This post is a summary of our published article: Bergeron, S., Merwin, K. E., Dubé, J., & Rosen, N. O. (2018). Couple sex therapy versus group therapy for women with genito-pelvic pain. Current Sexual Health Reports, 10, 79-87. doi:10.1007/s11930-018-0154-5
Co-authored by Elyse Burchill and Kat Merwin
Pain during sex: While it is not uncommon for women to experience pain during sex, if this problem persists it may have consequences on women’s physical and mental well-being as well as put a strain on her partner and their relationship [2,9]. Genito-pelvic pain/penetration disorder (GPPPD) affects 14 to 34% of young women and 6.5 to 45% of older women [1,10]. GPPPD is a specific condition in which women experience pain in the pelvic area after or during vaginal intercourse. Women with this disorder tend to report significantly lower quality of life compared to women without .
A woman’s partner can influence how the woman perceives and manages this pain. In fact, research has found that different types of partner responses are associated with lower or higher levels of for women with GPPPD. In several of our previous studies, we examined three types of partner responses to women’s pain during intercourse [6,7,8]. (See here for a description of the different types of partner responses.) We previously found that negative and solicitous partner responses were associated with more pain for women, whereas facilitative responses were associated with less pain [7,8]. Given these findings, it is important that the partners of women with GPPPD are included in the treatment options in order to improve sexual and psychological well-being of both members of the couple, while improving the overall quality of the relationship. Different methods of treatment have been explored and there are two types of treatments that have been found to be beneficial for couples coping with GPPPD.
The purpose of this paper was to evaluate and contrast two different methods of treatment for GPPPD and to provide recommendations as to when each treatment is likely to be the most beneficial.
Group Cognitive Behavioral Therapy (group CBT) is a common approach which focuses on reducing pain and improving sexual function and satisfaction. This is accomplished by addressing thoughts, behaviors, and interactions that individuals (who may or may not be in relationships) may have with their sexual partners. During this time women are guided through a series of steps. These steps allow them to learn about the pain they are dealing with, explore what influences it and are given the chance to adapt new coping and communication mechanisms to facilitate the improvement of sexual functions. In a study comparing group CBT to a corticosteroid cream, women in the CBT group reported lower pain levels and were more satisfied with overall sexual functioning six months after treatment .
Couples Cognitive Behavioral Therapy (couples CBT) has also recently been explored as a way to treat GPPPD as well. This involves couples setting goals and being guided through different methods of improving coping mechanism along with intimacy and relaxation exercises. A significant amount of time is dedicated to the practice of adaptive communication techniques. In research conducted on the effectiveness of couples CBT it was demonstrated that women with GPPPD showed significantly lower levels of pain after treatment. Both women and their partners reported more sexual satisfaction and better psychological well-being after treatment .
Which one is better?
Both group and couples CBT are effective treatments of genito-pelvic pain/penetration disorder (GPPPD). However, given the large role of partners in the women’s perception and management of pain, couples CBT seems to be the most beneficial treatment.
When treating women with GPPPD who are in relationships, couples CBT should be considered first because of the couples-focused approach which allows the therapist to adjust the treatment for each unique couple’s needs. Despite this, there are times when it may be more advantageous to use group CBT as well. In cases where there are pre-existing relationship difficulties that include psychological and physical violence, couples therapy may have negative effects (e.g., increase tension in the relationship) and it would be advised to begin with group therapy . Group therapy may also be the more appropriate choice when women are not in relationships or when their partner may be unable to attend weekly appointments. Group CBT can also help create a sense of normalcy for women with GPPPD. Finally, group CBT may also be more accessible; due to its cost efficiency and structured approach, it is often easier for health professionals to provide this treatment option.
Treatments are continuously being discovered, re-evaluated, and improved upon. The most important take away is women with GPPPD (and their partners) need to find what works best for them.
- American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing
- Arnold, L. D., Bachmann, G. A., Rosen, R. G., Kelly, S., & Rhoads, G. (2006). Vulvodynia: Characteristics and associations with comorbidities and quality of life. Obstetrics & Gynecology,107, 617-624. doi: 10.1097/01.AOG.0000199951.26822.27
- Bergeron, S., Khalifé, S., Dupuis, M., McDuff, P., Nezu, Arthur, M., & Davila, J., (2016). A randomized clinical trial comparing group cognitive-behavioral therapy and a topical steroid for women with dyspareunia. Journal of Consulting and Clinical Psychology, 84, 259-268. doi: 10.1037/ccp0000072
- Corsini-Munt, A., Bergeron, S., Rosen, N. O., Mayrand M-H., & Deslisle, I. (2014). Feasibility and preliminary effectiveness of a novel cognitive-behavioral couple therapy for provoked vestibulodynia: A pilot study. The Journal of Sexual Medicine, 11, 2515-1527. doi: 10.1111/jsm.12646
- Maharaj, N. (2017). Perspectives on treating couples impacted by intimate partner violence. Journal of Family Violence,32, 431-437. doi:10.1007/s10896-016-9810-6
- Rosen, N. O., Bergeron, S., Glowacka, M., Delisle, I., & Baxter, M. (2012). Harmful or helpful: perceived solicitous and facilitative partner responses are differentially associated with pain and sexual satisfaction in women with provoked vestibulodynia.Journal of Sexual Medicine,9(9), 2351-2360. doi: 10.1111/j.1743-6109.2012. 02851.x
- Rosen, N. O., Bergeron, S., Leclerc, B., Lambert, B., & Steben, M. (2010) Woman and partner-perceived partner responses predict pain and sexual satisfaction in provoked vestibulodynia (PVD) couples. The Journal of Sexual Medicine, 7, 3715-3724. doi: 10.1111/j.1743-6109.2010.01957. x.
- Rosen, N.O., Bergeron, S., Sadikaj, & Delisle, I. (2015). Daily associations among male partner responses, pain during intercourse, and anxiety in women with vulvodynia and their partners. Journal of Pain,16, 1312-1320. doi: 10.1016/j.jpain.2015.09.003
- Sheppard, C., Hallam-Jones, R., & Wylie, K. (2008). Why have you both come? Emotional, relationship, sexual and social issues raised by heterosexual couples seeking sexual therapy (in women referred to a sexual difficulties clinic with a history of vulval pain). Sexual and Relationship Therapy,23, 217-226. doi: 10.1080/14681990802227974
- Van Lankveld, J. J. D. M., Granot, M., Schultz, W. C. M. W., Binik, Y. M., Wesselmann, U., Pukall, C. F., et al. (2010).Women’s sexual pain disorders.Journal of Sexual Medicine, 7, 615-631. doi: 10.1111/j1743-6109.2009. 01631.x