Health economic evaluation of a randomized controlled trial (EMBLA study), an internet-based treatment for provoked vulvodynia

Abstract Internet-based treatment (IBT) for provoked vulvodynia (PVD) may reduce pain during intercourse and increases pain acceptance. However, a there is still a knowledge gap regarding the cost-effectiveness of IBT for PVD. The aim of this study was to perform a health economic evaluation of guided internet-based intervention for PVD as an addition to standard treatment. The sample consisted of 99 women with a PVD diagnosis. Healthcare related costs, health-related quality of life, and quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were analyzed. After the IBT, the intervention group had fewer visits to a midwife than the control group (p = 0.03), but no between-group differences were found for visits to other professionals, treatment length, health-related quality of life, QALYs, and costs for treatment. It was estimated a cost of 260.77 € for a clinical meaningful change in pain acceptance. Internet-based treatment as add-on to clinical treatment may lower number of visits to a healthcare

Understanding sexual pain in endometriosis

Sexual dysfunctions, particularly sexual pain, are common in adult women of all ages. In patients with endometriosis, a chronic gynecological pain condition affecting women of reproductive age, sexual pain is the third most common symptom. Multiple biological factors are involved in endometriosis-related sexual pain including tissue damage, inflammation, hormonal changes, alterations within the peripheral and central nervous system and pelvic floor muscle dysfunctions. Conceptual models of sexual pain espouse a multifactorial view, with empirical evidence suggesting the implication of psychosexual and relationship difficulties in the development and persistence of sexual pain and associated distress. We review literature on the biological, psychological, sexual and interpersonal factors associated with development and persistence of sexual pain in women with endometriosis. In addition, we discuss chronic pain conditions frequently associated with endometriosis (vulvodynia, bladder pain syndrome and inflammatory bowel syndrome) and how they are linked with sexual pain. Finally we discuss the clinical implications and provided suggestions for future research and medical care, focusing on a multidisciplinary and biopsychosocial approach