Abstract
BackgroundProblems related to pain during vaginal penetration are complex and the etiology is multi-factorial. It was the aim of the present study to measure whether treatment using desensitization exercises and cognitive behavioral therapy (CBT) for women with provoked vulvodynia (PVD) could increase sexual interest, sexual satisfaction and response whilst decreasing experiences of sexual pain.Methods and outcome measuresSixty women suffering from PVD were treated during a 10-week period with a combination of mucosal desensitization and pelvic floor exercises and CBT. The McCoy Female Sexuality Questionnaire (MFSQ) was used to measure efficacy of the treatment. The Hospital Anxiety and Depression Scale (HADS) was used to measure psychological distress. The primary outcome measurements were changes in scores for the MFSQ and changes in individual items on the MFSQ directly after treatment completion. Secondary outcome measurements were changes in the MFSQ items 6 months after treatment and changes in HADS sub-scales 6 months after treatment. Statistical comparisons of answers to the MFSQ were carried out using the Wilcoxon signed rank test (paired). Validity of the MFSQ in this study was measured by testing one global question about sexuality and total scores on MFSQ using Spearman’s correlation test.ResultsStudy participants reported a statistically significant increase in sexual fantasies, increased sexual pleasure, excitement and vaginal lubrication after treatment was completed. PVD occurred less often which resulted in significantly less avoidance of sexual intercourse, increased frequency of masturbation and intercourse. All improvements were sustained at 6 months after treatment ended. Two questions showed no significant changes, these pertained to the individual’s contentment with her partner as a lover and a friend. The anxiety sub-scale of the HADS showed a significantly decreased level of anxiety at 6 months follow-up but no change in the scores on the depression sub-scale.ConclusionTreatment for PVD using desensitization exercises and cognitive behavioral therapy significantly improved sexual interest, response and activity and decreased the experience of pain. Larger studies and RCTs are required in order to draw conclusions about treatment and long term effects should be studied. Partners should be encouraged to participate in treatment regimes.Trial registrationThe study is registered with ISRCTN registry, ID ISRCTN40416405.
Highlights
Problems related to pain during vaginal penetration are complex and the etiology is multi-factorial
provoked vulvodynia (PVD) occurred less often which resulted in significantly less avoidance of sexual intercourse, increased frequency of masturbation and intercourse
In an unpublished quality control study, the authors discovered that a substantial number of women who sought help for PVD reported a history of depression and the Hospital Anxiety and Depression Scale (HADS) was used in the present study [21,22,23]
Summary
Problems related to pain during vaginal penetration are complex and the etiology is multi-factorial. It was the aim of the present study to measure whether treatment using desensitization exercises and cognitive behavioral therapy (CBT) for women with provoked vulvodynia (PVD) could increase sexual interest, sexual satisfaction and response whilst decreasing experiences of sexual pain. The problem is complex and because etiology has been scantily studied, national and international consensus on guidelines for treatment, have yet to be reached [2]. The scientific community uses several different sources in order to define symptoms related to painful sexual intercourse, generally named dyspareunia. In an up-date of guidelines for treatment of vulvodynia, it has been suggested that the classification of vulvodynia depends on the site of pain, whether it is provoked or unprovoked and whether the pain is generalized or localized [2]
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