Mindfulness-based cognitive therapy (MBCT) can be an effective way to treat women with provoked vestibulodynia (PVD), according to a recent Journal of Sexual Medicine study.
For some outcomes, MBCT was just as effective as cognitive behavioral therapy (CBT), the authors reported.
Women with PVD feel discomfort or pain when the entrance to the vagina – the vestibule – is touched in any way. Pelvic exams, tampon insertion, and sexual activity can be especially problematic.
PVD can take a toll on women’s psychological well-being, too. Women may feel anxious and fear the pain. Some may avoid intercourse and feel depressed over changes in their relationships.
Treatment options for PVD may include pelvic floor physical therapy, the use of vaginal dilators, and antidepressants. CBT can help women cope with their anticipation of pain and learn to relax in sexual situations.
In patients with other types of chronic pain, MBCT has also been an effective approach. The current study investigated whether it could help women with PVD as well.
The authors differentiated the two approaches in this way:
Whereas CBT is aimed at challenging and changing thoughts, mindfulness-based cognitive therapy (MBCT) aims to increase awareness of pain-related thoughts, while not identifying with their content, and neither engaging with nor changing them. Focused attention and acceptance of all sensations is fundamental to the skill of mindfulness, and acceptance is a concept central to coping for women with PVD.
One hundred thirty women participated in the study. All of the women had had PVD for at least six months. A tool called a vulvalgesiometer was used to assess pain. The women also completed a series of questionnaires to evaluate their pain, sexual function, and psychological health.
Sixty-three women (average age 31 years) underwent 8 weeks of group CBT, which involved psychoeducation, training in behavioral and communication skills, and cognitive techniques. The weekly sessions lasted 2.25 hours.
The remaining 67 women (average age 34 years) underwent group MBCT for the same duration. Their treatment involved psychoeducation and communication skills training as well, but it also included guided mindfulness exercises.
After each session, women were given homework to complete. The researchers followed up with participants at one- and six-month time points.
In general, women in both treatment groups had success, and the good results were maintained through the six-month follow up point. The women reported less pain during vulvalgesiometer assessments, improvements in the psychological aspects of pain, and better sexual function overall.
However, MBCT was “superior” to CBT for pain during intercourse or penetration, the researchers noted. Women in this group learned alternative ways to think about pain and other sensations, and this factor might have contributed to MBCT’s success, the authors noted.
“Mindfulness reduces the tendency to follow non-erotic distracting thoughts – a major factor identified as limiting in women’s sexual function – and enhances relationship intimacy,” they wrote.
They called the MBCT approach “promising” and recommended its consideration for women with PVD.
International Society for Sexual Medicine
“How is provoked vestibulodynia (PVD) treated?”
“What is provoked vestibulodynia (PVD)?”
The Journal of Sexual Medicine
Lori A. Brotto, PhD, et al.
“A Comparison of Mindfulness-Based Cognitive Therapy Vs Cognitive Behavioral Therapy for the Treatment of Provoked Vestibulodynia in a Hospital Clinic Setting”
(Full-text. Published online: May 15, 2019)