Eficácia do tratamento fisioterapêutico para vulvodínia: uma revisão sistemática

Abstract

Vulvodynia is described as pain in the vulvar region that may be spontaneous or on touch, may be generalized, or localized with no clear identifiable cause. The latter impacts dramatically impacts women's lives leading to sexual dysfunction, reduction in self-esteem and decrease in the quality of life. The aim was to assess the efficacy of physiotherapy for vulvodynia. The present systematic review was designed and reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). PubMed, Embase, Scopus, Web of Science, SciELO, PEDro, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched on February 2023. Two authors selected and extracted the data independently. We included full- text articles of clinical trials that compared physical therapies with no treatment or other treatments for vulvodynia. The risk of bias was assessed using the Cochrane Risk of Bias tool. Due to the high heterogeneity presented between the studies, it was not possible to carry out the qualitative analysis. The results were presented in narratively. The grading of Recommendations Assessment Development and Evaluation (GRADE) approach was used to evaluate the strength of evidence of the systematic review results. PROSPERO registration: CRD42023394207. A total of 2.274 articles were retrieved from the databases. Seven studies met the inclusion criteria and were included in a systematic review, a total of 477 patients. The interventions included were electromyography biofeedback (EMG) (n= 2), Transcutaneous electrical nerve stimulation TENS (n= 1), Transcranial direct current stimulation (TDSC) (n= 1), Low-Intensity Shockwave (LISWT) (n= 1), physiotherapy treatment (n= 1) and pelvic floor exercise more behavioral modifications (n= 1). Of the seven studies present in the article, all evaluated pain reduction, five evaluated sexual function, and two evaluated qualities of life. All interventions were effective for the main outcomes, only the TDSC intervention had no significant difference when compared to the placebo group (Sham). Three studies are at high risk of bias due to the lack of study blinding. The studied interventions (electromyography biofeedback, TENS, Shockwave, physiotherapy, and pelvic floor exercise) seem to improve pain, sexual function, and quality of life. However, the heterogeneity of the studies prevented the meta-analysis. Additionally, well-designed trials are needed to improve the certainty of the evidence.