Following perinatal loss, a type of ambiguous loss, bereaved couples struggle with and experience distress due to various forms of ambiguity. Moreover, the juxtaposition of their grief with society's minimization often disenfranchises them from traditional grieving processes. The purpose of this study was to explore sources of ambiguity and disenfranchised grief related to perinatal loss. Audio-taped interviews with 13 bereaved couples at 2, 6, and 13 months following the death of their fetus or infant were analyzed. Several categories of ambiguity and disenfranchised grief emerged, pertaining to: (a) the viability of the pregnancy; (b) the physical process of pregnancy loss; (c) making arrangements for the remains; and (d) sharing the news. This study uncovers the many sources of ambiguity and disenfranchised grief that bereaved couples face in interactions with family, friends, society, and healthcare professionals. These insights may inform healthcare professionals in their attempts to ease distress related to perinatal loss.

Female sexual pain disorders, although highly prevalent and increasingly studied, remain a distressing complaint for women and their partners. Empirical evidence points to a multifactorial conceptualization of the etiology, course, and associated difficulties of sexual pain; thus, treatment options span the medical, pelvic floor rehabilitation psychological and multimodal. Given the interpersonal context in which sexual pain occurs, recent work has underscored the importance of considering the dyadic framework in research and treatment. This review presents understanding from across disciplines focusing on the impact of sexual pain on the woman and the couple, proposed etiologic pathways and risk factors related to its development and course, and current treatment options. Recommendations for research point to an urgency for multidisciplinary exchanges in the development of conceptual models and refinement of targeted interventions.

Designing Safer Systems T he demand for home care services is growing in Canada (Canada Institute for Health Information 2003). There has been a 51% increase in the number of home care clients since 1997, with over 900,000 receiving services in 2007 (Canadian Home Care Association 2008). Yet, overwhelmingly, research on patient safety has focused on institutional settings. Moreover, there has been an augmentation in the medicalization of private homes, resulting not only from the escalating threshold for admission to hospital but also from the increasing acuity of patients at the time of their discharge. This shift in care setting has been facilitated by the explosion of "hospital at home" services and the ever-growing availability of mobile technology (e.g., hemo-and peritoneal dialysis, long-term intravenous catheters and oxygen/inhalation therapy) (Williams 2002). The physical environment, socioeconomic status, family dynamics and cognitive and physical abilities of the client and caregivers are essential factors to be considered when delivering services. Family members or friends who are unpaid caregivers are often untrained, elderly and contending with their own health challenges. They frequently lack sleep as they provide around

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.