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Does the addition of electrical stimulation or kinesiotherapy improve outcomes of amitriptyline treatment for women with vulvodynia? A randomized clinical trial

International Urogynecology Journal (2023)Cite this article

Abstract

Introduction and hypothesis

Women diagnosed with provoked vulvodynia frequently report a great deal of frustration in achieving symptomatic relief. Physical therapy and drug treatment are among the interventions most indicated by guidelines; however, whether those modalities are effective when combined remains unclear. The objective was to evaluate the effectiveness of adding a physical therapy modality compared with amitriptyline alone for the treatment of vulvodynia.

Methods

Eighty-six women with vulvodynia were randomized to (G1) 25 mg amitriptyline, once a day (n=27), (G2) amitriptyline + electrical stimulation therapy (n=29) or (G3) amitriptyline + kinesiotherapy (n=30). All treatment modalities were administered for 8 weeks. The primary endpoint was the reduction in vestibular pain. Secondary measurements focused on sexual pain, frequency of vaginal intercourse, Friedrich score, and overall sexual function. Data were analyzed using intention-to-treat.

Results

All treatment modalities resulted in a significant decrease in vestibular pain (p<0.001), sexual pain (p<0.05), Friedrich score (p<0.001), and an increase in the frequency of sexual intercourse (p<0.05). G3 was more effective than G1 at reducing sexual pain (G1: 5.3±3.3 vs G3: 3.2±2.7; p=0.01) and at improving sexual function (G1: 18.8±9.8 vs G3: 23.9±7.8; p=0.04).

Conclusion

Kinesiotherapy and electrotherapy additions to amitriptyline administration as well as amitriptyline alone, were effective at improving vestibular pain in women with vulvodynia. Women receiving physical therapy had the greatest improvement in sexual function and frequency of intercourse at post-treatment and follow-up.

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Acknowledgements

We would like to thank Julia Fante for contributing to data collection and Dr. José Paulo Martins Bonilha Júnior for all his support to my academic career.

The main author acknowledges a student grant from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology of University of Campinas, R. Alexander Flemming, 101 - Cidade Universitária, Campinas, SP, 13083-880, Brazil

    Marcela Grigol Bardin & Paulo César Giraldo

  2. Department of Clinical Medicine, University of Campinas, São Paulo, Brazil

    Juliana Lenzi

  3. Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York and Institute of Tropical Medicine, New York, NY, USA

    Steven S. Witkin

  4. Campinas, Brazil

    Ticiana Aparecida Alves De Mira

  5. School of Rehabilitation, Sherbrooke University, Québec, Canada

    Melanie Morin

Authors
  1. Marcela Grigol Bardin
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  3. Juliana Lenzi
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Correspondence to Marcela Grigol Bardin.

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Randomized controlled trial information

This clinical trial was registered under NCT02871661 (on 18 August 2016). (Initial participant enrollment: February) https://clinicaltrials.gov/ct2/show/NCT02871661

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Bardin, M.G., Giraldo, P.C., Lenzi, J. et al. Does the addition of electrical stimulation or kinesiotherapy improve outcomes of amitriptyline treatment for women with vulvodynia? A randomized clinical trial. Int Urogynecol J (2023). https://doi.org/10.1007/s00192-023-05454-z

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Keywords

  • Vulvodynia
  • Physical therapy
  • Amitriptyline
  • Pelvic floor exercise
  • Electric stimulation
  • Pelvic rehabilitation
  • Sexual dysfunction