A Network Analysis of Selected Psychosocial Factors in Vulvodynia and Its Subtypes

Guided internet-based acceptance and commitment therapy for provoked vestibulodynia: A randomized controlled trial

BACKGROUND

Provoked vestibulodynia (PVD) causes suffering in many women's lives due to its impact on relationships, sexual functioning and functioning in other key domains.

OBJECTIVE

Here, we report a randomized controlled trial conducted to examine whether Acceptance and Commitment Therapy (ACT) with a focus on values-based exposure, delivered online, benefits women with PVD.

METHODS

Participants (n = 88) were randomized to either guided online ACT for 10 weeks or a wait-list control group. Outcomes were assessed at baseline, post treatment and 1 year later. Analyses were based on intention to treat using linear mixed models.

RESULTS

There were significant group differences on the primary outcomes, Female Sexual Index and Female Sexual Distress Scale, in favour of online ACT with moderate effect sizes. Differences were also found on several secondary outcomes and therapeutic process measures, all in favour of ACT. No differences were found at post-treatment for depression or anxiety. At the 1-year follow-up, results were maintained and a difference between baseline and follow-up was also found for depression.

CONCLUSION/SIGNIFICANCE

In summary, a relatively brief, guided, online version of ACT appears to produce benefits for women with PVD and related impacts on daily functioning. 50% to 60% of the women who participated in the treatment reliably improved in sexual functioning and distress.

A Network Analysis of the Fear Avoidance Model of Genital Pain

Using a novel data-driven network approach, this study aimed to examine the interconnection between the key elements of the Fear-Avoidance Model of female genital pain - sexual arousal, fear-avoidant cognitions, and motivational coping - and its associated factors to predict the intensity and frequency of genital pain across women over time. Network modeling allowed for a comprehensive evaluation of the Fear-Avoidance model while capturing the dynamic features of genital pain. We estimated a cross-sectional and a temporal, contemporaneous, and between-persons network model on convenience-based data of 543 female students (mean age = 23.7 years, SD = 3.6) collected at three time points. Results showed that lubrication, pain catastrophizing, pain avoidance, fear-avoidance beliefs, sexual satisfaction, anxiety, and frequency of coital and non-coital sex predicted pain, with lubrication being the most consistent predictor across estimations. The network of women with recurrent genital pain showed a similar pattern as the network of the total sample, except that pain avoidance and fear-avoidance beliefs rather than pain catastrophizing predicted pain directly, and frequency of coital and non-coital sexual activities played a more prominent role. These results suggest that the main problem of genital pain centers around women not being sufficiently aroused during intercourse and inadequate ways of pain coping, which are critical targets of cognitive-behavioral therapy treatment and should be developed further.

A conceptual model for managing sexual pain with somatocognitive therapy in women with provoked vestibulodynia and implications for physiotherapy practice

Somatocognitive therapy is a multimodal physiotherapy treatment developed in the early 2000s to alleviate the burden of chronic pelvic pain. In recent years, somatocognitive therapy has been further developed to treat women with provoked vestibulodynia. This prevalent gynecological pain condition is a subgroup of chronic pelvic pain and the most common form of vulvodynia. Provoked vestibulodynia is a neglected multifactorial pain condition of unknown cause, adversely affecting women's sexual life, relation to their partners and their psychological health. Pain is located at the vulvar vestibule and is provoked by touch or pressure such as sexual intercourse. In the management of sexual pain, somatocognitive therapy combines bodily exploration, pain education, cognitive coping strategies and structured homework to improve sexual function and reduce pain. To support these processes, developing a sound therapeutic alliance with the patient is essential. The aim of this article is to provide a conceptual model for managing provoked vestibulodynia with somatocognitive therapy, including a theoretical rational for this treatment. We base our conceptual model on the biopsychosocial model, i.e., considering the complex interplay of biomedical, emotional/cognitive, psychosexual and interpersonal factors in provoked vestibulodynia management. In addition, implications for practice and a detailed description of somatocognitive therapy for provoked vestibulodynia will be provided, to allow replication in clinical practice and in clinical trials.

Pleasure despite pain: Associations between experiences of vulvar pleasure, vulvar pain, and sexual function in patients with chronic vulvar pain conditions

Background

Chronic pain can occur in the vulva, one of the primary pleasure centers of the body; however, the associations between pleasurable vulvar experiences and chronic vulvar pain have not yet been explored.

Aim

The aim of this study was to investigate associations between vulvar pleasure and pain experiences in patients with chronic vulvar pain.

Methods

This was a prospective cross-sectional study of 547 patients (aged ≥17 years) presenting over 10 months to 2 urban outpatient gynecology clinics specializing in vulvar pain. Prior to the initial evaluation, patients completed online validated questionnaires of pain-related anxiety, pain catastrophizing, and sexual functioning, as well as a researcher-developed questionnaire evaluating vulvar pleasure. Patients were divided into groups based on their pleasure and pain experiences. Between-group analyses consisting of t-tests, analyses of variance, and multivariate analyses of variance were conducted.

Outcomes

Outcomes consisted of total and subscale scores on the Pain Anxiety Symptoms Scale-20, Pain Catastrophizing Scale, Female Sexual Function Index, and a researcher-developed vulvar pleasure questionnaire.

Results

More than 70% of patients with chronic vulvar pain had experienced vulvar pleasure since the onset of their vulvar pain, with the clitoris as the most common source of pleasure. Average vulvar pleasure intensity was rated 7 (0, no pleasure; 10, extremely pleasurable). Masturbation ranked higher in pleasurable activities than vulvar stimulation by a partner or penetrative intercourse and was the most likely activity to lead to orgasm. When compared with patients who had not experienced vulvar pleasure since the onset of their vulvar pain, patients experiencing both pain and pleasure scored lower on the Pain Anxiety Symptoms Scale-20 total (P = .026) and fear subscale (P = .016), lower on the Pain Catastrophizing Scale total (P = .002) and all subscales (P = .008-.018), and higher on the Female Sexual Function Index total and all subscales (all P ≤ .001).

Clinical Implications

Incorporating strategies for cultivating vulvar pleasure in patients with chronic vulvar pain may be useful in comprehensive management approaches.

Strengths and Limitations

Strengths of this study include the novel examination of vulvar pleasure in a population with chronic vulvar pain and a large sample size. Limitations include the lack of a nonclinical comparator group and reliance on patient self-report.

Conclusion

Results suggest that greater vulvar pleasure is associated with lower pain-related anxiety, lower pain catastrophizing, and higher sexual functioning in patients with chronic vulvar pain conditions.

Mindfulness, Self-Compassion, and Acceptance as Predictors of Sexual Satisfaction in Cisgender Heterosexual Men and Women

Sexual satisfaction is a relevant indicator of sexual health, and psychotherapeutic interventions for sexual dysfunction also promote sexual satisfaction in men and women. Cognitive-behavioral psychotherapies for sexual dysfunction, including third-wave approaches, are effective in treating sexual dysfunction. Thus, third-wave cognitive-behavioral constructs may play a significant role in sexual satisfaction. This study intends to examine the predictive role of mindfulness awareness and attention, self-compassion and acceptance, and action constructs on cisgender heterosexual men's and women's sexual satisfaction. A web survey including self-report measures for assessing mindfulness awareness and attention (MAAS), self-compassion (SCS), acceptance and action (AAQ), and sexual satisfaction (GMSEX) was disseminated during 2022, and a sample of 420 participants was collected (n = 238 women; 56.7%; n = 182 men; 43.3%). No statistically significant differences were found between cisgender heterosexual men and women on mindfulness awareness and attention, self-compassion, acceptance and action, and sexual satisfaction. In addition, all variables account for 6.5% of cisgender heterosexual men's and women's sexual satisfaction variance, and mindfulness awareness and attention, self-compassion, and acceptance and action positively predicted sexual satisfaction. Overall, mindfulness awareness and attention, self-compassion, and acceptance and action play a significant predictive role in cisgender heterosexual men's and women's sexual satisfaction.