Low-intensity shock wave therapy (LISWT) is a safe, feasible way to relieve pain in women with provoked vestibulodynia (PVD), a recent Journal of Sexual Medicine study suggests.

“We believe we have found a new effective treatment for alleviating the most bothersome symptom in PVD, pain during penetration and intercourse,” the authors wrote.

In their study, shock wave therapy was well-tolerated and had few side effects.

Women with PVD experience pain when the vestibule (the vaginal entrance) is touched. This pain can make gynecological exams, tampon insertion, and sexual activity difficult and distressing. Researchers are not certain why PVD occurs. It’s possible that increased innervation or inflammatory responses in the area could play a role.

Current treatments for PVD include analgesics, local estrogen, antidepressants, acupuncture, physical therapy, cognitive behavioral therapy, and mindfulness. In severe cases, surgery might be considered. However, it’s not clear how well these approaches work.

Shock wave therapy has been studied for cardiology, orthopedics, and urology (including erectile dysfunction). The current study is the first to explore the use of LISWT in women with PVD.

Researchers worked with 32 women between January 2018 and January 2020. The participants were divided into two groups: a LISWT therapy group (23 women with a mean age of 27) and a sham treatment group (9 women with a mean age of 25).

Women in the LISWT group received 12 doses of LISWT, with two doses administered weekly for six weeks. Each dose was delivered in 500-pulse increments with a shock wave generator.

The same protocol was followed for the women in the sham treatment group, except no shock waves were activated.

Evaluations were made at three time points: before the first treatment, one month after the 12th treatment, and three months after the 12th treatment.

When rating their pain on a 10-point visual analog scale, women in the LISWT group experienced the greatest improvement. Their average baseline score was 8 points, but this fell to 5.70 points one month after treatment and 4.40 points three months after treatment. For the women in the sham group, average scores were 8.66 points at baseline, 8.30 points after one month, and 7.90 points after three months.

Other assessment tools, including the Wong-Baker Pain FACES Scale and the Female Sexual Function Index (FSFI) indicated more improvements for women in the LISWT group compared to those in the sham treatment group.

Pain thresholds were measured with an algometer, a device that applied pressure to the vaginal entrance. At the three-month mark, women receiving shock wave therapy had higher pain thresholds than the women in the sham treatment group.

“Self-limited low abdominal pain” was reported by one woman in the LISWT group. It was the only side effect reported.

The authors noted that this was a “pioneer” study and that more research was needed before LISWT could be considered a routine treatment for PVD.

Resources

• The Journal of Sexual Medicine - “Low-Intensity Shock wave for Treatment of Vestibulodynia: A Randomized Controlled Therapy Trial”
  Gruenwald, Ilan, MD, et al.
  (Full-text. Published: January 5, 2021)
  https://www.jsm.jsexmed.org/article/S1743-6095(20)31050-X/fulltext