Towards improved sexual health among women with provoked vestibulodynia: experiences from a somatocognitive therapy approach

Figures & data

Table 1. Overview of Somatocognitive therapy as it was conducted in the context of this study (table adapted and used with permission from Kaarbø et al. [30]).

Overview	Description
Brief name	Somatocognitive therapy (SCT)
What	SCT is a multimodal physiotherapy intervention designed to target the multiple dimensions of vulvar pain, utilising a biopsychosocial approach. A bodily approach is combined with a cognitive restructuring of negative thoughts. Overall, the aim is to improve body awareness to reduce vulvar pain and psychological distress and improve sexual function.
Materials: Participants	Resources: vulva.no
Materials: Physiotherapist	Equipment included a treatment bench, mat, pillows, massage balls, mirror, Pilates ball, and educational material.
Procedures	Initial appointment: Assess participant – take a thorough history (including previous experiences, beliefs, and expectations) and clinical examination (quality of movement, breathing pattern). The main areas of SCT include the following: Therapeutic alliance is an essential component of SCT; patient and therapist are in a close working relationship, agreeing on treatment goals and home assignments. Participants take an active part in the decision-making process about their own treatment and progression. The bodily approach: breathing patterns, maladaptive movement, and postural patterns are addressed in various positions (sitting, standing, walking, and in supine). Through manual techniques and touch, participants are taught various techniques to increase body awareness, improve relaxation, and reduce muscle tension. Education about PVD, chronic pain, stress, and healthy vulvo-vaginal and sexual behaviours. Coping with emotions and thoughts related to bodily experiences. Participants learn to become aware of negative/catastrophizing thoughts and learn how to restructure or accept these thoughts as well as how to overcome fear avoidance behaviour. An important aspect is the women’s ability to adapt and to self-manage their condition such as coping with pain and flare-ups. Structured homework promoting the application of learned techniques in daily situations. Gradual exposure to activities associated with pain, desensitisation exercises, and exercises to increase the pelvic floor and vulva awareness. Relaxation and breathing exercises. Last session – create a self-management toolbox with participant.
Who provided the treatment	Experienced female physiotherapist trained in SCT, the second author of the article.
How	Each session has a three-phased structure: (1) The conversation, (2) the bodily intervention/exploration, and (3) the home assignment.
Where	In a closed room with access to the gym, outpatient physiotherapy clinic, Oslo Metropolitan University, Norway. Home assignments performed by the participants integrated into ADL.
When and how much	The median number of sessions: 12 (min 7; max 15) face to face with a physiotherapist. Treatment period: minimum of 13 weeks and maximum of 22 weeks. Each session (including the initial session) lasted up to 60 min. The number of sessions required was personalised.
Tailoring	The treatment is personalised and tailored to the individual. The patient’s participation and collaboration are important. The treatment principles are the same for all but are adapted to suit the individual’s needs.

Table 2. Overview of the analytical process from codes to sub-themes and main themes.

Codes	Sub-themes	Main themes
Performing the body Negative feelings towards own body Using food and exercise to control the body vs. moving because it feels good Beginning to experience the body from the inside Beginning to inhabit the body with more comfort and confidence From self-critical to a more friendly and patient internal dialogue Avoidance and alienation of the vulva Developing more positive feelings towards the vulva Would have preferred a more hands-on treatment of the pelvic floor muscles	Beginning to shift from performing the body, towards inhabiting the body with comfort and confidence Beginning to relate to the body in more accepting and self-compassionate ways Outcast vulva: from avoidance to curiosity and acceptance	Developing positive feelings of embodiment
High-paced, high-stress lifestyles Not paying attention to or ignoring bodily and emotional needs Body as a fearful site Daring to be present with bodily feelings and sensations A movement from meeting internal cues with fearfulness, to more curiosity and calmness Contact is important to start a healing process Discovering and addressing unhelpful bodily habits Beginning to pay more attention to and prioritise own needs and wants A holistic approach feels meaningful, but can also be demanding/overwhelming	From bodily distance to purposely directing attention inwards From vague and intimidating, to understandable bodily signals Learning to trust, learn from, and be guided by internal cues	Developing a greater awareness of internal feelings and bodily states
Sex as duty, performance, and self-sacrificing care-work Difficulties with intimacy Beginning to assert personal boundaries (guided by internal cues) Disrupted connection to sexual desire and pleasure A new mindset around sexuality Exploring and reclaiming own sexual desire and pleasure A greater interest in own needs and wants	From sex as duty and performance, to mutual satisfaction and intimacy Developing a healthy curiosity towards own body and sexuality Taking ownership of own body and sexual health	Developing sex-positive beliefs and behaviours

Kaarbø MB, Danielsen KG, Haugstad GK, et al. Feasibility and acceptability of somatocognitive therapy in the management of women with provoked localized vestibulodynia-ProLoVe feasibility study. Pilot Feasibility Stud. 2022;8(1):68.

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