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:

Rosen, N. O., Vaillancourt-Morel, M.-P., Corsini-Munt, S., Steben, M., Delisle, I., Baxter, M.-L., & Bergeron, S. (2021). Predictors and moderators of provoked vestibulodynia treatment outcome following a randomized trial comparing cognitive-behavioral couple therapy to overnight lidocaine. Behavior Therapy. https://doi.org/10.1016/j.beth.2021.05.002

Use the following link to redeem 1 of 50 FREE downloads of this newly published paper: https://authors.elsevier.com/a/1dRIz1KFqOTW4. 

Provoked vestibulodynia, or PVD, is a type of chronic vulvar pain that affects up to 10% of cisgender women [1]. A recent blog post summarized the results of our randomized clinical trial comparing cognitive-behavioural couple therapy (CBCT) to a commonly used medical treatment for PVD (topical lidocaine). Check out the original post for more details about PVD and the treatment study! To sum it up briefly, CBCT and topical lidocaine both reduced cisgender women’s pain intensity during sex, but CBCT resulted in more benefits related to the emotional aspects of the pain and the negative impacts it has on couples’ lives [2].

Since both treatments were effective for reducing the intensity of women’s pain during sex, our next step was to look at whether all couples benefited in the same way from the two treatments, or if one treatment worked better for some women and their partners relative to the other treatment. This information could help healthcare providers personalize a treatment path for women who have pain during sex.

What did we do?

The study used data from the randomized clinical trial comparing CBCT to topical lidocaine. So, the sample consisted of 108 cisgender women diagnosed with PVD and their partners (105 mixed-sex and 3 same-sex couples). Bonus points if you checked out our original post about the PVD treatment study!

Before receiving either treatment, couples completed self-report measures about specific factors that could help or hinder the effects of each treatment on women’s pain intensity (the strength of the pain experience), pain unpleasantness (the emotional suffering associated with the pain), and sexual function (sexual desire, arousal, orgasm, and satisfaction). The factors were grouped into three categories:

All the factors were selected based on previously completed PVD research. For example, we know that women’s and partner’s heightened anxiety is linked to greater pain during sex and poorer sexual function in women with PVD [3]. Since anxiety is specifically targeted in CBCT (but not by topical lidocaine), we expected that people with high anxiety would benefit more if they received couple therapy than the lidocaine.

What did we find?

Both treatments had stronger benefits for reducing women’s pain intensity and pain unpleasantness when, before the start of treatment:

• Couples had a longer relationship duration

• Women had lower anxiety

• Partners were responding to women’s pain in an overly attentive and concerned manner (e.g., Are you in pain? Maybe we should stop?)

• Partners were more motivated to have sex to promote positive outcomes (e.g., increased intimacy)

CBCT was more effective than topical lidocaine for improving women’s sexual function when, before the start of treatment:

• Partners had higher anxiety

• Women were more motivated to have sex to avoid negative outcomes (e.g., conflict with their partner)

Topical lidocaine had stronger benefits than CBCT for improving women’s sexual function when, before the start of treatment:

• Partners were more motivated to have sex to promote positive outcomes (e.g., increased intimacy)

Other factors—such as women’s age or pain duration as well as other types of partners’ responses to women’s pain—did not specifically help or hinder treatment outcomes for CBCT or topical lidocaine.

What do these findings mean?

This study is the first to consider a variety of factors that might help or hinder treatment outcomes of CBCT or topical lidocaine. For CBCT, couples who started out with more problems in areas that were directly addressed by CBCT (e.g., higher anxiety, having sex to avoid negative outcomes) benefited more in their sexual function from this treatment relative to topical lidocaine.

For both treatments, relationship factors (e.g., partners’ responses to women’s pain, couples’ reasons for having sex) were important to treatment success. So, we found support for including both members of the couple in our research and treatment of PVD [4].

This study and the results of the randomized clinical trial [2] show that CBCT and topical lidocaine are suitable as first-choice interventions for women with PVD. Combining both treatments may help to target even more parts of PVD at the same time, but we don’t have enough research yet to say that this approach would be better than trying one treatment at a time. For women with PVD, the study results are good news. There are multiple paths to enhance sexual well-being and working with a trained healthcare provider can help guide the way.

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] 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

[3] Pâquet, M., Rosen, N. O., Steben, M., Mayrand, M., Santerre-Baillargeon, M., & Bergeron, S. (2018). Daily anxiety and depressive symptoms in couples coping with vulvodynia: Associations with pain, sexual function, and both partners’ sexual distress. The Journal of Pain, 19, 552-561. https://doi.org/10.1016/j.jpain.2017.12.264

[4] Rosen, N. O., & Bergeron, S. (2019). Genito-pelvic pain through a dyadic lens: Moving toward an interpersonal emotion regulation model of women’s sexual dysfunction. The Journal of Sex Research, 56, 440-461, https://doi.org/10.1080/00224499.2018.1513987

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