A randomized comparison of group cognitive–behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis

Abstract

This study compared group cognitive-behavioral therapy (12-week trial), surface electromyographic biofeedback (12-week trial), and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Subjects were 78 women randomly assigned to one of three treatment conditions and assessed at pretreatment, posttreatment and 6-month follow-up via gynecological examinations, structured interviews and standard questionnaires pertaining to pain (Pain Rating Index and Sensory scale of the McGill Pain Questionnaire, vestibular pain index, pain during intercourse), sexual function (Sexual History Form, frequency of intercourse, Information subscale of the Derogatis Sexual Functioning Inventory), and psychological adjustment (Brief Symptom Inventory). As compared with pretreatment, study completers of all treatment groups reported statistically significant reductions on pain measures at posttreatment and 6-month follow-up, although the vestibulectomy group was significantly more successful than the two other groups. However, the apparent superiority of vestibulectomy needs to be interpreted with caution since seven women who had been assigned to this condition did not go ahead with the intervention. All three groups significantly improved on measures of psychological adjustment and sexual function from pretreatment to 6-month follow-up. Intent-to-treat analysis supported the general pattern of results of analysis by-treatment-received. Findings suggest that women with dyspareunia can benefit from both medical and behavioral interventions.

Partner Behavioral Responses to Pain Mediate the Relationship Between Partner Pain Cognitions and Pain Outcomes in Women With Provoked Vestibulodynia

“…Partner attributions about the women's pain were measured with the Extended Attributional Style Questionnaire 3,12,27,40 , adapted for use with partners of women experiencing pain during intercourse. The partner version has been used in a previous sample of PVD couples, but has not been properly validated 20 .…”

“…This could indicate changes in partners' ability or desire to respond in positive ways as time goes on, suggesting that positive behavioral responding may take more self-regulation. One study showed that partner catastrophizing and self-efficacy partially mediated the association between higher partner solicitous responses and higher pain during intercourse in women with PVD, although only pain catastrophizing was a unique mediator 3,32 .…”

Randomized clinical trial of multimodal physiotherapy treatment compared to overnight lidocaine ointment in women with provoked vestibulodynia: Design and methods

“…pain occurred after successful unpainful intercourse) subtypes were included in the study. In order to confirm the PVD diagnosis, all women underwent a medical history interview and a physical examination including a standardized pelvic examination performed by a gynecologist of our team [18]. This evaluation followed the diagnostic criteria defined by Friedrich [2] and more recently modified by Bergeron et al [30]: 1) pain in the vestibule following touch or an attempted vaginal penetration; 2) acute pain during the cotton-swab test which consists in applying pressure following a random order to the vulvar vestibule.…”

“…This intervention is judged highly effective by vulvodynia specialists [15] and is listed as a first-line treatment for vulvodynia in clinical guidelines [16] and [17]. Individual physiotherapy modalities have been shown to reduce pain significantly in women with PVD [18], [19] and [20]. A randomized controlled trial (RCT) showed a 35% pain reduction during intercourse following PFM biofeedback [18].…”

“…Individual physiotherapy modalities have been shown to reduce pain significantly in women with PVD [18], [19] and [20]. A randomized controlled trial (RCT) showed a 35% pain reduction during intercourse following PFM biofeedback [18]. Manual therapy and auto-insertion techniques also appear to reduce pain [19] and [20].…”