Bergeron Sophie, Khalifé Samir, Dupuis Marie-Josée, McDuff Pierre
Department of Psychology.
Department of Obstetrics and Gynecology.
J Consult Clin Psychol. 2016 Mar;84(3):259-68. doi: 10.1037/ccp0000072. Epub 2016 Jan 4.
This 13-week randomized clinical trial aimed to compare group cognitive-behavioral therapy (GCBT) and a topical steroid in the treatment of provoked vestibulodynia, the most common form of dyspareunia.
Participants were 97 women randomly assigned to 1 of 2 treatment conditions and assessed at pretreatment, posttreatment and 6-month follow-up via structured interviews and standard questionnaires pertaining to pain (McGill Pain Questionnaire, 11-point numerical rating scale of pain during intercourse), sexual function (Female Sexual Function Index, intercourse frequency), psychological adjustment (Pain Catastrophizing Scale, Painful Intercourse Self-Efficacy Scale), treatment satisfaction, and participant global ratings of improvements in pain and sexuality.
Intent-to-treat multilevel and covariance analyses showed that both groups reported statistically significant reductions in pain from baseline to posttreatment and 6-month follow-up, although the GCBT group showed significantly more pain reduction at 6-month follow-up on the McGill Pain Questionnaire. The 2 groups significantly improved on measures of psychological adjustment, and the GCBT group had significantly greater reductions in pain catastrophizing at posttreatment. Both groups' sexual function significantly improved from baseline to posttreatment and 6-month follow-up, and the GCBT group was doing significantly better at the 6-month follow-up. Treatment satisfaction was significantly higher in the GCBT group, as were self-reported improvements in pain and sexuality.
Findings suggest that GCBT may yield a positive impact on more dimensions of dyspareunia than a topical steroid, and support its recommendation as a first-line treatment for provoked vestibulodynia.
这项为期13周的随机临床试验旨在比较团体认知行为疗法（GCBT）和局部用类固醇治疗激发性前庭痛（性交困难最常见的形式）的效果。
97名女性参与者被随机分配到两种治疗条件中的一种，并在治疗前、治疗后和6个月随访时通过结构化访谈以及与疼痛（麦吉尔疼痛问卷、性交时疼痛的11点数字评分量表）、性功能（女性性功能指数、性交频率）、心理调适（疼痛灾难化量表、性交疼痛自我效能量表）、治疗满意度以及参与者对疼痛和性功能改善的总体评分相关的标准问卷进行评估。
意向性治疗的多水平和协方差分析表明，两组从基线到治疗后以及6个月随访时报告的疼痛均有统计学意义的显著减轻，尽管在6个月随访时，GCBT组在麦吉尔疼痛问卷上的疼痛减轻更为显著。两组在心理调适指标上均有显著改善，且GCBT组在治疗后疼痛灾难化的减轻更为显著。两组的性功能从基线到治疗后以及6个月随访时均有显著改善，且GCBT组在6个月随访时表现得明显更好。GCBT组的治疗满意度显著更高，自我报告的疼痛和性功能改善情况也是如此。
研究结果表明，与局部用类固醇相比，GCBT可能对性交困难的更多方面产生积极影响，并支持将其推荐为激发性前庭痛的一线治疗方法。
