4, 99) of pain. The risk of bias was high in 03 studies, due to the lack of clarity in the outcome measurement process. The certainty of the evidence for vulvar pain using ACT was considered moderate. Conclusion: The results suggest an association between psychosocial factors and vulvodynia. Psychotherapy and psychotherapeutic techniques significantly improve vulvar pain, psychological adjustment, and sexual function and quality of life in women with vulvodynia. Furthermore, our meta-analysis showed that ACT and other psychotherapeutic interventions improve psychological adjustment through pain acceptance. However, more rigorous studies are needed to improve the quality of evidence and improve clinical practice.