Psychological Treatments for Provoked Vestibulodynia: Integration of Mindfulness-Based and Cognitive Behavioral Therapies

Abstract

Provoked vestibulodynia (PVD) is a chronic and distressing genital pain condition involving sharp pain to the vulvar vestibule with lifetime prevalence as high as 12%. PVD is the most prevalent cause of pain during sexual intercourse (dyspareunia) in premenopausal women, and gives rise to considerable sexual and relational concerns. As intercourse for women with PVD is either painful or impossible, PVD has pronounced negative effects on women's romantic relationship adjustment and sexual intimacy, as well as their emotional well-being and sense of sexual self-efficacy. Given the low efficacy and high side-effect profile of medications for the treatment of PVD, attention has shifted toward psychological interventions over the past decade. Psychological treatments for PVD have the advantage of targeting both the experience of pain and its many psychosexual consequences, such as reduced desire and arousal. Cognitive behavioral therapy (CBT) currently represents one of the most popular first-line psychological interventions for PVD. Mindfulness has been increasingly used alongside, or instead of CBT for a variety of health-related conditions, particularly with respect to chronic pain disorders and more recently in women with PVD. This review provides a detailed overview of CBT and mindfulness-based approaches in treating PVD.

Loneliness Mediates the Relationship Between Pain During Intercourse and Depressive Symptoms Among Young Women

“…According to the circular cognitive behavioral model of provoked vestibulodynia, cognitive-emotional processes such as catastrophizing and fear of pain can lead to physical reactions such as pelvic floor tension and decreased lubrication that ultimately lead to more pain (ter Kuile, Both, & van Lankveld, 2010). Interventions such as CBT, acceptance and commitment therapy, and mindfulness-based stress reduction that target these psychosocial processes might help to alleviate some of the bodily reactions that cause or maintain pain during intercourse (Dunkley & Brotto, 2016; McCracken & Vowles, 2014; Rosenbaum, 2013; ter Kuile et al, 2010). …”

Female Genito-Pelvic Pain/Penetration Disorder: Review of the Related Factors and Overall Approach

“…The initial therapeutic approach must be psychoeducation of the couple. 36 Neither the patient nor the partner should face this stage performing a passive role: it is an opportunity to understand the problem, to learn about female anatomy, and to challenge myths. The couple should also be informed about the biopsychosocial nature of GPPPD and the role of psychological and marital issues as triggers and persistence factors.…”

“…2 The use of progressively larger vaginal dilators (systematic desensitization) associated with a physiotherapy program should be strongly encouraged. 36 The efficacy of this treatment appears to be mediated by avoidance behavior 2 and reduction of cognitive distortions, and by the increased control over pain. 34 By the end of a cognitive-behavioral program, women's anxiety levels decrease, and marital harmony and global sexual satisfaction improve.…”

Sensory processing of women diagnosed with genito-pelvic pain/penetration disorder: a research proposal

“…A multi-disciplinary, multi-modal approach [30][31][32][33][34] is emphasised for treatment of GPPPD. Current GPPPD treatment options range from medical intervention, physical therapy, and psychosocial treatments, which reflect the current concepts regarding its aetiology [33].…”