Scott, Naomi; (1999) A preliminary investigation into the experience of pain for women with unexplained vulvodynia. Doctoral thesis (D.Clin.Psy.), UCL (University College London).

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Abstract

Essential Vulvodynia is a genito-urinary condition characterised by vulval pain, psychological distress and associated sexual dysfunction. Various features of Essential Vulvodynia are shared in common with patients suffering from Chronic Pain syndrome: ongoing pain, lack of an apparent physical pathology, and resistance to traditional medical treatment. Research has demonstrated that patients with Essential Vulvodynia have considerable levels of distress (Stewart, Reicher and Gerulath, 1994), but it is unclear which factors in particular contribute to distress. The present study aims to substantiate the findings of psychological distress of Stewart et al (1994) among women with Essential Vulvodynia. This study also aims to deconstruct the experience of Essential Vulvodynia in order to identify the aspects of the condition likely to give rise to psychological distress. Patients with Essential Vulvodynia may experience distress for a number of reasons: a) lack of organic findings which leads to feeling disbelieved; b) the sensitive site of the pain; or c) the experience and consequences of having any persistent pain. The present study compares Essential Vulvodynia (V) and three other groups that differ on the above variables. Chronic Pain (CP) - persistent pain with no organic pathology; Rheumatoid Arthritis (RA) - persistent pain with organic pathology; and Gynaecological Problems (Gyn) - sensitive site but no pain. The groups are compared on depression, anxiety, pain beliefs, pain intensity, coping and quality of life. Differences between the groups emerged in the following way: The V group had less physical pain than the CP group; and were less limited in physical activities than the CP and RA groups. The V group also had stronger beliefs than the CP and RA groups about their pain signifying damage and harm; about a medical cure being the appropriate treatment for chronic pain; and about significant others responding attentively when one is in pain. The V group did not believe as strongly as the RA group in the appropriateness of medication. Further, the V group were more limited in their roles and activities due to physical causes than the Gyn group. The CP and V groups appeared to be similar on other measures of quality of life (e.g. social functioning and vitality); on anxiety and depression; beliefs (e.g. control); and use of active coping strategies. In light of the apparent similarity between Chronic Pain patients and Essential Vulvodynia patients, and the growing body of research indicating the efficacy of cognitive-behavioural pain management programmes for patients with chronic pain, it would seem likely that a similar approach to treatment may also be appropriate for patients with Essential Vulvodynia. Therefore, the second aim of this study was to evaluate the efficacy of a cognitive- behavioural pain management programme for a group of women with Essential Vulvodynia. As Cognitive Behaviour therapy is the treatment of choice for patients with chronic intractable pain, it seems feasible that this approach to treatment will also be effective for patients with Essential Vulvodynia. In this study, a pilot group of eleven women with Vulvodynia were assessed before and after an eight week treatment trial. The results suggest an increased use in coping strategies and a decrease in reported physical pain after treatment. However, other factors, such as depression, and anxiety remained unaffected. Findings are discussed with regards to future treatment for women with Essential Vulvodynia.

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