Predictors and Moderators of Provoked Vestibulodynia Treatment Outcome Following a Randomized Trial Comparing Cognitive-Behavioral Couple Therapy to Overnight Lidocaine.

Provoked vestibulodynia is a vulvar pain condition causing sexual dysfunction, affecting 8% to 10% of women. Our recently published randomized clinical trial (N = 108 couples) found that cognitive behavioral couple therapy (CBCT) and topical lidocaine reduced women's pain and associated sexual symptoms, with CBCT showing more benefits. Little is known about pretreatment predictors of treatment outcomes in couples sex therapy. In the current study, we examined women and their partners' pretreatment demographic (age, relationship length), clinical (pain duration, anxiety) and interpersonal (partner responses to pain, sexual goals) predictors/moderators of women's pain intensity, pain unpleasantness, and sexual function at posttreatment and 6-month follow-up. Longer relationship duration, lower anxiety in women, partner higher solicitousness and partner higher approach sexual goals predicted better pain outcomes for women with PVD irrespective of treatment condition. CBCT was more effective than lidocaine for improving women's sexual function at posttreatment when, at pretreatment, women had partners with higher anxiety and women reported lower approach sexual goals, whereas lidocaine was more effective for improving women's sexual function at follow-up when partners had higher approach sexual goals. Findings can assist clinicians in determining what treatment will be most beneficial for whom.

Sexual Cues Mediate the Daily Associations Between Interpersonal Goals, Pain, and Well-being in Couples Coping With Vulvodynia.

Background: Vulvodynia is an idiopathic vulvovaginal pain condition that has significant sexual and relational consequences. Most women with vulvodynia continue to have intercourse, possibly because of a desire to approach positive outcomes (e.g., intimacy) and avoid negative outcomes (e.g., partner disappointment). Purpose: This study examined daily associations between approach and avoidance sexual goals and women's pain during intercourse and couples' sexual and relational well-being, as well as the mediating role of sexual cues. Methods: Over 8 weeks, on sexual activity days (M = 8.77), women with vulvodynia (N = 101) and their partners reported their sexual goals, attention to sexual cues, sexual function, and relationship satisfaction, and women reported pain during intercourse. Results: On days when women and partners held higher approach goals, they attended more to positive sexual cues, and in turn, felt more relationally satisfied, whereas on days when they held higher avoidance sexual goals, partners were more focused on negative sexual cues, and in turn, partners reported lower relationship satisfaction. On days when women reported higher approach goals, they reported less pain, and both they and their partners attended more to positive sexual cues, and in turn, both had higher sexual function, whereas on days when women reported higher avoidance goals, both they and their partners attended more to negative sexual cues, and in turn, women reported greater pain, and both partners reported poorer sexual function. Conclusions: Interventions should target cognitive-affective processes during sexual activity as one pathway by which sexual goals impact pain and adjustment.

Daily associations between partner responses and sexual and relationship satisfaction in couples coping with provoked vestibulodynia.

INTRODUCTION: Women with provoked vestibulodynia (PVD) experience a recurrent vulvo-vaginal pain triggered primarily during sexual intercourse. Although affected couples report adverse effects on their sexual and global romantic relationships, few studies have examined interpersonal factors that may influence their sexual and relationship satisfaction. Cross-sectional studies have shown that greater partner solicitous and negative responses and lower facilitative responses are associated with poorer sexual and relationship satisfaction in women with PVD. AIM: The aim of this study was to investigate the within-person associations between partner responses to painful intercourse and the sexual and relationship satisfaction of affected couples. METHODS: In a dyadic daily experience study, 69 women (M(age) = 28.46, SD = 6.66) diagnosed with PVD and their cohabitating male partners (M(age) = 30.29, SD = 8.13) reported on male partner responses, as well as sexual and relationship satisfaction on sexual intercourse days (M = 6.81; SD = 5.40) over 8 weeks. MAIN OUTCOME MEASURES: Dependent measures were the (i) Kansas Marital Satisfaction Scale and (ii) Global Measure of Sexual Satisfaction Scale. RESULTS: On sexual intercourse days when women perceived more facilitative partner responses than usual and on days when they perceived lower negative partner responses than usual, they reported higher sexual and relationship satisfaction. On sexual intercourse days when men reported more solicitous responses than usual, both they and their female partners reported lower sexual satisfaction. CONCLUSIONS: Interventions aimed at improving the day-to-day sexual and relationship satisfaction of couples with PVD should target increasing facilitative and decreasing negative and solicitous partner responses.

Relationship satisfaction moderates the associations between male partner responses and depression in women with vulvodynia: a dyadic daily experience study.

Vulvodynia is a prevalent vulvovaginal pain condition that interferes with women's psychological health. Given the central role of sexuality and relationships in vulvodynia, relationship satisfaction may be an important moderator of daily partner responses to this pain and associated negative sequelae, such as depression. Sixty-nine women (M age=28.12 years, SD=6.68) with vulvodynia and their cohabiting partners (M age=29.67 years, SD=8.10) reported their daily relationship satisfaction, and male partner responses on sexual intercourse days (M=3.74, SD=2.47) over 8 weeks. Women also reported their depressive symptoms. Relationship satisfaction on the preceding day moderated the associations between partner responses and women's depressive symptoms in several significant ways: (1) On days after women reported higher relationship satisfaction than usual, their perception of greater facilitative male partner responses was associated with their decreased depression; (2) on days after women reported lower relationship satisfaction than usual, their perception of greater negative male partner responses was associated with their increased depression; (3) on days after men reported higher relationship satisfaction than usual, their self-reported higher negative responses were associated with decreased women's depression, and higher solicitous responses were associated with increased women's depression, whereas (4) on days after men reported lower relationship satisfaction than usual, their self-reported higher negative responses were related to increased women's depression, and higher solicitous responses were associated with decreased women's depression. Targeting partner responses and relationship satisfaction may enhance the quality of interventions aimed at reducing depression in women with vulvodynia.

Impact of male partner responses on sexual function in women with vulvodynia and their partners: a dyadic daily experience study.

OBJECTIVE: There is a paucity of research investigating the role of interpersonal variables in vulvodynia--a prevalent, chronic, vulvo-vaginal pain condition that negatively affects many aspects of women's sexual health, emotional well-being and intimate relationships. Cross-sectional studies have shown that male partner responses to painful intercourse are associated with pain and sexual satisfaction in women with vulvodynia. Partner responses can be solicitous (attention and sympathy), negative (hostility and frustration), and facilitative (encouragement of adaptive coping). No research has assessed the influence of daily partner responses in this population. Further, there is limited knowledge regarding the impact of partner responses on sexual function, which is a key measure of impairment in vulvodynia. METHODS: Using daily diaries, 66 women (M age = 27.91, SD = 5.94) diagnosed with vulvodynia and their cohabiting male partners (M age = 30.00, SD = 8.33) reported on male partner responses and sexual function on days when sexual intercourse occurred (M = 6.54, SD = 4.99). Drawing on the Actor-Partner Interdependence model (APIM), a multivariate multilevel modeling approach was adopted. RESULTS: A woman's sexual functioning improved on days when she perceived greater facilitative and lower solicitous and negative male partner responses, and when her male partner reported lower solicitous responses. A man's sexual functioning was poorer on days when he reported greater solicitous and negative responses. CONCLUSIONS: Findings suggest that facilitative male partner responses may improve sexual functioning whereas solicitous and negative responses may be detrimental. Partner responses should be targeted in psychological interventions aimed to improve the sexual functioning of affected couples.

Harmful or helpful: perceived solicitous and facilitative partner responses are differentially associated with pain and sexual satisfaction in women with provoked vestibulodynia.

INTRODUCTION: Provoked vestibulodynia (PVD) is a highly prevalent vulvovaginal pain condition that negatively affects women's emotional, sexual, and relationship well-being. Recent studies have investigated the role of interpersonal variables, including partner responses. AIM: We examined whether solicitous and facilitative partner responses were differentially associated with vulvovaginal pain and sexual satisfaction in women with PVD by examining each predictor while controlling for the other. METHODS: One hundred twenty-one women (M age = 30.60, SD = 10.53) with PVD or self-reported symptoms of PVD completed the solicitous subscale of the spouse response scale of the Multidimensional Pain Inventory, and the facilitative subscale of the Spouse Response Inventory. Participants also completed measures of pain, sexual function, sexual satisfaction, trait anxiety, and avoidance of pain and sexual behaviors (referred to as "avoidance"). MAIN OUTCOME MEASURES: Dependent measures were the (i) Pain Rating Index of the McGill Pain Questionnaire with reference to pain during vaginal intercourse and (ii) Global Measure of Sexual Satisfaction Scale. RESULTS: Controlling for trait anxiety and avoidance, higher solicitous partner responses were associated with higher vulvovaginal pain intensity (ß = 0.20, P = 0.03), and higher facilitative partner responses were associated with lower pain intensity (ß = -0.20, P = 0.04). Controlling for sexual function, trait anxiety, and avoidance, higher facilitative partner responses were associated with higher sexual satisfaction (ß = 0.15, P = 0.05). CONCLUSIONS: Findings suggest that facilitative partner responses may aid in alleviating vulvovaginal pain and improving sexual satisfaction, whereas solicitous partner responses may contribute to greater pain.