One in five women experience pain during intercourse. The latest edition of the Diagnostic and Statistical Manual of Mental Disorders, the Bible of American Psychiatrists, lists it as “genito-pelvic pain or penetration disorder.” However, this type of pain is not purely psychological.
Caused vestibulodynia is a condition experienced by approximately 8% of women in North America. It is characterized by intense pain to the vaginal opening during sexual intercourse or when buffers are introduced. To reduce the burning sensation, many women apply lidocaine, an anesthetic cream.
A new study of 108 couples found that cognitive-behavioral therapy (CBT) for couples was more effective than lidocaine. The study was carried out by Sophie Bergeron, professor of the Department of Psychology at the Faculty of Arts and Sciences of the University of Montreal, director of the Sexual Health Laboratory at the UdeM and holder of the Chair of Canadian Research on Intimate Relationships and Sexual Welfare, and Natalie O. Rosen of Dalhousie University. Marc Steben and Marie-Hélène Mayrand of the Université de Montréal, Marie-Pier Vaillancourt-Morel of the Université du Québec à Trois-Rivières, Serena Corsini-Munt of the University of Ottawa and Isabelle Delisle also contributed to the study, which has just been published in Journal of Consulting and Clinical Psychology.
The causes of the induced vestibulodynia have yet to be determined. There is a long list of risk factors, including biomedical factors such as repeated infections that cause inflammation in the vulvar area (cystitis, vaginal infections), the use of certain oral contraceptives, genetic predisposition, marital factors, and depression and anxiety. Anomalies in the pelvic floor muscles they are also associated with induced vestibulodynia, but it is not known whether they are a consequence of pain or its cause. Similarly, it is unclear whether anxiety is a cause or an outcome, but it has been found that the higher the level of anxiety, the greater the pain.
“Psychological intervention is recommended because once the pain starts, it has such a negative impact on sexuality and the relationship that it becomes very important to break the vicious cycle of fear and avoidance,” says Sophie Bergeron. “Pain often leads to loss of desire in women and frustration for both couples. This is a real problem; it’s not imaginary.”
Few validated treatments
Couple therapy is usually offered by psychologists and sexologists. In the case of induced vestibulodynia, the couple plays a critical role and can help alleviate the problem or aggravate it. Therefore, it is important to include the couple in the intervention. However, some interventions were not previously supported by evidence.
Now, for the first time, a randomized clinical trial has compared the effectiveness of the TCC and lidocaine pair.
It was found that the therapy was more effective than the application of lidocaine to reduce women’s fear of pain, sexual anxiety and alarm and to enhance their sexual experience. After six months, the women were twice as satisfied with their sex lives and their partners three times as satisfied.
Nature of the sessions
Couples attended acceptance and commitment therapy (ACT) sessions for 12 weeks.
“Acceptance means that instead of trying to get a person to change their thinking, we encourage them to accept it,” Bergeron explains. “We practice cognitive diffusion, a technique that creates a psychological distance between the person and their thoughts. At the beginning of therapy, women define themselves by their genito-pelvic pain. Therapy helps them reduce the retention that they also have these thoughts. We also try to break the association sexuality = pain and replace it with new associations, such as sexuality = pleasure with my partner, intimacy with my partner “.
Therapy also examines sexual motivations. What is important to the couple’s sexuality? “We try to explore other aspects of sexuality that are enjoyable,” she says. “In terms of behavior, we can help them expand their repertoire of pain-free sexual activities. In general, vaginal penetration is painful, so we try not to always focus on that.”
Finally, therapy works on the emotional regulation of the couple. “When a couple reacts to a painful experience with anger or frustration, it only makes the problem worse. We help the couple manage their emotional relationship. We get the couple to be more empathetic with the woman’s experience of pain and the woman to be more empathetic to their partner’s frustration. We help them see each other as a united team. “
The importance of the couple in therapy
According to Sophie Bergeron, the couple’s involvement “helps alleviate the woman’s pain because she is no longer alone with her pain.” The two partners report that they better understand each other’s problem and experience and feel relieved to be able to work together to improve the situation.
At the end of the therapy, couples report the satisfaction of having regained their sexuality in a non-threatening way, focusing on pleasurable experiences rather than allowing the pain to take control. This treatment could be effective for other types of genito-pelvis pain too.
University of Montreal
Citation: A new study shows that couple CBT is effective in relieving pain during intercourse (2021, May 24) recovered on May 24, 2021 at https://medicalxpress.com/news/2021-05-couple- cbt-effective-alleviating-pain.html
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