Pain specialist management of sexual pain-IV. Pharmacological.

INTRODUCTION: The biopsychosocial model of care for women with sexual pain is a widely endorsed approach which includes pharmacologic treatments. OBJECTIVES: In this study we formulated a summary of current pharmacologic treatments for female sexual pain within a chronic pain paradigm and reviewed evidence for existing pharmacologic treatments and present promising treatment approaches. METHODS: Internet, PubMed, and Cochrane Library databases were searched for relevant articles on female sexual pain within the clinical purview and scope of practice of pain management. RESULTS: A thorough review of the literature was conducted to include basic science studies, clinical trials, systematic reviews, consensus statements, and case-reports. An effort was made to also include a sampling of information on real-world patient self-directed therapies. The level of evidence for most pharmacologic therapies for female sexual pain is low. Results of clinical studies were summarized for a variety of sexual pain causes. The evidence for the use of topical and oral pharmacologic treatment strategies for sexual pain were reviewed. CONCLUSION: Pharmacologic modalities play a significant role in treating female sexual pain, providing options to women as a part of multimodal care. Despite low evidence levels, current and novel treatment options have good safety and tolerability. Pain specialists can provide consultation on pharmacologic strategies to improve the care of women with chronic sexual pain.

Pain specialist management of sexual pain-II. Interventional.

INTRODUCTION: Treatment of female sexual pain often requires the use of diverse modalities crossing multiple medical disciplines. Interventional procedures are important in the diagnosis and treatment of female sexual pain. Pain specialists and other medical specialties can provide these capabilities. OBJECTIVES: To provide a current summary of the procedures used in the diagnosis and treatment of female sexual pain. METHODS: The internet, PubMed, and the Cochrane Library were searched for relevant articles on female sexual pain within the clinical purview and scope of the practice of pain management. RESULTS: A thorough review of the literature was conducted to include basic science studies, clinical trials, systematic reviews, consensus statements, and case reports. An effort was made to also include a sampling of information on real-world patient self-directed therapies. Descriptions of interventional procedures for the diagnosis and treatment of sexual pain were made and clinical studies reviewed. The evidence for the use of various interventional treatment strategies for sexual pain was assessed. CONCLUSIONS: The process of care for female sexual pain employs an interdisciplinary biopsychosocial model that includes a role for interventional procedures commonly performed by pain management specialists. These specialists are a resource of knowledge, skills, and abilities that can be used to improve the care of women with chronic sexual pain.

Pain specialist management of sexual pain-III. Neuromodulation.

INTRODUCTION: Some women with sexual pain do not respond to conservative multi-modal care modalities. Neuromodulation is a group of methods which alter nerve activity by delivering electrical energy or pharmaceutical agents directly to target neural structures. Multiple forms of neuromodulation may provide durable treatment options to fill the unmet therapeutic need of a certain population of women with chronic sexual pain. OBJECTIVES: To provide a current review of neuromodulation treatments used for female sexual pain and introduce neuromodulation techniques which may be applied in novel ways to specific sexual pain phenotypes. METHODS: Internet, PubMed and Cochrane Library were searched for relevant articles on female sexual pain within the clinical purview and scope of practice of pain management. RESULTS: A thorough review of the literature was conducted to include basic science studies, clinical trials, systematic reviews, consensus statements, and case-reports. A sampling of information on real-world patient outcomes was included. The amount and quality of evidence for neuromodulation to treat female sexual pain is low-moderate. Descriptions of neuromodulation procedures for sexual pain were made and clinical studies reviewed. The effects of autonomic nervous system (ANS) dysregulation on the experience of pain were discussed with consideration of interventional procedures to facilitate restoration of ANS equilibrium. CONCLUSION: Treating female sexual pain is complex. There are considerable numbers of women who have unsatisfactory sexual pain relief despite evidence-based interdisciplinary care. These women may benefit from referral to consider neuromodulation treatment options. Neuromodulation is a relatively new capability in the arsenal of pain management and other specialists that can be considered for women with treatment refractory sexual pain.