Introduction. Provoked vestibulodynia (PVD) is a highly prevalent vulvo-vaginal pain condition that negatively affects women's emotional, sexual and relationship well-being. Recent studies have investigated the role of interpersonal variables, including partner responses.Aim. We examined whether solicitous and facilitative partner responses were differentially associated with vulvo-vaginal pain and sexual satisfaction in women with PVD by examining each predictor while controlling for the other.

Objective. There is a paucity of research investigating the role of interpersonal variables in vulvodynia -a prevalent, chronic, vulvo-vaginal

Introduction. Provoked vestibulodynia (PVD), a recurrent, localized vulvo-vaginal pain problem, carries a significant psychosexual burden for afflicted women, who report impoverished sexual function, and decreased frequency of sexual activity and pleasure. Interpersonal factors such as partner responses to pain, partner distress, and attachment style are associated with pain outcomes for women, and sexuality outcomes for both women and partners. Despite these findings, no treatment for PVD has systematically included the partner.Aims. This study pilot-tested the feasibility and potential efficacy of a novel cognitive-behavioral couple therapy (CBCT) for couples coping with PVD.Methods. Couples (women and their partners) in which the woman was diagnosed with PVD (n=9) took part in a 12-session, manualized CBCT intervention and completed outcome measures pre-and post-treatment.Main Outcome Measures. The primary outcome measure was women's pain intensity during intercourse using a numerical rating scale. Secondary outcomes included sexual functioning and satisfaction for both partners. Exploratory outcomes included pain-related cognitions, psychological outcomes, and treatment satisfaction, feasibility and reliability.Results. One couple separated before the end of therapy. Paired t-test comparisons involving the remaining 8 couples demonstrated significant improvements in women's pain, and sexuality outcomes for both women and partners. Exploratory analyses indicated improvements in pain-related cognitions, as well as anxiety and depression symptoms for both members of the couple. Therapists' reported high treatment reliability, and participating couples' reported high participation rates and treatment satisfaction indicate adequate feasibility.Conclusions. Treatment outcomes along with treatment satisfaction ratings confirm the preliminary success of CBCT in reducing pain and psychosexual burden for women with PVD and their partners. . While these women do not report significant differences in relationship satisfaction when compared to control women [12], qualitative studies suggest that women with vulvodynia report that the pain can have a damaging effect on the couple's relationship, and fear losing their partner because of the pain [13]. Recent research also highlights the significant positive correlation between intimacy and sexual function and satisfaction for women with PVD [14], and the influence of attachment styles on pain and sexuality outcomes for both women and partners [15].Despite the growing evidence for the bidirectional associations between PVD and romantic relationship factors, current treatments typically focus solely on the woman, and no empirically-tested treatment has systematically included the partner.Fueled by a biopsychosocial, multidimensional understanding of pain, there is a recent increase in the number of studies that have examined cognitive, affective, and behavioral factors related to PVD, and their associations with sexuality outcomes in afflicted women and their partners...

Objective: This randomized clinical trial compared a novel cognitive-behavioral couple therapy (CBCT) and topical lidocaine for provoked vestibulodynia. Method: Participants were 108 women (M age = 27.06) and their partners randomized to one of two treatments and assessed at pre-and post-treatment and 6-month follow-up via questionnaires pertaining to the primary outcomes of women's pain (numerical rating scales of pain intensity and unpleasantness), and secondary outcomes of pain anxiety (Pain Anxiety Symptoms Scale), both partners' sexual function (Female Sexual Function Index; International Index of Erectile Function), sexual distress (Female Sexual Distress Scale Revised), pain-related psychological distress (Pain Catastrophizing Scale), treatment satisfaction, and global ratings of improvements in pain and sexuality. Results: Intent-to-treat multilevel analyses showed that for women, CBCT yielded significantly more improvements than lidocaine in pain unpleasantness at 6-month follow-up, pain anxiety and pain catastrophizing at post-treatment and 6-month follow-up, and sexual distress at post-treatment, and resulted in better treatment satisfaction and global sexuality improvements at both time points. Partners significantly improved in their sexual function, sexual distress, and pain catastrophizing from pre-to post-treatment and pre-treatment to 6-month follow-up, with no significant group differences. Partners in the CBCT condition reported significantly greater treatment satisfaction at both time points, and greater sexuality improvements at post-treatment. Conclusions: CBCT yielded better outcomes on more dimensions of provoked vestibulodynia than lidocaine. Public Health SignificanceThis study shows that CBCT is an efficacious treatment for women with a subset of genito-pelvic pain and that involving partners may be beneficial.

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