An initial proof of concept: A replicated single-case study of a CBT group treatment with partner involvement for vulvodynia

Figures & data

Figure 1. Flow chart of the recruitment process.

Table 1. Participant characteristics of the women at baseline.

	Age	Education	Relationship length (years)	Pain (years)	Previous treatment	TE	% sessions completed
1	19	High School	4	4	Gynecological	6	100%
2	37	Vocational	10	17	Physiotherapy	8	80%
3	34	University	2	1.5	Gynecological	7	87%
4	24	University	0.5	7	At midwife	7	93%
5	28	High School	8	10	At midwife	2	93%

TE = treatment expectancy (0–10).

Table 2. Overview of the treatment.

Week	Couple session	Group session	Themes	Exercise
1-2	1		Treatment expectations, rationale, and model	Hygiene tips and recommendations
3		1	Treatment expectations, rationale, and model	Formulation of individual treatment goals
4		2	Fear and muscle tension	Progressive relaxation “Looking at your vulva”
5		3	Introduction of stepwise exposure Anatomy of the pelvic floor Fear and pelvic floor muscle tension	Stepwise exposure Pelvic floor relaxation
6		4	Thoughts, feelings, and behavior	Stepwise exposure Cognitive strategies
7		5	Sexual arousal and pain	Stepwise exposure Sensate focus
8-9	2		Progress update and problem solving
10		6	Woman and partner responses to pain	Stepwise exposure Sensate focus (variation) Communication styles
12		7	Communication	Stepwise exposure Stepwise return of intercourse Communication about sex
14		8	Negotiation	Stepwise exposure Negotiation about wants and needs
16		9	Tools for the future	Stepwise exposure Maintenance plan
18		10	Evaluation of treatment	Evaluation form
19-22	3		Evaluation of treatment
+3 M		FU1	Follow-up on progress
+6 M	FU2		Follow-up on progress

FU1 = follow-up session one. FU2 = follow-up session two. M = months.

Figure 2. Individual graphs of repeated measures.

FU1=3-month follow-up, FU2=6-month follow-up.

Table 3. Repeated measures on pain when touching the entrance of the vagina (0–10) for each participant.

	Baseline M (SD)	Treatment M (SD)	Change in M	NAP	NAP CI 90%	Tau-U	TAU-U CI 90%
1	2 (1.46)	0 (0)	−2	0.07*	−1<>-0.42	−0.71*	−1<>-0.27
2	5 (0.53)	2 (1.79)	−3	0.10*	−1<>-0.36	−0.79*	−1<>-0.36
3	3 (1.09)	1 (1.12)	−2	0.09**	−1<>-0.42	−0.83**	−1<>-0.42
4	3 (0.85)	2 (0.66)	−1	0.27	−0.85<>-0.07	−0.45	−0.85<>-0.07
5	1 (1.23)	1 (0.83)	0	0.52	−0.35<>0.43	−0.11	−0.50<>0.28

M = mean. SD = standard deviation. NAP = nonoverlap of all pairs. Tau-U = percent of data showing improvement between phases. CI = confidence interval.

*p < .05; **p < .01; ***p < .001.

Table 4. Repeated measures on pain when partner inserts one finger into the vagina (0–10) for each participant.

	Baseline M (SD)	Treatment M (SD)	Change in M	NAP	NAP CI 90%	Tau-U	TAU-U CI 90%
1	3 (1.11)	1 (0.51)	−2	0.04***	−1<>-0.48	−0.79**	−1<>-0.36
2	6 (0.79)	3 (2.36)	−3	0.14**	−1<>-0.28	−0.62*	−1<>-0.18
3	7 (1.17)	4 (1.86)	−3	0.05***	−1<>-0.51	−0.91***	−1<>-0.51
4	1 (0.74)	1 (0.93)	0	0.43	−0.52<>0.26	−0.13	−0.52<>0.26
5	3 (0.97)	2 (1.03)	−1	0.48	−0.44<>0.34	−0.05	−0.44<>0.34

M = mean. SD = standard deviation. NAP = nonoverlap of all pairs. Tau-U = percent of data showing improvement between phases. CI = confidence interval.

*p < .05; **p < .01; ***p < .001.

Table 5. Repeated measures on pain when having (or attempting) intercourse with partner (0–10) for each participant.

	Baseline M (SD)	Treatment M (SD)	Change in M	NAP	NAP CI 90%	Tau-U	TAU-U CI 90%
1	6 (1.89)	4 (1.17)	−2	0.31	−0.82<>0.06	−0.23	−0.67<>0.21
2	6 (1.07)	3 (1.99)	−3	0.09**	−1<>-0.38	−0.83**	−1<>-0.38
3	9 (0.67)	9 (1.08)	0	0.58	−0.21<>0.60	−0.06	−0.31<>0.47
4	4 (0.99)	5 (1.33)	+1	0.72	0.05<>0.83	0.59*	0.20<>0.98
5	4 (1.48)	3 (1.11)	−1	0.33	−0.73<>0.05	−0.18	−0.57<>0.22

M = mean. SD = standard deviation. NAP = nonoverlap of all pairs. Tau-U = percent of data showing improvement between phases. CI = confidence interval.

*p < .05; **p < .01; ***p < .001.

Table 6. Descriptive statistics of pre-, post- and follow-up measurements of each participant.

	1	2	3*	4	5
Sexual function (FSFI)
Pre	21.4	21.1	3.5	23.9	16
Post	23.8	25.4	10	19.9	25.10
Follow-up 3 months	25.9	3.2	7	17.2	27.1
Follow-up 6 months	32	29.1	2	19.7	3.3
Change in %	+49%	+27%	−43%	−18%	− 79%
Pain Catastrophizing (VPCQ)
Pre	23	24	27	0	11
Post	2	1	18	17	14
Follow-up 3 months	3	2	0	6	8
Follow-up 6 months	1	1	11	17	6
Change in %	−97%	−96%	−59%	-	−45%
Avoidance behavior (CSPCS-A)
Pre	8	6	14	3	4
Post	5	4	5	6	5
Follow-up 3 months	5	4	4	8	3
Follow-up 6 months	4	6	5	4	2
Change in %	−50%	0%	−64%	+33%	−50%
Endurance behavior (CSPCS-E)
Pre	3	6	11	8	10
Post	2	4	2	5	5
Follow-up 3 months	2	5	2	8	5
Follow-up 6 months	2	3	2	11	4
Change in %	−33%	−50%	−81%	+36%	−60%

Change in % between pre-measure and 6-month follow-up; FSFI, Female Sexual Function Index (2–36); VPCQ, catastrophic and pain cognitions subscale from the Vaginal Penetration Cognitions Questionnaire (0–30); CSPCS-A and CSPCS-E, Avoidance and Endurance subscales from the CHAMP Sexual Pain Coping Scale (4–28). *=Participant 3 got pregnant between the post- and follow-up assessments.

Table 7. Self-reported improvement and treatment satisfaction.

	Pain during intercourse	Overall quality of sex life	Treatment satisfaction
1	Moderate improvement	Great improvement	10
2	Great improvement	Great improvement	9
3	Great improvement	Moderate improvement	10
4	Small improvement	Great improvement	6
5	Moderate improvement	Great improvement	9

Self-reported improvement rated between 0 and 5. Treatment satisfaction rated between 0 and 10.