By Katrina Bouchard

This post is a summary of a recently published article from the Couples and Sexual Health Lab with our close collaborators at Université de Montréal:

Bergeron, S., Vaillancourt-Morel, M.-P., Corsini-Munt, S., Steben, M., Delisle, I., Mayrand, M.-H., & Rosen, N. O. (2021). Cognitive-behavioral couple therapy versus lidocaine for provoked vestibulodynia: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 89, 316-326. https://doi.org/10.1037/ccp0000631

Provoked vestibulodynia, or PVD, is a type of chronic vulvar pain. Individuals with PVD experience pain around the vaginal opening (also known as the ‘vestibule’) that occurs as a result of touch or pressure to the area (hence the ‘provoked’ part of the name). PVD is the most common cause of pain during vaginal intercourse and affects up to 10% of cisgender women [1]. Any individual with a vulva can experience vulvar pain—regardless of their gender identity—though most research to date has focused on the experience of cisgender women.

Unsurprisingly, having chronic pain during sexual activity can put a damper on women’s sex lives. What might be less obvious is that women’s partners experience consequences too, including a negative toll to their sexual and relationship well-being [2]. Thankfully, there are a number of effective treatments for women with PVD [3]. However, until now, there were no scientifically based treatments that also involved the women’s partners, such as cognitive-behavioral couple therapy.

What did we do?

The purpose of the study was to compare a new, cognitive-behavioural couple therapy (CBCT) to a commonly used medical treatment for PVD—topical lidocaine. Topical lidocaine consists of applying a 5% lidocaine ointment overnight to the entrance of the vagina where the pain is located. 

A total of 108 cisgender women diagnosed with PVD and their partners participated in the study (105 mixed-sex and 3 same-sex couples). The study used a randomized design, meaning that couples were randomly assigned to receive either the CBCT intervention or the topical lidocaine. The CBCT intervention included 12 weekly sessions with a therapist trained in clinical psychology [4]. The therapists followed a detailed treatment manual written by the study authors, which was based on principles from cognitive-behavioural pain management, sex therapy for couples, and the latest scientific evidence about PVD. 

Couples completed surveys before treatment, immediately after treatment, and 6 months later. Women with PVD reported on their pain experience during intercourse, and both members of the couple reported on their sexuality, treatment satisfaction, and their own impressions of improvements in pain and sexuality at the same three time points.

What did we find?

Let’s start with a key outcome of research on treatments for PVD: Change in women’s reports of pain following treatment. Both treatments (CBCT and topical lidocaine) led to improvements in women’s ratings of pain intensity, but their pain unpleasantness—that is, the emotional part of experiencing pain—improved more from the CBCT. These reductions in women’s pain ratings were still found 6 months after treatment, meaning that the improvements lasted over time. In short, both CBCT and topical lidocaine reduced women’s pain during intercourse.

Beyond pain ratings, women who received the CBCT intervention reported more improvements in other pain-related outcomes including how much anxiety and worry they felt about the pain. The CBCT intervention also had a bigger impact than topical lidocaine for sexuality, including a greater drop in women’s sexual distress, and both women and their partners reported that they felt that their sexuality improved more with the CBCT treatment.

Interestingly, both treatments were associated with improvements in overall sexual function, even though only the CBCT targeted sexuality directly. Couples may report better sexual function as a result of women’s pain having decreased, regardless of the type of treatment that helped reduce the pain.

The partners of women with PVD also benefited from treatment; both treatments led to improvements in partners’ sexual function, sexual distress, and pain-related anxieties. Most notably, even though some improvements were similar between the two treatments, both women and partners who received the CBCT reported being more satisfied with treatment than couples who received the topical lidocaine.

What do these findings mean?

This study is the first to show that CBCT is as effective as a commonly prescribed medical treatment for PVD and should be recommended as a treatment option for couples. CBCT was even more beneficial than topical lidocaine for reducing other negative impacts of the pain on couples’ lives. Delivered in actual clinical practice—that is, without the strict procedures of a scientific study—CBCT might lead to even better outcomes because the therapist can tailor the interventions to meet a particular couple’s needs.

This study adds to a growing body of research showing that psychological interventions are helpful for individuals and couples coping with pain during sexual activities [5]. For many women, sex hurts. Seeking treatment from a trained healthcare provider can help.

References

[1] Bergeron, S., Reed, B. D., Wesselmann, U., & Bohm-Starke, N. (2020). Vulvodynia. Nature Reviews. Disease Primers, 6, Article 36. https://doi.org/10.1038/s41572-020-0164-2

[2] Smith, K. B., & Pukall, C. F. (2014). Sexual function, relationship adjustment, and the relational impact of pain in male partners of women with provoked vulvar pain. The Journal of Sexual Medicine, 11, 1283-1293. https://doi.org/10.1111/jsm.12484

[3] Goldstein, A. T., Pukall, C. F., Brown, C. B. et al. (2016). Vulvodynia: Assessment and treatment. The Journal of Sexual Medicine, 13, 572-590. https://doi.org/10.1016/j.jsxm.2016.01.020

[4] Corsini-Munt, S., Bergeron, S., Rosen, N. O., et al. (2014). A comparison of cognitive-behavioural couple therapy and lidocaine in the treatment of provoked vestibulodynia: study protocol for a randomized clinical trial. Trials, 15, 506. https://doi.org/10.1186/1745-6215-15-506

[5] Rosen, N. O., Dawson, S. J., Brooks, M., & Kellogg-Spadt, S. (2019). Treatment of vulvodynia: Pharmacological and non-pharmacological approaches. Drugs, 79, 483-493. https://doi.org/10.1007/s40265-019-01085-1

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