Vulvodynia is a chronic pain condition affecting the vulva that lasts at least three months and has no clear cause. A common type, localized provoked vulvodynia (LPV), involves pain triggered by contact, such as sitting, wearing tight clothes, or sexual activity. This condition can significantly impact physical and emotional health, relationships, and quality of life. Despite vulvar pain affecting an estimated 10%-28% of women, many do not seek treatment, leading to underreported prevalence.

Managing LPV is challenging due to the lack of consensus on effective treatments. Earlier reviews of treatment options, published in 2011 and 2016, focused mainly on larger studies and did not include smaller or qualitative studies. This created gaps in understanding how psychological treatments might improve sexual functioning and overall well-being beyond just pain relief.

Therefore, a new review updates the research by analyzing all studies on psychological treatments for LPV published between 2010 and 2023. Psychological interventions, such as cognitive behavioral therapy, aim to help individuals adapt to LPV and enhance their autonomy, self-awareness, and coping skills. By including a wider range of study designs, this review highlights opportunities to improve care for individuals living with LPV.

The research team followed a structured framework to find and evaluate studies addressing treatments for LPV. The search, conducted in 2021 and updated in 2023, used keywords related to vulvodynia in multiple databases. Studies in English or French were included if they specifically examined LPV treatments, while those focusing on diagnosis, causes, or unrelated topics were excluded.

Ultimately, the search yielded 88 relevant studies on psychological treatments for LPV from 2010 to 2023. Four main approaches were identified: cognitive-behavioral therapy (CBT), acceptance and commitment therapy (ACT), somatocognitive therapy (SCT), and group educational seminars.

CBT, particularly mindfulness-based CBT (MbCT), was the most extensively studied, demonstrating effectiveness in reducing pain and improving psychological and sexual outcomes. MbCT stood out for integrating education, relaxation techniques, and mindfulness practices, showing sustained benefits in pain reduction and sexual function over standard CBT. However, limitations such as small sample sizes, inconsistent methodologies, and minimal focus on partner involvement were noted.

Group education sessions also yielded positive effects on psychological and sexual health but faced challenges like limited sample sizes and lack of randomization.

ACT emphasizes accepting pain while aligning actions with personal values, incorporating mindfulness and encouraging meaningful activities despite discomfort. Online ACT delivery showed promise in improving pain acceptance and quality of life, but results for sexual function were mixed, and dropout rates remained high.

SCT integrates cognitive-behavioral therapy and physiotherapy, focusing on body awareness and emotional coping strategies. Participants engaging in SCT reported reduced pain and improved self-efficacy. The research highlighted the significance of a strong patient-clinician relationship and personalized interventions, though small sample sizes and varied study designs limited broader conclusions.

This review indicates that psychological therapies for LPV show potential but are still under-researched. Most studies involved participants who were young, white, partnered, heterosexual, and well-educated, with limited diversity in race, sexual orientation, or relationship status. Psychological outcomes like anxiety, depression, and pain perception were often assessed using validated scales, but the wide variety of measures makes it hard to compare studies.

Nevertheless, it appears that psychological treatments for LPV may be useful for addressing not only pain but also the broader emotional, relational, and sexual impacts of the condition. Cognitive-behavioral therapy, acceptance and commitment therapy, somatocognitive therapy, and group education programs each demonstrate potential to improve outcomes for women with this condition.

Future research should prioritize diverse populations, standardized assessment tools, and partner-focused approaches to better understand and expand the accessibility of these interventions. By addressing these gaps, psychological therapies can play a pivotal role in enhancing the quality of life for individuals living with LPV.

References:

• Logan, G. S., Gustafson, D. L., Swab, M., Rains, A., Miller, M. E., Jackman, V. A., & Bajzak, K. (2025). Psychological modalities for the treatment of localized provoked vulvodynia: A scoping review of literature from 2010 to 2023. The Journal of Sexual Medicine, 22(1), 132–155. https://doi.org/10.1093/jsxmed/qdae163