Clinical Psychology and Personality

Clinical Psychology and Personality

Couple-based Cognitive Behavioral Therapy Program for Vaginismus: Introduction and the Feasibility from the perspectives of the Experts, the Therapists, and the Patients

Document Type : Original Article

Authors
1 Ph.D. Graduated in Clinical Psychology, Department of Psychology, Faculty of Humanities, Shahed University, Tehran, Iran
2 Professor of Clinical Psychology, Department of Psychology, Faculty of Humanities, Shahed University, Tehran, Iran
3 Associate Professor of Clinical Psychology, Department of Psychology, Faculty of Humanities, Shahed University, Tehran, Iran
Abstract
Introduction: Genito-pelvic pain disorder is one of the sexual dysfunctions associated with penetration that reduces the couple's sexual performance and satisfaction, required to psychological interventions and therapeutic programs have been designed to recover it. The present study aimed to determine the feasibility of a developed couple-based cognitive behavioral therapy program in reducing pain and fear, increasing sexual performance and satisfaction in women with vaginismus and their partners.
Method: The present study was conducted in the first stage following a Delphi design and the second stage in a single-case design. Thus, 7 experts completed a feasibility questionnaire by reading the detailed protocol summary before starting the therapy sessions. In addition, the protocol therapist evaluated the protocol in terms of feasibility criteria at the end of each session, and each of the 6 people (3 couples) under treatment also presented their views on the feasibility criteria of this protocol at the end of the treatment.
Results: The experts evaluated the feasibility of the program from the dimensions of the appropriate situation and necessity. Experts considered the feasibility of the program “much” in the areas of acceptability, practicality, adaptation, and expansion, and “moderate” feasible in the areas of demand, ​​implementation, and integration, which means it required a more detailed evaluation. In the second stage performed during the course of developed couple-based cognitive behavioral therapy program, the therapist evaluated the feasibility of the program “much” in the areas of acceptability, demand, practicality, and adaptation, and “moderate” in the implementation. Patients described the feasibility of the program as “much” in the components implementation, and practicality, and “moderate” in the acceptability.
Discussion and conclusion: The developed cognitive-behavioral therapy program based on couple participation has indicated relatively appropriate feasibility according to the opinions of experts, patients, and therapist.
Keywords

1-    American Psychiatric Association. Diagnostic Statistical Manual of Mental Disorders fifth edition (DSM-5).  Washington DC: APA; 2013. doi:10.1176/appi.books.9780890425596
2-    American Psychiatric Association. Diagnostic Statistical Manual of Mental Disorders Fifth Edition – Text Revision (DSM-5-TR).  Washington DC: APA; 2022.
3-    Banaei M, Kariman N, Ozgoli G, Nasiri M, Khiabani A. Sexual penetration cognitions in women with genito-pelvic pain and penetration disorder: a systematic review and meta-analysis. Sexual and Relationship Therapy. 2023; 38(4): 638-52. doi:10.1080/14681994.2021.1894327
4-    Lopez-Brull A, Perez-Dominguez B, Blasco-Ortiz C, Morales-Baixauli M, Nahon I, Casaña-Granell J. Assessing Sexual Functioning with the Female Sexual Function Index in Women Suffering from Genito-Pelvic Pain Penetration Disorder Undergoing a Therapeutic Educational Program. Am J of Sex Educ. 2024; 19(3): 337-46. doi:10.1080/15546128.2023.2243809
5-    Alizadeh A, Farnam F. Coping with dyspareunia, the importance of inter and intrapersonal context on women’s sexual distress: a population-based study. Reproductive Health. 2021; 18:1-11.
6-    Ter Kuile MM, Weijenborg P. A woman who never could have coitus: treatment of lifelong vaginismus. Bio-Psycho-Social Obstetrics and Gynecology: A Competency-Oriented Approach. 2017; 297-309.
7-    Pithavadian R, Chalmers J, Dune T. The experiences of women seeking help for vaginismus and its impact on their sense of self: An integrative review. Women's Health. 2023; 19: 17455057231199383.
8-    Kurban D, Eserdag S, Yakut E, Mishra PC. The treatment analysis of the patients suffering from vaginismus and the correlation with the psychological issues. International journal of reproduction, contraception, obstetrics and gynecology. 2021; 10(4): 1328-36.
9-    Charbonneau-Lefebvre V, Rosen NO, Bosisio M, Vaillancourt-Morel M-P, Bergeron S. An attachment perspective on partner responses to genito-pelvic pain and their associations with relationship and sexual outcomes. The Journal of Sex Research. 2021; 58(2): 235-47. doi:10.1080/00224499.2020.1761936
10- Maseroli E, Scavello I, Rastrelli G, Limoncin E, Cipriani S, Corona G, et al. Outcome of medical and psychosexual interventions for vaginismus: a systematic review and meta-analysis. The journal of sexual medicine. 2018; 15(12): 1752-64.
11- Turk D. A cognitive-behavioral perspective on the treatment of individuals experiencing chronic pain. C Turk Dennis‌, J Gatchel, Robert (Eds), Psychological Approaches to Pain Management: a practitioner’s handbook. 2018: 115-37.
12- Işık C, Aslan E. The effects of sexual counseling and pelvic floor relaxation on sexual functions in women receiving vaginismus treatment: a randomized controlled study. International Urogynecology Journal. 2023; 34(3): 683-92.
13- Ergani SY. Evaluation of Sexual Function and Satisfaction Before and After Therapy in Couples Who Applied With The Diagnosis of Vaginismus. ACH Medical Journal. 2023; 2(3): 146-51. doi:10.5505/achmedj.2023.46855
14- Bergeron S, Pâquet M, Steben M, Rosen NO. Perceived partner responsiveness is associated with sexual well-being in couples with genito-pelvic pain. Journal of Family Psychology. 2021; 35(5): 628. doi:10.1037/fam0000829
15- CorsiniMunt S, Bergeron S, Rosen NO, Mayrand MH, Delisle I. Feasibility and preliminary effectiveness of a novel cognitive–behavioral couple therapy for provoked vestibulodynia: a pilot study. The journal of sexual medicine.2014; 11(10): 2515-27.
16- Ter Kuile MM, Melles R, de Groot HE, Tuijnman-Raasveld CC, van Lankveld JJ. Therapist-aided exposure for women with lifelong vaginismus: a randomized waiting-list control trial of efficacy. Journal of consulting and clinical psychology. 2013 Dec; 81(6): 1127.
17- Mohammadi A. The Effect of Cognitive behavioral Therapy on Anxiety, Sexual Function Improvement, and Merital Satisfaction in the Patients with Vaginismus [master’s thesis]. Payam e Noor University; 2012.
18- Edalatian, R. The Effectiveness of Cognitive Behavioral Therapy on the Improvement of Vaginism Disorder and Sexual Satisfaction [master’s thesis]. Tabriz University; 2012.
19- Hamid N, Dehghani-Zadeh Z, Firoozi AA. The Effect of Cognitive Behavior Therapy on the Sexual Function of Women with Vaginism Disorder. The Iranian of Journal of Obstetrics. Gynecology and Infertility. 2012; 20 (15): 1 -11. doi:10.22038/ijogi.2012.6151 [In Persian]
20- Tadayyon M, Rezaei A, Mollaei-Nezhad M, Shirali K. The Effectiveness of Cognitive Behavioral Therapy on the Terrifying Thoughts of Women with Primary Vaginismus: A Single-Case Trial. Journal of Obstetrics. Gynecology and Infertility. 2016; 19 (39): 25-34.
21- Bergeron S, Pâquet M, Steben M, Rosen NO. Perceived partner responsiveness is sexual well-being in couples with genito-pelvic pain. Journal of family psychology. 2021; 35(5):628-638.
22- Bokaie M, & Bostani Khalesi Z. Couple therapy and vaginismus: a single case approach. Journal of sex & marital therapy. 2019; 45(8): 667-672. doi:10.1080/0092623X.2019.1610126
23- Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, et al. How we design feasibility studies. American journal of preventive medicine. 2009; 36(5): 452-457.
24- O’Cathain A, Hoddinott P, Lewin S, Thomas KJ, Young B, Adamson J, ... et al. Maximising the impact of qualitative research in feasibility studies for randomised controlled trials: guidance for researchers. Pilot and feasibility studies. 2015; 1(1): 1-13. doi:10.1186/s40814-015-0026-y
25- Pashaei‌zad H. A Glance to Delphi Method. Peyke Noor Journal. 2008; 6(1): 64-79.
26- Rahmani A, Vaziri Nezhad R, Ahmadi Nia H, Rezaeian M. Methodological Principles and Applications of the Delphi Method: A Narrative Review. JRUMS. 2020; 19 (5)‌: 515-538.
27- Tongco MDC. Purposive sampling as a tool for informant selection. Ethnobotany Journal. 2007; 5: 147-158. doi:10.17348/era.5.0.147-158
28- Zarghami F. Efficacy and feasibility of the Unified Protocol of emotional disorders (UP) in 8-11 years old Iranian children with anxiety disorders and comorbid depressive symptoms. [Ph.D. Thesis] in Clinical Psychology, Shahed University. 2019.
29- Lawshe CH. A quantitative approach to content validity. Personnel psychology. 1975; 28: 563–575. doi:10.1111/j.1744-6570.1975.tb01393.x
30- Wilson F‌R, Pan W, Schumsky DA. Recalculation of the critical values for Lawshe’s content validity ratio.  J Measurement evaluation in counseling development. 2012; 45(3): 197-210. doi:10.1177/0748175612440286
31- Hyrkäs K, Appelqvist-Schmidlechner K, Oksa L. Validating an instrument for clinical supervision using an expert panel. International Journal of Nursing Studies. 2003; 40(6): 619-625.
32- CorsiniMunt S, Bergeron S, Rosen N. O, Mayrand M. H, Delisle I. Feasibility and preliminary effectiveness of a novel cognitive–behavioral couple therapy for provoked vestibulodynia: a pilot study. The journal of sexual medicine, 2014; 11(10): 2515-2527.