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Multidisciplinary Treatment for Provoked Vestibulodynia

Treatment Trajectories, Predictors, and Moderators of Sexual Distress and Pain

Smith, Kelly B., PhD*,†; Sadownik, Leslie A., MD*,†; Dargie, Emma, PhD; Albert, Arianne Y.K., PhD*,§; Brotto, Lori A., PhD*,§

doi: 10.1097/AJP.0000000000000682
Original Articles

Objectives: Multidisciplinary treatment programs for provoked vestibulodynia (PVD) are recommended, yet few have been evaluated. This study examined women’s symptom trajectories over time, as well as baseline demographic, psychosocial and pain characteristics as predictors/ moderators of sexual pain and distress following treatment at a clinic using multidisciplinary concurrent methods. We also examined the impact of baseline variables on the probability of having low sexual distress scores following treatment.

Materials and Methods: Women attending a multidisciplinary treatment program for PVD were invited to complete questionnaires before, following, and at 6 and 18 months after program completion. Questionnaires included the Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS), State-Trait Anxiety Inventory (STAI), Pain Catastrophizing Scale (PCS), Painful Intercourse Self-Efficacy Scale (PISES), and Pain Vigilance and Awareness Questionnaire (PVAQ). Linear mixed-effects models evaluated the FSDS and FSFI pain subscale as criterion variables, and the other baseline variables as predictors and moderators.

Results: Significant improvements in sexual distress and pain were observed over time. No significant moderators were identified, but higher baseline levels of FSFI desire and arousal predicted greater improvements in sexual distress. Similarly, higher baseline levels of desire predicted greater improvements in pain. Among women distressed at baseline and with 6 month FSDS scores, 25% (n=35) were no longer sexually distressed at 6 months; higher baseline levels of desire were associated with greater probability of having low sexual distress at 6 months.

Discussion: Although global improvements were observed, women with poorer baseline sexual functioning were less likely to improve after multidisciplinary treatment.

*Department of Obstetrics & Gynaecology, University of British Columbia

BC Centre for Vulvar Health

§Women’s Health Research Institute, Vancouver, BC

Private Practice, Ottawa, ON, Canada

Supported by an Innovation and Translational Research Award from the Vancouver Coastal Health Research Institute (VCHRI), Vancouver, British Columbia, Canada awarded to L.A.B. Funding for the Multidisciplinary Vulvodynia Program was provided by a donation from the Mrs Leslie Diamond Foundation. A portion of K.B.S. salary during the time of this research was paid by the VCHRI award indicated above. K.B.S. has also been directly employed as a therapist and Interim Director for the Multidisciplinary Vulvodynia Program. In addition, the Women’s Health Research Institute, Vancouver, British Columbia, Canada received salary recovery payment for the statistical services A.Y.K.A. provided on this study, with the payment provided from the VCHRI award indicated above. The remaining authors declare no conflict of interest.

Reprints: Lori A. Brotto, PhD, Gordon & Leslie Diamond Health Care Centre, 2775 Laurel Street, 6th Floor, Vancouver, BC, Canada V5Z 1M9 (e-mail:

Received May 7, 2018

Received in revised form December 1, 2018

Accepted December 6, 2018

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