Comparison of cognitive-behavioral couple therapy and lidocaine for the treatment of provoked vestibulodynia: A randomized clinical trial

couple en thérapie

Description :

Chronic pain problems related to the female reproductive system are a major health problem for women. Poorly understood, these conditions entail considerable personal and financial costs. One such condition is provoked vestibulodynia, or vulvar vestibule pain, affecting 8-10% of women. Despite its negative impact on psychosexual and relationship satisfaction, there is little empirical research evaluating treatments for afflicted couples. The research carried out built on the findings of our work investigating the impact of relational factors in provoked vestibulodynia, as well as our previous research evaluating the efficacy of cognitive-behavioural group therapy for this problem.

This randomized clinical trial, conducted at the Université de Montréal and Dalhousie University, aimed to evaluate the efficacy of a new 12-week Cognitive Behavioral Couple Therapy (CBCT) for women suffering from vestibulodynia, in comparison with one of the most commonly prescribed first-line medical interventions, topical lidocaine. We were primarily interested in whether there was a significant difference between the two treatments in terms of women’s pain during intercourse following treatment. We also wanted to assess significant differences between the two treatments, at post-treatment and six-month follow-up, in terms of pain unpleasantness, women’s and partners’ sexuality (sexual function, distress and satisfaction), psychological adjustment (pain anxiety and catastrophizing), self-reported improvement and satisfaction with treatment.

Women experiencing pain during intercourse took part in a diagnostic gynecological examination, and couples then participated in a structured interview and completed questionnaires before treatment, immediately after treatment and six months after the end of treatment. A total of 108 couples whose women suffered from provoked vestibulodynia were randomly assigned to one of these two types of treatment for a period of 12 weeks.

Women who underwent CBCT reported a greater decrease in pain unpleasantness, a greater decrease in pain anxiety and catastrophizing, a greater decrease in sexual distress, a greater overall improvement in sexuality, and were more satisfied with the treatment received. Partners randomized to couple therapy and lidocaine treatment reported improvements in sexual function, sexual distress and catastrophizing. However, partners who underwent CBCT reported greater satisfaction with the treatment received and greater improvement in their overall sexuality. Thus, couple therapy was more effective than lidocaine on several dimensions. Moreover, the improvements reported by the partners demonstrated the importance of including them in the treatment of provoked vestibulodynia.

This study was approved by the CHUM and Université de Montréal Faculty of Arts and Sciences Research Ethics Boards, and funded by the Canadian Institutes of Health Research (CIHR).

To read the main paper of this study : Bergeron, S., Vaillancourt-Morel, M.-P., Corsini-Munt, S., Steben, M., Delisle, I., Mayrand, M.-H., & Rosen, N.O. (2021). Cognitive-behavioral couple therapy versus lidocaine for provoked vestibulodynia: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 89(4), 316–326.