title: Impact of a multidisciplinary vulvodynia program on sexual functioning and dyspareunia.
abstract: BACKGROUND
  For many years, multidisciplinary approaches, which integrate psychological, physical, and medical treatments, have been shown to be effective for the treatment of chronic pain. To date, there has been anecdotal support, but little empirical data, to justify the application of this multidisciplinary approach toward the treatment of chronic sexual pain secondary to provoked vestibulodynia (PVD).
  
  
  OBJECTIVE
  This study aimed to evaluate a 10-week hospital-based treatment (multidisciplinary vulvodynia program [MVP]) integrating psychological skills training, pelvic floor physiotherapy, and medical management on the primary outcomes of dyspareunia and sexual functioning, including distress.
  
  
  METHODS
  A total of 132 women with a diagnosis of PVD provided baseline data and agreed to participate in the MVP. Of this group, n = 116 (mean age 28.4 years, standard deviation 7.1) provided complete data at the post-MVP assessment, and 84 women had complete data through to the 3- to 4-month follow-up period.
  
  
  RESULTS
  There were high levels of avoidance of intimacy (38.1%) and activities that elicited sexual arousal (40.7%), with many women (50.4%) choosing to focus on their partner's sexual arousal and satisfaction at baseline. With treatment, over half the sample (53.8%) reported significant improvements in dyspareunia. Following the MVP, there were strong significant effects for the reduction in dyspareunia (P = 0.001) and sex-related distress (P < 0.001), and improvements in sexual arousal (P < 0.001) and overall sexual functioning (P = 0.001). More modest but still statistically significant were improvements in sexual desire, lubrication, orgasmic function, and sexual satisfaction. All improvements were retained at 2- to 3-month follow-up.
  
  
  CONCLUSIONS
  This study provides strong support for the efficacy of a multidisciplinary approach (psychological, pelvic floor physiotherapy, and medical management) for improving dyspareunia and all domains of sexual functioning among women with PVD. The study also highlights the benefits of incorporating sexual health education into general pain management strategies for this population.
authors.affiliation: Department of Gynaecology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Brotto
authors.forename: Paul
authors.initials: P
authors.lastname: Yong
authors.forename: Kelly B
authors.initials: KB
authors.lastname: Smith
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Sadownik
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D004414:Dyspareunia / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007989:Libido; D017773:Pelvic Floor / Q000503:physiopathology*; D010549:Personal Satisfaction; D026741:Physical Therapy Modalities; D015397:Program Evaluation; D012017:Referral and Consultation; D012736:Sex Education; D012747:Sexual Partners / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D056650:Vulvodynia / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*
keywords: Dyspareunia; Genital Pain; Multidisciplinary Treatment; Pelvic Floor Physiotherapy; Provoked Vestibulodynia; Psychological Therapy; Sex Therapy; Vulvar Vestibulitis Syndrome