Treating vulvar vestibulitis with electromyographic biofeedback of pelvic floor musculature

OBJECTIVE: To evaluate the effectiveness of electromyographic biofeedback o f pelvic floor musculature in the management of patients with moderate to s evere vulvar vestibulitis syndrome. STUDY DESIGN: Twenty-nine patients with moderate to severe vulvar vestibuli tis syndrome were included in this study. Each patient was given a computer ized electromyographic assessment of pelvic floor muscles. She was then pro vided with a portable electromyographic home trainer biofeedback device, an d specific instructions were given to perform biofeedback-assisted pelvic f loor muscle rehabilitation exercises. The patients received monthly evaluat ions of the pelvic floor muscles to ensure and motivate comppliance and to monitor improvement and symptom changes. Patients were evaluated on a month ly basis for vestibulodynia and dyspareunia. RESULTS: Fifteen of the 29 treated patients (51.7%) demonstrated markedly d ecreased introital tenderness, and 14 of them (93.3%) were able to resume s exual activity without discomfort. Nine patients (31.0%) demonstrated a sig nificant decrease in introital tenderness and pain, and six of the nine (66 .7%) resumed sexually active Thus, 20 of the 29 women (69%) became sexually active. Following completion of treatment, 24 (88.9%) reported negligible or mild pain. Five of the 29 did not show any significant improvement, and none of them were able to resume sexual activity. Within six months of the start of therapy, 90% ultimately resuming sexual activity had done so. CONCLUSION: Electromyographic biofeedback of pelvic floor musculature is an effective approach to vulvar vestibulitis.