A randomized comparison of individual cognitive-behavioural therapy and pelvic floor rehabilitation in the treatment of provoked vestibulodynia
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Provoked vestibulodynia (PVD) is the most common condition leading to painful intercourse and is currently best understood within a biopsychosocial framework. Although the usefulness of non-medical treatment options for vulvar pain is recognized by many, there is limited research investigating the effectiveness of these treatments using a biopsychosocial approach to outcome measurement. Furthermore, there is little evidence to support the mechanisms by which these treatments lead to pain reduction. This study aimed to address these gaps by investigating two non-medical treatment options: individual cognitive-behavioural therapy (ICBT) and pelvic floor rehabilitation (PFR). Twenty women with PVD were randomly assigned to eight sessions of either ICBT or PFR. Participants were assessed at pre-treatment, post-treatment, and 6-month follow-up via gynecological examination, structured interviews and standardized questionnaires measuring pain, psychological, and sexual variables, quantitative sensory testing, and a pelvic floor muscle (PFM) evaluation. The primary outcome was change in intercourse pain intensity. Secondary outcomes included changes in other features of vestibular pain (e.g., frequency), cotton-swab test pain intensity, vestibular sensitivity, sexual functioning, PFM functioning, and pain cognitions. Changes in psychosexual and PFM functioning were investigated as predictors of treatment outcome. Results indicated no differences in the effectiveness of the treatment groups with respect to pain outcomes, with both groups demonstrating significant reductions in pain. Between-group differences were minimal in other areas, with some suggestion that participants in the ICBT group fared better with respect to sexual functioning, while participants in the PFR group demonstrated more improvements in PFM tone. Participants in both groups demonstrated meaningful improvements in pain cognitions, with the ICBT group demonstrating greater changes in rumination. The study was not able to detect significant predictors of treatment outcome. The results of the study suggest that both ICBT and PFR may lead to clinically meaningful improvements in pain, as well as in other areas of psychosexual functioning. Future treatment studies should consider incorporating general chronic pain clinical trial recommendations to allow for better comparison of outcomes with other studies.