(Press-News.org) 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 under "genito-pelvic pain or penetration disorder." However, this type of pain is not purely psychological.
Provoked vestibulodynia is a condition experienced by approximately 8% of women in North America. It is characterized by severe pain at the vaginal opening during sexual intercourse or when inserting tampons. To reduce the burning sensation, many women apply lidocaine, an anesthetic cream.
A new study of 108 couples found cognitive-behavioural therapy (CBT) for couples to be more effective than lidocaine. The study was conducted by Sophie Bergeron, professor in the Psychology Department in the Faculty of Arts and Science at Université de Montréal, director of the UdeM Sexual Health Laboratory and holder of the Canada Research Chair in Intimate Relationships and Sexual Wellbeing, and Natalie O. Rosen of Dalhousie University. Marc Steben and Marie-Hélène Mayrand of Université de Montréal, Marie-Pier Vaillancourt-Morel of 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 the Journal of Consulting and Clinical Psychology.
Unclear causation
The causes of provoked vestibulodynia have yet to be determined. There is a lengthy list of risk factors, including biomedical factors such as repeated infections causing inflammation in the vulvar area (cystitis, vaginal infections), the use of certain oral contraceptives, genetic predisposition, marital factors, and depression and anxiety. Abnormalities in the pelvic floor muscles are also associated with provoked vestibulodynia, but it is not known whether they are a consequence of the pain or its cause. Similarly, it is unclear whether anxiety is a cause or a result, but it has been found that the higher the level of anxiety, the greater the pain.
"Psychological intervention is recommended because once pain sets in, it has such a negative impact on sexuality and on the relationship that it becomes very important to break the vicious cycle of fear and avoidance," says Sophie Bergeron. "The pain often leads to loss of desire in women and frustration in both partners. This is a real problem; it's not imaginary."
Few validated treatments
Couple therapy is commonly offered by psychologists and sexologists. In the case of provoked vestibulodynia, the partner plays a critical role and can help alleviate the problem or aggravate it. It is therefore every important to include the partner in the intervention. However, some interventions were not previously supported by evidence.
Now for the first time, a randomized clinical trial has compared the efficacy of couple CBT and lidocaine.
Therapy was found to be more effective than lidocaine application in reducing women's fear of pain, sexual distress and alarm, and in improving 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
The 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 defusion, a technique that creates a psychological distance between the person and his or her thoughts. At the beginning of the therapy, the women define themselves by their genito-pelvic pain. The therapy helps them reduce the hold those thoughts have over them. We also try to break the sexuality = pain association and replace it with new associations, such as sexuality = pleasure with my partner, intimacy with my partner."
The therapy also looks at sexual motivations. What is it about sexuality that is important to the couple? "We try to explore other aspects of sexuality that are pleasurable," she says. "In terms of behaviour, we can help them expand their repertoire of sexual activities that don't cause pain. Generally, it's vaginal penetration that's painful, so we try not to always focus on that."
Finally, the therapy works on the couple's emotional regulation. "When one partner 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 partner to be more empathetic to the woman's experience of pain and the woman to be more empathetic to her partner's frustration. We help them see themselves as a united team."
The importance of the partner in therapy
According to Sophie Bergeron, the partner's involvement "helps alleviate the woman's pain because she is no longer alone with her pain." Both partners report they understand the problem and the other's experience better, and they are relieved to be able to work together to improve the situation.
At the end of the therapy, couples report satisfaction with having reclaimed their sexuality in a non-threatening way by refocusing on pleasurable experiences rather than allowing the pain to take control. This treatment could well be effective for other types of genito-pelvic pain as well.
INFORMATION:
Boston, MA-- How does the switch to a high-deductible health plan affect children with asthma? A new study led by researchers at the Harvard Pilgrim Health Care Institute suggests that enrollment in a high-deductible health plan (HDHP) may not be associated with changes in asthma medication use or asthma exacerbations when medications are exempt from the deductible. The findings were published in JAMA Pediatrics on May 10.
To treat asthma, clinical guidelines recommend the use of controller medications, but adherence to these medications is generally suboptimal, putting those affected at risk for asthma exacerbations. High out-of-pocket costs have been associated with decreased controller medication use and adverse asthma outcomes for children and adults. ...
The energy available from sunlight is 10,000 times more than what is needed to supply the world's energy demands. Sunlight has two main properties that are useful in the design of renewable energy systems. The first is the amount power falling on a fixed area, like the ground or a person's roof. This quantity varies with the time of day and the season. The second property is the colors or spectrum of the sunlight.
One way to capture solar energy is to use solar cells that directly turn sunlight into electricity. In a solar module like those that people place on their roof, many cells are assembled on a rigid panel, connected to one another, sealed, and covered ...
New research from the Clemson University Center for Human Genetics has identified specific cell clusters in the brain of the common fruit fly affected by acute cocaine exposure, potentially laying the groundwork for the development of drugs to treat or prevent addiction in humans.
While cocaine's neurological effects are well known, the underlying genetic sensitivity to the drug's effects is not. In human populations, susceptibility to the effects of cocaine varies due to both environmental and genetic factors, making it challenging to study. Approximately 70 percent of genes in the fruit fly, Drosophila melanogaster, have human counterparts, providing researchers with a comparable model when studying ...
BOSTON -- A multidisciplinary team from MassGeneral Hospital for Children (MGHfC), Brigham and Women's Hospital and other institutions have identified the mechanism of how an extremely rare but serious post-COVID-19 complication develops in children and adolescents. Led by MGHfC pediatric pulmonologist Lael Yonker, MD, researchers determined that viral particles remaining in the gut long after an initial COVID-19 infection can travel into the bloodstream, instigating the condition called Multisystem Inflammatory Syndrome in Children (MIS-C).
The syndrome can occur several weeks after an initial infection; symptoms include high fever, abdominal pain, vomiting, diarrhea, rash and extreme fatigue. The hyperinflammatory ...
A novel compound similar in structure to the psychedelic drug ibogaine, but lacking its toxic and hallucinogenic effects, has been found to rapidly reverse the effects of stress in mice.
Researchers found that a single dose of tabernanthalog (TBG) can correct stress-induced behavioral deficits, including anxiety and cognitive inflexibility, and also promotes the regrowth of neuronal connections and restores neural circuits in the brain that are disrupted by stress. The study was published May 25 in Molecular Psychiatry.
"It was very surprising that a single treatment with a low dose had such dramatic effects within a day," said corresponding author ...
Invasive alien plants are plant species that grow in an environment outside their native habitat. If they successfully establish self-sustaining populations in these new environments - an event called "naturalization" - they can have considerable negative impacts on local ecosystems, economies, and societies. But not all alien plant species are equally effective in invading new habitats. Therefore, an international team of scientists, headed by Konstanz-based biologist Professor Mark van Kleunen, investigated different types of "invasiveness" and possible factors that determine invasion success of alien plants in Europe.
The new study, published in PNAS, describes ...
Osaka, Japan - Chronic inflammation of the pancreas is a debilitating disease with poorly understood causative factors. Now, researchers at Osaka University have identified the disturbed molecular pathways and revealed the underlying mechanisms that may inform an effective and much-needed therapeutic strategy.
The pancreas is an important organ with a dual role in digestion and the production of various hormones including insulin and glucagon that fine-tune blood sugar levels.
Chronic pancreatitis (CP) is characterized by inflammation of the gland ...
In the latest National Autism Indicators Report, researchers from Drexel University's A.J. Drexel Autism Institute examined surveys of family members of autistic adults who use Developmental Disability services, and found needs for additional supports like respite care and assistance to plan for crisis and emergencies, especially among families whose adult lived with them.
Data from the surveys showed over one quarter of families with autistic adults who use Developmental Disability services and live with family do not have enough services or supports for themselves, according to the report. And over half of these ...
LA JOLLA--In a new paper, scientists from La Jolla Institute for Immunology (LJI) bring together research findings from COVID-19 researchers around the world. The results are striking: human T cells can target more than 1,400 sites on the SARS-CoV-2 virus.
"Our lab and many others have shown this very broad and diverse T cell response," says LJI Research Assistant Professor Daniela Weiskopf, Ph.D., co-author of the Cell Host & Microbe review.
This kind of research review, called a "meta-analysis," pools the results of multiple studies, and the researchers give close consideration to how the studies were conducted.
In the case of COVID-19, a global meta-analysis of T cell response studies is especially helpful because different patient populations ...
An in vitro study conducted by a group of researchers at São Paulo State University (UNESP) in Araraquara, Brazil, shows how fungi and bacteria can activate genes associated with head and neck tumors, as the metabolism of biofilms (communities in which these microorganisms self-organize in a structured and coordinated manner) stimulate tumor cells by favoring the cell signaling pathways required for tumor development and resistance to treatment. The findings include entirely novel information on the links between microbial biofilms and cell behavior in head and neck cancer.
The researchers discovered that metabolites secreted by biofilms, termed the secretome, can modulate the expression of proto-oncogenes and cell cycle genes associated with tumor cell growth and survival. Their analysis ...
