Key Practice Recommendations

1. Recommend pelvic floor physical therapy and cognitive behavior therapy as first-line treatments for vulvodynia.
Evidence rating: SORT B
Sources: Section One, references 11, 19, 20, 21, and 22
Websites: https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.14815
https://www.nature.com/articles/s41572-020-0164-2
https://www.dovepress.com/etiology-diagnosis-and-clinical-management-of-vulvodynia-peer-reviewed-fulltext-article-IJWH
https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2021.678961/full
https://onlinelibrary.wiley.com/doi/10.1111/jmwh.13456

2. Screen for syphilis in all sexually active individuals ages 15 to 44 years living in communities with high syphilis rates, defined as a county rate of primary and secondary syphilis among women greater than 4.6 cases/100,000 population.
Evidence rating: SORT B
Sources: Section Two, references 5 and 10.
Websites: https://www.acog.org/news/news-releases/2024/04/acog-recommends-obstetrician-gynecologists-increase-syphilis-screening-for-pregnant-individuals
https://www.cdc.gov/mmwr/volumes/72/wr/mm7246e1.htm?s_cid=mm7246e1_w

3. Screen all pregnant patients for syphilis at the beginning of pregnancy, again in the third trimester, and at delivery.
Evidence rating: SORT B
Source: Section Two, reference 12.
Website: https://www.acog.org/news/news-releases/2024/04/acog-recommends-obstetrician-gynecologists-increase-syphilis-screening-for-pregnant-individuals

4. Collaborate with local public health departments to coordinate contact tracing and facilitate the treatment of patients with syphilis and their partners.
Evidence rating: SORT C
Source: Section Two, reference 6
Website: https://www.cdc.gov/mmwr/volumes/70/rr/RR7004a1.htm?s_cid=RR7004a1_w

5. Report suspected gonorrhea treatment failure immediately to the Centers for Disease Control and Prevention through local or state health departments.
Evidence rating: SORT C
Source: Section Two, reference 6
Website: https://www.cdc.gov/mmwr/volumes/70/rr/RR7004a1.htm?s_cid=RR7004a1_w

6. For patients with stress incontinence, recommend pelvic floor physical therapy and use of intravaginal devices such as continence pessaries as the main nonprocedural treatments.
Evidence rating: SORT B
Source: Section Three, reference 10
Website: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012337.pub2/full

7. For patients with urge incontinence, recommend conservative treatments such as pelvic floor physical therapy and bladder training.
Evidence rating: SORT B
Source: Section Three, reference 10
Website: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012337.pub2/full

8. Consider cystoscopy for patients with interstitial cystitis/bladder pain syndrome and suspected Hunner lesions based on age older than 50 years, bladder-centric symptoms, presence of comorbid autoimmune or inflammatory conditions, or absence of other systemic symptoms.
Evidence rating: SORT C
Source: Section Four, reference 1
Website: https://www.auajournals.org/doi/10.1097/JU.0000000000002756

9. Treat patients with interstitial cystitis with a multimodal pain management approach.
Evidence rating: SORT B
Source: Section Four, reference 1
Website: https://www.auajournals.org/doi/10.1097/JU.0000000000002756