Banca de DEFESA: JANICE FRANÇA DE QUEIROZ

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : JANICE FRANÇA DE QUEIROZ
DATE: 18/12/2024
TIME: 14:00
LOCAL: REMOTO: https://meet.google.com/rap-vzqi-dau
TITLE:

VULVODYNIA: PSYCHOSOCIAL FACTORS AND PSYCHOTHERAPEUTIC APPROACHES

KEY WORDS:

Vulvodynia; vestibulodynia; vulvar pain; psychosocial factors; psychotherapy.

PAGES: 92
BIG AREA: Ciências da Saúde
AREA: Medicina
SUMMARY:

Introduction: Vulvodynia is a condition characterized by vulvar pain, which can be chronic, lasting three months or more, without a clearly identifiable cause. It can be generalized and spontaneous, or localized and provoked. It is a common gynecological condition with an estimated global prevalence of approximately 8% of the world population, typically affecting women between the ages of 20 and 40, with symptoms of vulvar pain in almost 10% of women at age 40. It can be caused by multifactorial factors, such as hormonal changes, recurrent infections, injuries, trauma to the genital area, genetic predisposition or inflammation in the vulvar region, psychosocial factors, among others. Women with vulvodynia feel distress and discomfort when undergoing gynecological examinations or engaging in penetrative sex, with increased pain intensity, sexual dysfunction, high levels of anxiety and depression, and a decrease in quality of life. Psychosocial factors are associated with the cause of vulvodynia, since its diagnosis is associated with psychological, emotional and sexual difficulties in women. Considering the significant psychological component involved in the prognosis of vulvodynia, psychotherapy and psychotherapeutic techniques can offer clinically practical and effective treatment options for vulvar pain.

Objectives: to evaluate the psychosocial factors and psychotherapeutic techniques in the management of vulvodynia.

Materials and methods: Two systematic reviews were conducted, one of which included meta-analysis. The recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) were followed. In article 1, a search strategy was used for observational studies (case-control and cohort) that investigated the psychosocial factors associated with vulvodynia, its effects on women's sexuality, mental health and quality of life, evaluating vulvar pain as the primary outcome, in the databases: PubMed, LILACS, Embase, CINAHL, Web of Science, Scopus and PsycINFO, and the risk of bias was assessed using the Newcastle-Ottawa Scale for Observational Studies. In article 2, a search strategy was used for randomized clinical trials comparing psychotherapeutic interventions and psychotherapeutic techniques for vulvodynia, with assessment of the primary outcome of vulvar pain intensity, in the following databases: PubMed, Embase, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, PsycInfo and Clinical Trial Databases, and the risk of bias was assessed using the Cochrane Risk of Bias tool (RoB 2.0) and RevMan 5.4 was used for data synthesis (meta-analysis). In both articles, two authors independently selected and extracted data from the articles, and to classify the strength of the evidence, the Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE) approach was used.

Results: A total of 3,182 articles were identified for the first review, of which 22 studies met the eligibility criteria and were included, comprising 2,624 patients. There was an association of psychosocial factors with vulvodynia. For sexual function, the outcomes presented were dyspareunia and sexual dysfunction. For quality of life, it was shown that women with chronic vulvar pain had greater difficulty performing physical activities and experienced negative moods and feelings. The risk of bias showed average quality of the studies, from good to excellent. The studies failed to describe the results (unexposed cohort or control group) and contained a small study population, which made meta-analysis impossible. In the second review, a total of 1,884 articles were identified, of which 10 studies met the eligibility criteria and were included in the systematic review, and 02 studies were included in the meta-analysis, comprising 951 participants. When comparing Acceptance and Commitment Therapy (ACT) with the control group, the mean difference in the combined analysis for the Chronic Pain Acceptance Questionnaire did not differ significantly between ACT and other therapies, for post-treatment assessment (MD = 0.77; 95% CI -3.45, 4, 99). The risk of bias was high in 03 studies, due to the lack of clarity in the process of measuring the results. The GRADE for the certainty of the evidence for vulvar pain using ACT was considered moderate.

Conclusion: There is certainty of evidence in the association between psychosocial factors, vulvodynia, sexual function and psychological adjustment (depression and anxiety), suggesting that coping with psychosocial causes can improve the overall quality of life of patients with vulvodynia, reducing symptoms. Treatments that incorporate ACT and other psychotherapeutic techniques appear to reduce vulvar pain, improve sexual function, emotional well-being and quality of life. However, the non-heterogeneity of some studies included in the research, and the small sample size, prevented the performance of a meta-analysis in both studies, making it impossible to obtain more robust results.

COMMITTEE MEMBERS:
Presidente - 1199080 - ANA KATHERINE DA SILVEIRA GONCALVES DE OLIVEIRA
Interna - 347027 - EULALIA MARIA CHAVES MAIA
Externa ao Programa - 2786809 - MARIA THEREZA ALBUQUERQUE BARBOSA CABRAL MICUSSI - UFRNExterna à Instituição - ISABEL CRISTINA CHULVIS DO VAL GUIMARÃES - UFF
Externo à Instituição - JOSÉ ELEUTÉRIO JÚNIOR - UFC