1. Selected interventions, and homework exercises
Breaking the bell jar and including the partner when treating dyspareunia: A pilot study examining an innovative Couple Cognitive Behavioral Therapy for women with provoked vestibulodyina
Serena Corsini-Munt, MA., Sophie Bergeron, PhD., Natalie Rosen, PhD., Marie-Hélène Mayrand, MD., Victoria Ann Hainault, & Nayla Awada, BSc.
Introduction
Provoked vestibulodynia (PVD), a chronic, recurrent sharp/burning pain elicited via pressure to the vulvar vestibule or attempted vaginal penetration (e.g., sexual intercourse), is the most frequent cause of dyspareunia (i.e., pain during intercourse) in premenopausal women.
Because of its deleterious impact on sexuality and romantic relationships, PVD carries a heavy psychosocial burden, with many women reporting shame, inadequacy and low self-esteem, and their partners reporting psychological distress alongside negative attributions about the pain.
Previous research has demonstrated the efficacy of group cognitive-behavioral therapy for women with PVD.
No study to date, however, has systematically examined the efficacy of couple therapy, an often-recommended treatment option for women with PVD, and their partners.
Methods
Couples in which the woman was diagnosed with PVD were recruited across two university centers (N=8).
Each couple completed 12 one-hour sessions with a therapist trained to use the CBCT manual, and took part in two evaluation points (pre-treatment and post-treatment) carried out via semi-structured interviews and validated self-report questionnaires.
Results
Participant characteristics
Results & Discussion
Preliminary pre-and post-treatment comparisons of our variables indicate significant improvements in pain, sexual satisfaction for both partners, and women’s sexual function. Also found were significant decreases in woman and partner catastrophization, and increases in pain self-efficacy – both variables known to have an impact on pain.
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These results suggest that CBCT may be an effective, and feasible intervention option for couples facing PVD.
Couple satisfaction appears to have changed only minimally, perhaps because many of our couples did not score in the distressed range of couple satisfaction at pre-treatment.
Women
Partners
Age (years)
25.9
(19-35)
28.2
(21-45)
Education (years)
15.6
(13-18)
16.3
(12-21)
Pre-treatment pain rating (0-10)
6.4
(3-8)
Duration of relationship
40.3 months, or 3,4 years
(18 – 97 months)
Duration of pain
80.1 months, or 6.7 years
(30 – 168 months)
Outcome measures
Percent change – treatment effects
Pain
Visual analog scale (VAS) of 0 – 10
McGill Pain Questionnaire (MPQ)
Sexual satisfaction
Global Measure of Sexual Satisfaction (GMSEX)
Sexual function
Derogatis Interview for Sexual Satisfaction – Short Form (DISF-SF)
Pain self-efficacy
Painful Intercourse Self-Efficacy Scale (PISES)
Catastrophizing
Pain Catastrophizing Scale (PCS)
Couple Satisfaction
Couple Satisfaction Index (CSI)
Partner responses
West Haven-Yale Multidimensional Pain Inventory – Negative and Solicitous subscales (MPI-N, MPI-S); Spouse Response Inventory – Facilitative subscale (SRI-F)
Treatment satisfaction
VAS of 0 – 10
Acceptability / feasibility
Feedback from participants
Conclusion
The promising results of this pilot trial provide important understanding regarding treatment feasibility of a potentially effective, novel targeted couple therapy intervention for women with PVD, and their partners.
The data collected and feedback received from couples will help our research team refine the CBCT manual for our future randomized controlled trial.
Treatment satisfaction & feasibility/acceptability
Purpose
CBCT manual outline (sampled)
Women
Partners
Satisfaction with treatment (0-10)
9.0
(7-10)
9.1
Pain improvement
75% report “moderate progress” to “complete resolution” of the woman’s pain
Global sex life improvement
100% report “moderate” to “a lot” of progress in their sexual life
Most useful interventions
Emotional disclosure, building (sexual) communication, the progressive approach of interventions, breathing exercises, sensate focus.
Least useful interventions
Pain journals, PVD psychoeducation.
Ses.
Selected interventions, and homework exercises 1
Telling their story
Readings and journaling 2
Value clarification exercise re: goals for sex
Breathing – mindfulness and tantric 3
Identifying pain factors
Pain localization 4
Impact on sex and the relationship; communication
Needs statements, and body scan relaxation 5
Role of anxiety/anticipation
Kegels * if appropriate 6
Partner (and woman) responses to pain
Sensate focus massage; sharing intimate memories 7
Sex communication; redefining sex narrative
Dilatation * if appropriate 8
Facilitating desire/arousal
Desire list; sensate focus 9
Cognitive defusion; attributions
Practice cognitive defusion 10
Revisiting cognitive defusion
Sensate focus 11
Assertion and avoidance
Couple’s choice for HW 12
Progress and setbacks
Tools for the future
This study aimed to pilot a newly developed, 12-session, cognitive-behavioral couple therapy (CBCT) intervention for couples living with PVD for feasibility, acceptability, and potential efficacy.
References
Bergeron, S. 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,
Dworkin, R. H. et al. (2005). Core outcome measures for chronic pain clinical trials: IMMPACT recommendations.
Pain, 113, 9-19.
Latthe, P., Latthe, M., Say, L., et al. WHO systematic review of prevalence of chronic pelvic pain: a neglected
reproductive health morbidity. BMC Pub Health ;6:177.
Masheb, R. Kerns, R., Lozano, C., Minkin, M., & Richman, S. (2009). A randomized clinical trial for women with
vulvodynia: Cognitive-behavioral therapy vs. supportive psychotherapy. Pain, 141,
Reed, B. D., Haefner, H. K., & Edwards, L. (2008). A survey on diagnosis and treatment of vulvodynia among
vulvodynia researchers and members of the International Society for the Study of Vulvovaginal Disease. The
Journal of Reproductive Medicine, 53(12),
Rosen, N. O., Bergeron, S., Lambert, B., & Steben, M. (2013). Provoked vestibulodynia: Partner and patient
catastrophizing and dyadic adjustment as mediators of the associations between partner responses, pain and
sexual satisfaction. Archives of Sexual Behavior, 42(1),
We initially recruited 9 couples for this pilot, with 1 couple separating before completing all 12 sessions, indicating 11% attrition. Of the 8 couples who completed treatment, there was 100% compliance with session attendance (i.e., no “no shows”).
Acknowledgements: We are grateful for the help of Alex Anderson, Sheila MacNeil, Delphine Maillé, & Pierre McDuff.