Women with provoked vestibulodynia (PVD) feel pain whenever the vestibule area of their genitals – the place where the vulva and the vagina meet – is touched. This area is generally around the entrance to the vagina. PVD makes sex difficult for many women.
PVD can be difficult to treat. Some women need to try a variety of treatments before finding relief.
If a doctor knows the cause of PVD, treatment of that condition is usually the first step. For example, if a woman has an infection, treating that infection may reduce the pain.
Other possible treatments include:
• Pelvic floor physical therapy and vaginal dilators (plastic tampon-shaped tubes placed in the vagina to relax tense muscles)
• Pain medications (such as creams and gels that numb the area)
• Hormonal therapy
Some women with PVD need to have surgery. A vestibulectomy involves removing the vestibule, which in turn removes the nerves. After surgery, pelvic floor physical therapy is an important part of the recovery process.
Counseling or sex therapy can be another helpful option, especially if couples attend together. PVD has an effect on both members of a couple, not just the woman with PVD. While she experiences the pain, both partners can feel the disruption to intimacy and the emotional impact it can have on the relationship.
In 2014, the Journal of Sexual Medicine published the results of a pilot study involving 8 couples facing PVD. The couples attended weekly one-hour cognitive-behavioral couple therapy sessions for twelve weeks. During these sessions, couples learned more about PVD, discussed their sexual goals, and worked on communication strategies.
At the end of the treatment period, all of the couples reported improvements. Women felt less pain and both members of the couples felt more sexually satisfied. Depression and anxiety were also reduced.
Research published in the Journal of Sexual Medicine in 2016 also suggests that couple therapy may be helpful. The study involved 77 women with PVD. Scientists found that when patients had more positive thoughts about penetration, they had better sexual function and satisfaction.
The results suggest that women who expect penetration to be painful and unsuccessful may feel more anxious about intercourse and worried that they are disappointing their partner. The distress can lead to more pain and less satisfaction.
On the other hand, women who see penetration as a positive way to connect with their partner may be more likely to have a more pleasurable sexual experience.
The researchers added that better communication between partners can foster stronger relationships and greater sexual satisfaction. By discussing sex openly, partners can understand each other’s feelings and needs. They can learn to manage PVD together.
A qualified sex therapist or counselor can help women see penetration in a more positive way. Couples attending therapy can also develop better communication skills and learn to feel more comfortable discussing sex and PVD.