Internet-based treatment for vulvodynia

Abstract: Localized provoked vulvodynia is the most common cause of sexual pain and most often affects women between 20 and 30 years old. The etiology of provoked vulvodynia remains unclear, but an interplay of biomedical and psychosocial mechanisms is believed to contribute to the onset. The choice of treatment for provoked vulvodynia depends on locally available resources. Internet interventions can reach patients in distant geographical areas and may thus promote equal access to healthcare services. A few studies have investigated the effects of cognitive behavioral therapy on provoked vulvodynia. However, there appear to be no studies of the effects of an internet intervention using an acceptance and commitment therapy approach, also called third-wave cognitive behavioral therapy, for women with provoked vulvodynia.The aim of this thesis was to investigate the effects and patient experiences of a guided internet-based intervention for women with provoked vulvodynia during the waiting period for clinical treatment. All four studies included in this thesis were tied to a multicenter randomized controlled study: the EMBLA study. Participants were randomized to a six-week guided internet intervention or a waiting list before treatment as usual. Pain during intercourse, other pain-related variables, and pain acceptance were variables used to assess the effects of the intervention. Later, interviews were carried out with participants to ascertain their experiences of this internet-based treatment. Lastly, health-related quality of life and healthcare utilization were assessed to obtain a health economic evaluation of the intervention. Internet-based treatment had a positive effect on pain during intercourse and pain acceptance, but the results should be interpreted with caution due to the small sample size. This form of treatment was perceived as credible and helpful for managing provoked vulvodynia, but some difficulties related to the internet-based treatment were also reported. The intervention contributed to meaningful clinical effects at low costs per patient, indicating that internet-based treatment is not inferior to the standard of care. Internet-based treatment may serve as a complement to regular care, especially for patients living in geographical locations with low access to specialized care or where there are long waiting lists to initiate treatment.