Provoked Vestibulodynia (PVD) is the most common form of chronic vulvar pain, affecting 12% of women in the general population. PVD is characterized by a severe burning pain in response to pressure localized to the vaginal entrance. Research examining the pain component of PVD indicates that it has much in common with other chronic pain conditions. Increased pain sensitivity has been demonstrated in other chronic pain conditions to be due in part to impairment in centrally acting endogenous pain modulation systems, such as Diffuse Noxious Inhibitory Control (DNIC). DNIC is triggered by the simultaneous application of two painful stimuli, with pain at one body site inhibiting pain at another body site. Because DNIC consists of a feedback loop that involves the spinal cord and the brain, it is thought to be dependent upon both sensory and affective pain components. In the current study, 20 women with PVD and 24 controls underwent sensory testing to determine the integrity of DNIC function. Unexpectedly, women with PVD displayed a DNIC response of greater magnitude than controls. Participants also completed measures to assess the interplay between group, DNIC, and psychosocial functioning. Women with PVD experienced decreases in psychosocial functioning; however, this reduction was not found to mediate the relationship between group and DNIC function. Findings of intact DNIC function in women with PVD do not imply that PVD is not a chronic pain condition. DNIC is a complex and dynamic process and warrants further study using different stimuli and paradigms. This study supports previous literature, while adding to the development of a greater understanding of the interaction between psychophysical and psychosocial components of chronic pain, which will allow for the creation of better assessment and treatment strategies. / Thesis (Master, Psychology) -- Queen's University, 2007-09-14 00:14:17.698

Provoked vestibulodynia (PVD), or recurrent vulvar pain, is a prevalent condition among women. Although research has documented that PVD is associated with sexual problems, little research has systematically examined the intimate relationships of affected women. The general purpose of the current studies was to comprehensively examine sexual and relationship functioning among women with provoked vulvar pain. In order to do so, three related studies were conducted. The first study was a systematic review of the literature examining sexual and relationship satisfaction among PVD-affected women. Secondly, an online study was conducted using both standardized and qualitative measures to examine sexual, relationship, and psychological functioning among women with self-reported provoked vulvar pain and their male partners in comparison to controls. The online study also examined associations between affected women’s pain and women and partner’s functioning. The final study was a laboratory-based study that included women with PVD and matched control women and examined psychosexual functioning, including sexual and relationship satisfaction, and vestibular pain sensitivity; additionally, this study examined potential associations between women’s pain and self-reported functioning. Overall, these studies suggest that women with provoked vulvar pain experience decreased sexual functioning, sexual satisfaction, and psychological functioning in comparison to control women, and that pain-affected partners experience decreased sexual functioning and sexual satisfaction. The findings also indicate that some aspects of women’s pain experiences are related to their self-reported functioning and to that of their partners. This research has implications for understanding the potential sexual and relationship consequences associated with provoked vulvar pain, and is among the first to comprehensively examine affected partners’ functioning. It is hoped that these studies will contribute novel information to the vulvar pain literature, and that they will encourage future research examining sexual and relationship functioning among women with provoked vulvar pain and their partners. / Thesis (Ph.D, Psychology) -- Queen's University, 2010-08-25 12:02:29.446

Provoked Vestibulodynia (PVD) is a common form of chronic genital pain, affecting approximately 12% of premenopausal women. Even though knowledge of vulvodynia has been present in the medical field for many years, it was previously thought to be of psychogenic origin and has never been thoroughly investigated for the purpose of pain classification. When investigating any pain condition, one of the most important distinctions to make is whether or not the pain is neuropathic. Even though this possibility has never been investigated in women with PVD, some have claimed that PVD pain contains elements of neuropathy, even treating this pain with medication created for neuropathic pain conditions. The purpose of this study was to use standardized measures and determine whether PVD may have a neuropathic component. Women with PVD completed an online survey assessing various pain and psychosocial variables. Their responses were compared with those of pain-free controls and women experiencing an established neuropathic pain condition, post-herpetic neuralgia (PHN). Women with PVD scored above established cut-offs on measures of neuropathic pain (NP). Further, for some NP measures there was no difference in scores between PVD and PHN women. Women with PVD also had similar psychosocial profiles as those with PHN, although women with PHN reported poorer health-related quality of life. Interestingly, the number of NP symptoms did not predict pain/psychosocial disturbance, or vary as a function of pain duration or intensity. Overall, these results lend support to the argument that PVD is a chronic pain condition. Further, these results indicate that women with PVD likely experience some form of NP. These results add to the understanding and classification of PVD, justifying further investigation, for example, via psychophysical testing and functional magnetic resonance imaging. / Thesis (Master, Psychology) -- Queen's University, 2011-09-21 16:25:34.216

Introduction: Provoked vestibulodynia is a common life impacting disease. Research hasshown higher pain intensity and anxiety levels in primary (pain present since first penetrativeattempt) provoked vestibulodynia (PVD1) compared to secondary provoked vestibulodynia(PVD2) and mixed results regarding age and female sexual functioning when comparing thegroups.Aim: The aim of this study was to further investigate the differences between PVD1 andPVD2 regarding pain intensity, sexual functioning, age and anxiety levels. The secondary aimwas to analyze how PVD group, age, anxiety and pain intensity associates with sexualfunctioning.Method: A total of 57 women from the Netherlands and Sweden were recruited via socialmedia, advertisement and regional caregivers. This study was part of a larger study oncognitive behavioral group therapy for women with provoked vestibulodynia. Data wasextracted from a survey assessing intensity of pain, sexual functioning, age and anxiety levels.A t-test was used to compare the PVD1 and PVD2 groups and a multivariate regressionanalysis was used to analyze the variables association with sexual functioning.Results: No statistically significant differences were found regarding pain intensity, sexualfunctioning, age and anxiety levels between PVD1 and PVD2. Decreased sexual functioningwas significantly related to higher age and pain intensity.Conclusion: We found no significant differences between PVD1 and PVD2. Increased ageand higher pain intensity seems to associate with lower sexual functioning. Longitudinalstudies with a greater sample size are needed for further investigation.

Although Provoked Vestibulodynia has a great impact on women’s relationships, including their partners, research has predominantly focused on the women. This thesis aimed to expand the knowledge regarding psychosexual health of the partner. Depressive symptoms, anxiety, sexual distress, and domains of sexual function (erectile function, orgasmic function, sexual desire, intercourse satisfaction, overall sexual satisfaction) were investigated through descriptive comparisons, correlations, and regression analyses. The sample consisted of male partners (N=53) of women with PVD, aged 20-50 years. Baseline data from a larger RCT was compared with data from external studies. Results showed that PVD partners reported similar levels of depressive symptoms and anxiety as comparison groups. However, PVD partners expressed higher levels of sexual distress, and lower levels of sexual function than comparison groups. Several domains of sexual function predicted overall sexual satisfaction, whereas depressive symptoms did not explain levels of sexual distress. However, depressive symptoms co-occurring with poorer overall sexual satisfaction and orgasmic function, explained higher sexual distress. We conclude that partners have a perceived impaired sexual health. Their impairment is localised to sexuality and not generalised to the rest of their lives. Partner involvement is integral in the treatment of PVD and should be investigated in future research.

Vaginismus is a sexual pain disorder, where spasm of musculature of the outer third of the vagina interferes with intercourse. Vaginismus exists in two forms: total vaginismus, where intercourse is impossible, and the more seldom described partial vaginismus, in which intercourse is possible but painful. The aim of the thesis was to develop a useful definition of partial vaginismus for both clinical and scientific purposes; to describe the prevalence of partial vaginismus among women with superficial coital pain; to report on symptoms and clinical findings in women with partial vaginismus; and to present treatment results for women with vaginismus. In a clinical sample of 224 women with superficial coital pain, we found a great overlap of the clinical diagnoses of partial vaginismus (PaV) and vulvar vestibulitis (VVS) (nowadays called provoked vestibulodynia); 102 women had both PaV and VVS. All women with VVS had vaginismus. Partial vaginismus was more common in all our samples than total vaginismus. sEMG of pelvic floor muscles was found to be of no value in distinguishing women with partial vaginismus with or without vulvar vestibulitis (PaV+/-VVS) (n=47) from each other or from an asymptomatic group (n=27). Women with PaV+/-VVS (n=53) reported not only burning pain but also itch during a standardized penetration situation (sEMG of pelvic floor muscles), while asymptomatic women (n=27) did not. In most cases, the appearance of burning pain preceded the appearance of itch. In a retrospective interview study, 24 women with PaV+/-VVS reported pain after intercourse more often than pain during penetration at the onset of the problem. When the women ceased having intercourse, both symptoms were equally common. Intensity of pain during penetration increased dramatically from very low at onset of the problem to very high when the women ceased having intercourse, while intensity of pain after intercourse was already high at onset of the problem and increased to very high when the women ceased having intercourse. Pain after intercourse in women with PaV+/-VVS was described as burning and/or smarting and lasted in mean for two hours, while pain during penetration was described with words like sharp/incisive/bursting and lasted for one minute. At long-term follow-up (more than three years) of a group of women treated with cognitive behaviour therapy for vaginismus (n=59, response rate 44/59 on a questionnaire), a majority were able to have and enjoy intercourse. The proportion of women with positive treatment outcome was, however, associated to the definition of treatment outcome. An ability to have intercourse at end of therapy was maintained at follow-up. Every tenth women with vaginismus healed spontaneously after thorough assessment. Conclusion: Partial vaginismus was more common in our studies than total vaginismus, and all women with vulvar vestibulitis had partial vaginismus. Women with PaV+/-VVS reported not only burning pain during standardized penetration but also itch. When the problem started in women with PaV+/-VVS, pain after intercourse was more common than pain during penetration. Pain after intercourse was described as longlasting and burning and/or smarting, while pain during penetration was described as short and sharp/incisive/bursting. Long-term follow-up results of a series of women treated with CBT for vaginismus show good treatment outcome.

No description available.

L’étude de l’intimité a été négligée chez les couples dont la femme présente une vulvodynie, un problème de santé sexuelle qui affecte négativement les femmes et leurs partenaires. Or, l’intimité a été associée à des indicateurs d’adaptation psychologique et conjugale auprès d’autres populations cliniques. L’objectif de la thèse était d’examiner les liens entre l’intimité et le bien-être sexuel chez les femmes présentant de la vulvodynie et leurs partenaires. Le but du premier article était d’examiner l’intimité conjugale et l’intimité sexuelle en lien avec la satisfaction sexuelle, la fonction sexuelle, le sentiment d’auto-efficacité face à la douleur et l’intensité de la douleur vulvo-vaginale de la femme. Quatre-vingt-onze femmes présentant de la vulvodynie et leurs partenaires ont complété des mesures auto-rapportées. Chez les femmes, une plus grande intimité sexuelle a été associée à une satisfaction sexuelle et à un sentiment d’auto-efficacité plus élevés. Des degrés plus élevés d’intimité conjugale et sexuelle ont été associés à une fonction sexuelle plus élevée. L’intimité sexuelle et conjugale n’ont pas été associées à l’intensité de la douleur. Le deuxième article visait, par une méthodologie observationnelle et des mesures auto-rapportées, à examiner les associations entre deux composantes centrales de l’intimité – le dévoilement et la réponse empathique – et la satisfaction et la détresse sexuelle chez cinquante femmes et leurs partenaires. Le dévoilement et la réponse empathique ont été évalués selon la perspective d’une observatrice formée et auto-rapportés par les couples après une tâche de discussion. Les femmes et les partenaires ayant une plus grande réponse empathique rapportaient eux-mêmes une satisfaction sexuelle plus élevée. Pendant la discussion, une plus grande réponse empathique chez les femmes a été associée à une plus grande satisfaction sexuelle chez leurs partenaires. Un plus grand dévoilement chez le couple, tel que perçu par les femmes et leurs partenaires, a été associé à une plus grande satisfaction sexuelle chez les partenaires. Une plus grande réponse empathique chez les femmes a été associée à une plus faible détresse sexuelle chez les partenaires. Un plus grand dévoilement chez le couple, tel que perçu par les partenaires, a été associé à une plus faible détresse sexuelle chez ces derniers. Les implications cliniques, théoriques et méthodologiques de la thèse sont discutées. / Intimacy has been a neglected area of research among couples coping with vulvodynia, a sexual health problem which has a negative impact on the sexual well-being of both the woman and her partner. Yet, intimacy has been associated with indicators of psychological and marital adjustment in other clinical populations. The main goal of this thesis was to investigate associations between intimacy and sexual well-being in women with vulvodynia and their partners. The first article aimed to examine relationship intimacy and sexual intimacy in relation to sexual satisfaction, sexual function, pain self-efficacy and pain during intercourse in women. Ninety-one women with vulvodynia and their partners completed self-report questionnaires. Women’s higher sexual intimacy was associated with their higher sexual satisfaction and pain self-efficacy. Women’s higher relationship intimacy and sexual intimacy were also associated with their higher sexual function. Relationship intimacy and sexual intimacy were not associated with pain intensity. Using a combination of observational and self-report methodologies, the second article aimed to investigate the associations between two central components of intimacy – empathic response and disclosure – and sexual satisfaction and distress among fifty women and their partners. Disclosure and empathic response were measured from the perspective of a trained observer and self-reported by women and their partners immediately following a discussion task. During the discussion, greater empathic response in women and partners were associated with their own higher sexual satisfaction. Greater women’s empathic response was associated with their partners’ higher sexual satisfaction. Greater disclosure in couples, as perceived by women and partners, was associated with higher partners’ sexual satisfaction. Greater empathic response in women was associated with partners’ lower sexual distress. Greater disclosure in couples, as perceived by partners, was associated with partners’ lower sexual distress. Clinical, theoretical, methodological implications of the thesis are discussed.

Thèse de doctorat présenté en vue de l'obtention du doctorat en psychologie - recherche intervention, option psychologie clinique (Ph.D) / L’une des causes la plus fréquente de douleur génito-pelvienne est la vestibulodynie provoquée (VP), qui affecterait 8% à 12% des femmes de la population générale (Harlow et al., 2014). Elle se caractérise par une douleur à l’entrée du vestibule vulvaire provoquée par l’application d’une pression, principalement lors des relations sexuelles. La VP a de nombreuses conséquences négatives sur la vie sexuelle, relationnelle et psychologique des femmes et de leurs partenaires amoureux (Bergeron et al., 2015). Des études ont démontré que certains facteurs interpersonnels affectent l’intensité de la douleur et l’ajustement des couples à la VP (Rosen & Bergeron, 2019). Bien qu’associée à des niveaux plus élevés de douleur chez les femmes et à une plus faible fonction et satisfaction sexuelles chez les couples avec la VP, l’insécurité d’attachement (i.e., anxiété d’abandon et/ou évitement de l’intimité) a été peu étudiée dans cette population (Granot et al., 2010; Leclerc et al., 2015). Ainsi, on note une absence d’études utilisant une perspective longitudinale ou dyadique, malgré le contexte très intime dans lequel la douleur survient. De plus, aucune étude n’a examiné ses associations avec des facteurs proximaux pouvant influencer la douleur ou encore en contexte de traitement. Ainsi, l’objectif général de la thèse était de mieux comprendre les mécanismes liés à l’attachement qui sous-tendent l’ajustement des femmes et de leur partenaire à la VP. Le premier article examinait les associations longitudinales entre l’attachement, le sentiment d’auto-efficacité dans la gestion de la douleur et l’intensité de la douleur chez les couples avec la VP. Deux-cent-treize couples avec la VP ont complété des questionnaires auto-rapportés lors de deux temps de mesures, espacés de deux ans. Les résultats ont démontré qu’une plus grande anxiété d’abandon prédisait un plus faible sentiment d’auto-efficacité dans la gestion de la douleur, qui en retour prédisait une plus grande intensité de la douleur chez les femmes deux ans plus tard. Plus d’évitement de l’intimité chez les femmes avec la VP était également un prédicteur d’une plus grande intensité de la douleur deux ans plus tard. Le second article de la thèse examinait les associations entre l’attachement, les réponses des partenaires et l’ajustement sexuel et relationnel chez 125 couples avec la VP. Des effets acteurs et partenaires ont été trouvés dans les associations entre l’insécurité d’attachement et plus de réponses négatives et moins de réponses facilitatrices pour les deux membres du couple, qui en retour était associé à un plus faible bien-être sexuel et relationnel. Le troisième article a examiné l’attachement et la maltraitance à l’enfance comme modérateurs de l’efficacité thérapeutique en comparant un traitement médical – la lidocaïne topique – à une thérapie cognitive comportementale de couple (TCCC) pour la VP développée par notre équipe. Un essai clinique randomisé impliquant 108 femmes avec la VP a trouvé que les femmes avec des niveaux élevés d’évitement de l’intimité ou de maltraitance à l’enfance bénéficiaient davantage de la lidocaïne que de la TCCC dans l’amélioration de leur satisfaction, leur fonction et leur détresse sexuelles à la fin du traitement ou six mois plus tard. Les implications et les contributions théoriques, cliniques et méthodologiques de ces résultats sont discutées. / One of the most common causes of genito-pelvic pain is provoked vestibulodynia (PVD), affecting approximately 8% to 12% of women in population-based samples (Harlow et al., 2014). PVD is characterized by pressure provoked pain at the entrance of the vulvar vestibule, occurring mostly during sexual intercourse. PVD has deleterious effects on women and partners’ psychological, sexual and relational wellbeing (Bergeron et al., 2015), Studies show that proximal and distal interpersonal factors are associated with pain intensity and couples’ adjustment to PVD (Rosen & Bergeron, 2019). Although associated with greater pain intensity and poorer sexual satisfaction and function in couples with PVD, attachment insecurity (i.e., abandonment anxiety and/or avoidance of intimacy) has been scantily studied in this population (Granot et al., 2010; Leclerc et al., 2015). In fact, very few studies have examined the impact of attachment on couples’ adjustment while using longitudinal or dyadic methodologies, despite the very intimate nature of the context in which pain arises. Also, no study to date has examined attachment in relation to proximal variables affecting the pain experience or in a treatment setting. Therefore, the overarching goal of this thesis was to better understand how attachment affects couples’ adjustment to PVD. The first article of the thesis examined the longitudinal associations between attachment, pain self-efficacy and pain intensity in women and their partners. Two-hundred and thirteen couples completed self-report questionnaires on two occasions, spaced out over two years. Results showed that greater attachment anxiety predicted lower pain self-efficacy in women with PVD, which in turn predicted higher pain intensity two years later. Greater attachment avoidance in women with PVD also predicted higher pain intensity over two years. The second article tested the associations between attachment, partner responses to pain and relationship and sexual adjustment in 125 couples with PVD. Actor and partner effects were found between attachment insecurity and greater negative and fewer facilitative partner responses for both members of the couple, which in turn was associated with poorer relational and sexual wellbeing. The third article examined attachment and childhood maltreatment as moderators of treatment efficacy while comparing a first line medical treatment – topical lidocaine – to cognitive-behavioral couples therapy (CBCT) for PVD developed by our team. In a randomized clinical trial implicating 108 women with PVD, higher levels of attachment avoidance or childhood maltreatment were associated with poorer outcomes in CBCT compared to topical lidocaine on women’s sexual satisfaction and function at either post-treatment or 6-month follow-up. Implications of the results, along with theoretical, clinical, and methodological contributions of the thesis are discussed.

La vestibulodynie provoquée (VP) est la forme la plus répandue de douleur génito-pelvienne/trouble de la pénétration et la cause la plus fréquente de douleur vaginale chez les femmes pré-ménopausées. Les femmes qui en souffrent rapportent plus de détresse psychologique ainsi qu’un fonctionnement sexuel appauvri, une diminution de la fréquence des activités sexuelles et du plaisir, et plus d’attitudes négatives à l’égard de la sexualité. Les recherches portant sur les couples souffrant de VP ont montré le rôle prépondérant des variables relationnelles dans la modulation des conséquences sexuelles et psychologiques pour les femmes et leurs partenaires. Cependant, aucune analyse dyadique n’a été appliquée au facteur de risque étiologique le plus robuste, soit la maltraitance durant l’enfance. Par ailleurs, malgré des recommandations répétées pour inclure le partenaire dans le traitement psychologique pour la VP, aucune étude à ce jour n’a examiné l’efficacité d’une psychothérapie qui inclut systématiquement le partenaire et dont la cible est le couple. L’objectif général de cette thèse a été d’utiliser une perspective dyadique afin d’examiner les antécédents de maltraitance et l’efficacité d’une intervention conçue pour améliorer les issues des couples souffrant de VP. Le premier article vise à examiner les liens entre la maltraitance durant l’enfance des femmes souffrant de VP et leurs partenaires, et leur fonctionnement sexuel, leur ajustement psychologique, leur satisfaction conjugale et enfin avec la douleur rapportée par les femmes durant les relations sexuelles. Quarante-neuf couples souffrant de VP ont complété des questionnaires auto-rapportés. La maltraitance durant l’enfance chez les femmes était associée à un fonctionnement sexuel plus faible chez les femmes et les hommes, une augmentation de l’anxiété chez les femmes seulement, et une douleur affective accrue durant les relations sexuelles. La maltraitance durant l’enfance chez les hommes était associée à un fonctionnement sexuel plus faible, moins de satisfaction conjugale, plus d’anxiété chez les femmes et les hommes, et une douleur affective accrue durant les relations sexuelles rapportée par les femmes. En se basant sur les recommandations issues des études empiriques, une thérapie cognitive et comportementale pour les couples (TCCC) souffrant de VP a été développée. Le deuxième article présente les résultats d’une étude pilote testant son efficacité, fidélité et faisabilité potentielles. Neuf couples ont complété des questionnaires auto-rapportés pré- et post-traitement. La TCCC de 12 rencontres était manualisée. Les femmes ont rapporté une amélioration significative de la douleur, du fonctionnement et de la satisfaction sexuels, et les partenaires ont rapporté une amélioration significative de leur satisfaction sexuelle. Les couples ont rapporté des niveaux élevés de satisfaction quant à la psychothérapie, et les psychothérapeutes ont rapporté suivre le manuel de traitement de manière fidèle. Le troisième article, s’appuyant sur les résultats prometteurs de l’étude pilote, décrit le protocole de recherche pour un essai clinique randomisé mesurant l’efficacité de la TCCC comparée à une intervention médicale de première ligne, la lidocaïne topique, pour le traitement de la VP. Enfin, les implications cliniques et théoriques de la thèse sont discutées. / Provoked vestibulodynia (PVD), a chronic, recurrent pain elicited via pressure to the vulvar vestibule or attempted vaginal penetration, is the most common form of pain during intercourse (genito-pelvic pain/penetration disorder), and the most frequent cause of vulvar pain in pre-menopausal women. Because of its deleterious impact on sexuality, it carries a heavy psychosexual burden for afflicted women, who report impoverished sexual function, decreased sexual frequency and pleasure, and more negative attitudes about sex. Research among couples with PVD has demonstrated the prominent role of partner variables in the modulation of PVD-associated consequences for women, and the negative sexual and psychological consequences experienced by partners. Yet, a dyadic analysis has not been applied to the most robust etiological risk factor for adult-onset PVD, childhood trauma or maltreatment. Furthermore, despite repeated recommendations to include the partner in psychological treatment of PVD, no study to date has examined the effectiveness of a treatment that systematically includes the partner and targets the couple. The overarching goal of this thesis was to use a dyadic perspective in examining trauma antecedents of PVD and treatment effectiveness of an intervention designed to improve outcomes for couples with PVD. The first article aimed to examine associations between childhood maltreatment of both women with PVD and their partners and their sexual functioning, psychological adjustment and couple satisfaction, as well as women’s reported pain during sexual intercourse. Forty-nine couples with PVD completed self-report questionnaires. Women’s childhood maltreatment was associated with lower sexual functioning for women and men, increased anxiety for women only, and increased affective pain during sexual intercourse. Male partners’ childhood maltreatment was associated with lower sexual functioning, decreased couple satisfaction and increased anxiety for women and men, and higher affective pain reported by women during sexual intercourse. Drawing from the recommendations in the empirical literature, a Cognitive-Behavioural Couple Therapy (CBCT) for PVD was developed. The second article presents the results from its pilot testing for potential effectiveness, reliability and feasibility. Nine couples completed pre- and post-treatment self-report measures following the 12-session, manualized intervention. Women reported significant improvements in pain, sexual function and satisfaction, and partners reported significant improvements in sexual satisfaction. Exploratory analyses revealed improvements in anxiety, depression and pain-related cognitions, such as pain catastrophizing, for both women and partners. Couples reported high rates of treatment satisfaction and therapists reported good treatment reliability. The third article, building on the promising pilot study results, describes the research protocol for a randomized clinical trial to assess the efficacy of CBCT compared to a first-line medical intervention, topical lidocaine, for the treatment of PVD. In this ongoing trial, couples with PVD are randomized to one of the two treatment options. The clinical and theoretical implications of the thesis are discussed.