For years Alyssa Snow suffered from chronic, unexplained vulvar pain, and had tried a pharmacy of medical interventions before someone suggested she and her partner try cognitive behavioural therapy, a form of therapy that helps people develop alternative ways of thinking and behaving to reduce their psychological distress and better manage pain.
“I know when I first heard about it, I didn’t think it was necessarily a good way to try and treat pain,” says her partner, Nathan Barrett. “But in therapy, they taught us both many different techniques for her to try and control the pain.”
The therapy was part of a ground-breaking trial at the QEII Health Sciences Centre where women diagnosed with provoked vestibulodynia (PVD) were asked if they’d like to volunteer for a randomized trial. Vulvodynia is chronic and unexplained pain in and around the vulva; it’s called PVD when it only happens when “provoked” by something like inserting a tampon, having sex, or riding a bike. Half the women received a topical anaesthetic ointment and half participated in 12 weeks of couples therapy. The couples learn pain-management skills, and how to communicate about sex and accommodate the pain so as to increase their sexual satisfaction.
The study is being conducted at both the QEII and the Centre Hospitalier de l'Université de Montréal. In Halifax, the trial is headed by Dr. Natalie Rosen, a QEII psychologist and director of the Couples and Sexual Health Research Laboratory at Dalhousie University. “We can target pain management, interference with their sex life and their relationship — all through this multi-faceted intervention,” Dr. Rosen says.
For Alyssa, it gave her effective ways to think about pain. Even close family members ask about her sore “tummy,” as though there were something shameful about pain in your vagina compared to pain in another body part. “As much as sometimes I’ll just say I hate my vagina some days, it’s very tied to the female identity,” she says.
“If I gained one thing, as a woman, through this treatment, it was they let me know that I’m the expert of my own body. That was so empowering — the resilience that you learn,” she adds. “I felt it was such a relief to have something I could control.”
Alyssa plays rugby, works as a fitness instructor and plans to have children one day. PVD impacts all of that, but no other medical professional ever asked about anything non-physical. “This treatment addressed those parts of my life,” she says. “I couldn’t hold a job with this pain, or hold up social relationships, and school became difficult.”
Nathan learned more about her situation, and how men in his situation can fall into a persona that is either too comforting (and “baby” their partner) or too critical (and dismiss the experience of pain). He found the mindfulness exercises helpful for dealing with his own stresses, too.
“But it was mostly helpful for me because I knew Alyssa wasn’t in as bad a situation as she had been previously,” he says.
Dr. Rosen and her team say about eight per cent of women suffer from PVD. The burning, cutting pain can bring chaos to women’s lives. “Sex is happening with another person and the interferences that this pain is causing, the consequences aren’t just for the woman—they’re for her partner too, because they're part of that relationship,” she says. “It’s the first couple therapy treatment for vulvodynia in the world. That’s really exciting. There’s a lot of interest within the health-professional community.”
The trial will involve 120 couples, 60 of which will come through the QEII, and will analyze the results against the ointment-only approach to isolate the effects of each treatment. That could lead to publishing a therapy manual so the treatment could be rolled out across Canada. “Ideally, everyone is going to benefit.”
Alyssa and Nathan agree. For a long time, Alyssa found her only consistent pain reliever to be a plugged-in heat pad, but that ruled out activities that would take her away from the socket. “Dr. Rosen and her team finally addressed other parts of my life that pain was attached too,” Alyssa says. “I don’t want to be pitied or shamed. Pain is a sensation —if I can take care of it, that would be great. But it’s just a sensation.”
Recently, the couple celebrated their improved health with a camping trip. Alyssa left the heat pad at home.
