6.5 Therapeutic phase
In terms of the actual treatment, the therapeutic phase, three guiding principles can be used:
A. the problems are caused, and or sustained by a number of variables that interact with each other. One could think of hygienic but also sexual behavior, tonus of the pelvic floor muscles etc. This multitude of contributors requires a bio-psycho-social approach;
B. the results of treatment are mainly caused by so called ‘common factors’. Like in psychotherapy, completely different treatments, based on completely different theoretical rationales, all lead to more or less the same results of PVD treatment. This means that special attention should be given to universal treatment aspects like: rapport between professional and patient, the rationale as understood and accepted by the patient, rituals as used by the professional and especially the feeling of control of the patient. Especially this latter ends the state of demoralization many patients are in. This alone is sometimes enough to help them find back their own problem solving mechanisms;
C. the disturbed function of nerves and thereby pathological nociception functions at the vestibulum region easily leads to a vicious circle of pain-proliferation-pain etc. Keeping the universal treatment aspects in mind it seems possible to end this circle in many ways. Some prefer local analgesia, others medication per os, some surgery, some sex counseling or psychotherapy.