Overview & Efficacy: Several small controlled studies have shown that muscle tension biofeedback from the pelvic floor is at least as effective as surgery and cognitive restructuring for improvements in sexual function and significantly reduced pain during intercourse (but not quite as much as surgery) among people with vulvar vestibulitis.

This therapy is rated as between possibly and probably efficacious (levels 2 to 3 on a scale of 1 - 5 with 5 being the best) until more controlled and larger clinical studies with longer term follow-ups are published.

Why biofeedback would help this problem: The pelvic floor muscles do not behave normally when vulvar vestibulitis is present. There are more spasm and abnormal levels of tension. Psychophysiological recording techniques can record these patterns of muscle tension. Muscle tension biofeedback is used to show these patterns to the patient so she can learn to recognize when patterns become abnormal and to normalize them. When the patterns of muscle activity become normal, symptoms are significantly reduced or eliminated.

Brief summary of evidence supporting the efficacy of biofeedback for Vulvar Vestibulitis:

EMG biofeedback and pelvic floor exercises have been used to treat women with vulvar vestibulitis. A randomized study comparing biofeedback, with cognitive behavioral therapy, and with vestibulectomy demonstrated that all three groups reported statistically significant reductions in pain and improvements in sexual function and psychological adjustment (Bergeron et al., 2001). Although the vestibulectomy group was more successful than the two other groups in regard to pain reduction, some of the patients assigned to this group refused the intervention. The benefit of EMG biofeedback and pelvic floor exercises also been demonstrated in two uncontrolled studies, with patients showing reductions in pain and about 70% able to resume sexual activity without discomfort (Glazer, Rodke, Swencionis, Hertz, & Young, 1995; McKay et al, 2001).

* Much of the information provided here is from Carolyn Yucha and Christopher Gilbert's 2004 book "Evidence Based Practice in Biofeedback & Neurofeedback" AAPB, Wheat Ridge, CO.

Detailed information on biofeedback augmented treatment of Vulvar Vestibulitis

A. Citations to the papers summarized in the "brief summary" of Vulvar Vestibulitis

Bergeron, S., Binik, Y.M., Khalife, S., Pagidas, K., Glazer, H.I., Meana,.M, et al. (2001). A randomized comparison of group cognitive--behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain, 91(3), 297-306.

Glazer, H.I., Rodke, G., Swencionis, C., Hertz, R., & Young, A.W. (1995). Treatment of vulvar vestibulitis syndrome with electromyographic biofeedback of pelvic floor musculature. Journal of Reproductive Medicine, 40(4), 283-290.

McKay, E., Kaufman, R.H., Doctor, U., Berkova, Z., Glazer, H., & Redko, V. (2001). Treating vulvar vestibulitis with electromyographic biofeedback of pelvic floor musculature. Journal of Reproductive Medicine, 46(4), 337-342.