SAN DIEGO – Women with vulvodynia who received one counseling session with a licensed social worker after their diagnosis reported increased knowledge about their condition and less impact of vulvar symptoms on their lives, compared with women who did not receive the session, results from a pilot study showed.
"Several studies have shown a positive effect of individual and group psychosocial therapy programs in women with vulvodynia," a chronic pain syndrome affecting the vulvar area, Dr. Molly B. Moravek said at the annual meeting of the American College of Obstetricians and Gynecologists.
Dr. Molly B. Moravek
"However, this sort of long-term therapy is not feasible for all women due to time or financial constraints. No studies to date have investigated whether benefit can be derived from a single counseling session performed at the time of diagnosis," she noted.
Reported psychosocial effects from vulvodynia, a condition thought to affect 6%-15% of women seeking gynecologic care, include increased depression, anxiety, emotional distress, irritability, anger, perfectionistic traits, fear of negative evaluation, preoccupation with symptoms, somatization, and catastrophization. "Causation [of vulvodynia] is not known, but theories include neurological, physiological, and psychological etiologies," said Dr. Moravek of the department of obstetrics and gynecology at the University of Michigan Hospitals and Health System, Ann Arbor, who conducted the study along with colleagues in the university’s department of family medicine.
The aims of the current study were to determine the effect of a single session of a psychosexual counseling intervention compared with medical treatment alone on illness perceptions and coping mechanisms among women with vulvodynia, and to assess alterations in sexual function and pain perception after a single session of a psychosocial intervention.
Over a 4-month period, the researchers recruited 31 women from a specialty clinic dedicated to the treatment of vulvar diseases. All study participants were newly diagnosed with vulvodynia and were randomly assigned to receive either a 30- to 45-minute counseling session plus written educational materials or written materials alone (control group).
All patients were asked to complete a survey prior to randomization and at 6 weeks, including basic demographic information, the Female Sexual Function Index (FSFI), the Brief Illness Perception Questionnaire (BIPQ), and questions about knowledge of sexual and vulvar health.
The counseling session intervention was led by a licensed social worker who is certified in sex therapy and was tailored to the particulars of each patient’s psychosocial and medical situation. "The primary aims of the session were to increase knowledge about, and confidence in ability to deal with, vulvodynia; address common psychological effects from vulvodynia; and discuss sexual strategies for women who were having pain with intercourse," Dr. Moravek explained.
The mean age of the 31 women was 39 years; 16 received the intervention and 15 did not. At the 6-week follow-up, women in the intervention group trended toward increased sexual function in each of the six domains of the FSFI (desire, arousal, lubrication, orgasm, satisfaction, and pain), "whereas the controls showed more mixed results, and some even trended toward decreased function at the 6-week follow-up," she said. However, the mean total FSFI significantly favored the intervention group, with a P value of .02.
On the BIPQ, women in both groups reported an increased sense of control over their vulvodynia symptoms that reached statistical significance (P = .007 in controls and P = .006 in the intervention group). However, only women in the intervention group reported statistically significant improvements in their understanding of their illness (P = .011), the impact vulvodynia had on their lives (P = .009), how long they thought their symptoms would continue (P = .04), their concern over their symptoms (P = .003), and the emotional effect of their symptoms (P = .004). Additionally, only women in the intervention group scored significantly better on their self-perceived knowledge of vulvar health (P = .003) and sexual health (P = .025) at the 6-week follow-up.
Although the study is limited by its sample size, "we believe that it justifies a larger study examining the role of a single-session psychosocial intervention for patients with vulvodynia," Dr. Moravek said. "Future studies should also investigate different therapy modalities and durations, and the best way to incorporate a psychosocial intervention into the patient’s medical care."
The study was supported by the Ansbacher Fund for Resident/Fellow Education and Research at the University of Michigan. Dr. Moravek said that she had no relevant financial disclosures.