Pain characteristics, fear-avoidance variables, and pelvic floor function as predictors of treatment response to physical therapy in women with provoked vestibulodynia
Abstract
OBJECTIVE: The aim was to investigate whether pretreatment pain characteristics, psychological variables, and pelvic floor muscle (PFM) function predict the response to physical therapy (PT) in women with provoked vestibulodynia (PVD). MATERIALS AND METHODS: One hundred-five women diagnosed with PVD underwent 10 weekly sessions of individual PT comprising education, PFM exercises with biofeedback, manual therapy, and dilators. Treatment outcomes were evaluated at pretreatment, post-treatment, and 6-month follow-up and included pain intensity (numerical rating scale 0 to 10) and sexual function (Female Sexual Function Scale). Multilevel analyses were used to examine the potential predictors of response over time including pain characteristics (PVD subtype, pain duration), psychological variables (fear of pain, pain catastrophizing), and PFM function assessed with a dynamometric speculum (tone, flexibility, and strength). RESULTS: PVD subtype and PFM tone were significant predictors of greater treatment response for pain intensity reduction. Secondary PVD (ie, pain developed after a period of pain-free intercourse) and lower PFM tone at baseline were both associated with greater reduction in pain intensity after PT and at follow-up. Among the psychological variables, fear of pain was the only significant predictor of better treatment response when assessed through improvement in sexual function, where higher fear of pain at baseline was associated with greater improvement after PT. DISCUSSION: This study identified PVD secondary subtype, lower PFM tone, and higher fear of pain as significant predictors of better treatment response to PT in women with PVD.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Fear of pain is associated with changes in sexual function after a physiotherapeutic intervention.
“Vulvodynia type (secondary vulvodynia) and lower pelvic floor tone before the intervention were associated with pain reduction, whereas fear of pain was associated with changes in sexual function after a physiotherapeutic intervention. 22”
From Internet-based treatment for provoked vulvodynia: Factors associated with treatment outcomes (2025) · cites this paper as [22]
Vulvodynia type (secondary vulvodynia) and lower pelvic floor tone before the intervention are associated with pain reduction after a physiotherapeutic intervention.
“Vulvodynia type (secondary vulvodynia) and lower pelvic floor tone before the intervention were associated with pain reduction, whereas fear of pain was associated with changes in sexual function after a physiotherapeutic intervention. 22”
From Internet-based treatment for provoked vulvodynia: Factors associated with treatment outcomes (2025) · cites this paper as [22]
Cites
The Pain Catastrophizing Scale: Development and validation.
Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995) · Psychological Assessment · doi:10.1037//1040-3590.7.4.524 · Cited by 8,227 · see citing works
Rosen, C. B. (2000) · Journal of Sex & Marital Therapy · doi:10.1080/009262300278597 · Cited by 6,593 · see citing works
Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art.
Vlaeyen, J. W. S., & Linton, S. J. (2000) · Pain · doi:10.1016/s0304-3959(99)00242-0 · Cited by 4,931 · see citing works
Core outcome measures for chronic pain clinical trials: IMMPACT recommendations
Dworkin, R. H., Turk, D. C., Farrar, J. T., Haythornthwaite, J. A., Jensen, M. P., Katz, N. P., Kerns, R. D., Stucki, G., Allen, R. R., Bellamy, N., et al. (2005) · Pain · doi:10.1016/j.pain.2004.09.012 · Cited by 3,732 · see citing works
The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence
Leeuw, M., Goossens, M. E. J. B., Linton, S. J., Crombez, G., Boersma, K., & Vlaeyen, J. W. S. (2007) · Journal of Behavioral Medicine · doi:10.1007/s10865-006-9085-0 · Cited by 2,261 · see citing works
Validity of four pain intensity rating scales
Ferreira-Valente, M. A., Pais-Ribeiro, J. L., & Jensen, M. P. (2011) · Pain · doi:10.1016/j.pain.2011.07.005 · Cited by 1,872 · see citing works
A short version of the Pain Anxiety Symptoms Scale (PASS-20): Preliminary development and validity
McCracken, L. M., & Dhingra, L. (2002) · Pain Research and Management · doi:10.1155/2002/517163 · Cited by 644 · see citing works
Harlow, B. L., Kunitz, C. G., Nguyen, R. H. N., Rydell, S. A., Turner, R. M., & MacLehose, R. F. (2014) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2013.09.033 · Cited by 322 · see citing works
Haefner, H. K., Collins, M. E., Davis, G. D., Edwards, L., Foster, D. C., Hartmann, E., Kaufman, R. H., Lynch, P., Margesson, L. J., Moyal‐Barracco, M., et al. (2005) · Journal of Lower Genital Tract Disease · doi:10.1097/00128360-200501000-00009 · Cited by 321 · see citing works
Vulvodynia: definition, prevalence, impact, and pathophysiological factors
Pukall, C. F., Goldstein, A. T., Bergeron, S., Foster, D., Stein, A., Kellogg-Spadt, S., & Bachmann, G. (2016) · The Journal of Sexual Medicine · doi:10.1016/j.jsxm.2015.12.021 · Cited by 317 · see citing works
Self-citationVulvodynia: Assessment and Treatment
Goldstein, A. T., Pukall, C. F., Brown, C., Bergeron, S., Stein, A., & Kellogg-Spadt, S. (2016) · The Journal of Sexual Medicine · doi:10.1016/j.jsxm.2016.01.020 · Cited by 292 · see citing works
Self-citationVulvar vestibulitis syndrome: reliability of diagnosis and evaluation of current diagnostic criteria
Bergeron, S. (2001) · Obstetrics and Gynecology · doi:10.1016/s0029-7844(01)01389-8 · Cited by 240 · see citing works
Self-citationSchütze, R., Rees, C., Smith, A., Slater, H., Campbell, J. M., & O'Sullivan, P. (2018) · The Journal of Pain · doi:10.1016/j.jpain.2017.09.010 · Cited by 231 · see citing works
Gentilcore‐Saulnier, E., McLean, L., Goldfinger, C., Pukall, C. F., & Chamberlain, S. M. (2010) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2009.01642.x · Cited by 197 · see citing works
French, D. J., Noël, M., Vigneau, F., French, J. A., Cyr, C. P., & Evans, R. T. (2005) · Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement · doi:10.1037/h0087255 · Cited by 151 · see citing works
Guidelines for the management of vulvodynia
Mandal, D., Nunns, D., Byrne, M., McLelland, J., Rani, R., Cullimore, J., Bansal, D., Brackenbury, F., Kirtschig, G., Wier, M., et al. (2010) · British Journal of Dermatology · doi:10.1111/j.1365-2133.2010.09684.x · Cited by 151 · see citing works
An Exploration of the Psychometric Properties of the PASS-20 With a Nonclinical Sample
Abrams, M. P., Carleton, R. N., & Asmundson, G. J. G. (2007) · Journal of Pain · doi:10.1016/j.jpain.2007.06.004 · Cited by 140 · see citing works
Goldfinger, C., Pukall, C. F., Gentilcore‐Saulnier, E., McLean, L., & Chamberlain, S. M. (2009) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2009.01304.x · Cited by 130 · see citing works
Desrochers, G., Bergeron, S., Khalifé, S., Dupuis, M.-J., & Jodoin, M. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.09.014 · Cited by 123 · see citing works
Self-citationThe Recurrent Pain and Sexual Sequelae of Provoked Vestibulodynia: A Perpetuating Cycle
Basson, R. J. (2012) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2012.02803.x · Cited by 115 · see citing works
Augmented Central Pain Processing in Vulvodynia
Hampson, J. P., Reed, B. D., Clauw, D. J., Bhavsar, R., Gracely, R. H., Haefner, H. K., & Harris, R. E. (2013) · Journal of Pain · doi:10.1016/j.jpain.2013.01.767 · Cited by 115 · see citing works
Heightened Pelvic Floor Muscle Tone and Altered Contractility in Women with Provoked Vestibulodynia
Morin, M., Binik, Y. M., Bourbonnais, D., Khalifé, S., Ouellet, S., & Bergeron, S. (2017) · The Journal of Sexual Medicine · doi:10.1016/j.jsxm.2017.02.012 · Cited by 111 · see citing works
Self-citationDevelopment of a dynamometer for measuring the isometric force of the pelvic floor musculature
Dumoulin, C. L., Bourbonnais, D., & Lemieux, M. (2003) · Neurourology and Urodynamics · doi:10.1002/nau.10156 · Cited by 110 · see citing works
Self-citationMorin, M., Bergeron, S., Khalifé, S., Mayrand, M., & Binik, Y. M. (2013) · The Journal of Sexual Medicine · doi:10.1111/jsm.12367 · Cited by 110 · see citing works
Self-citationReliability of dynamometric measurements of the pelvic floor musculature
Dumoulin, C. L., Gravel, D., Bourbonnais, D., Lemieux, M., & Morin, M. (2004) · Neurourology and Urodynamics · doi:10.1002/nau.10175 · Cited by 106 · see citing works
Self-citationMoldwin, R., & Fariello, J. Y. (2013) · Current Urology Reports · doi:10.1007/s11934-013-0360-7 · Cited by 104 · see citing works
Psychological predictors of recovery from low back pain: a prospective study
George, S. Z., & Beneciuk, J. M. (2015) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-015-0509-2 · Cited by 104 · see citing works
Reliable and Valid Self-Report Outcome Measures in Sexual (Dys)function: A Systematic Review
Daker‐White, G. (2002) · Archives of Sexual Behavior · doi:10.1023/a:1014743304566 · Cited by 101 · see citing works
A Conceptual Model for the Pathophysiology of Vulvar Vestibulitis Syndrome
Zolnoun, D., Hartmann, K. E., Lamvu, G., As-Sanie, S., Maixner, W. D., & Steege, J. F. (2006) · Obstetrical & Gynecological Survey · doi:10.1097/01.ogx.0000219814.40759.38 · Cited by 94 · see citing works
Morrissey, D., El-Khawand, D., Ginzburg, N., et al. (2015) · Urogynecology · doi:10.1097/spv.0000000000000177 · Cited by 91 · see citing works
Pelvic floor maximal strength using vaginal digital assessment compared to dynamometric measurements
Morin, M., Dumoulin, C. L., Bourbonnais, D., et al. (2004) · Neurourology and Urodynamics · doi:10.1002/nau.20021 · Cited by 89 · see citing works
Self-citationGenital pain in women: Beyond interference with intercourse
Bergeron, S., Rosen, N. O., & Morin, M. (2011) · Pain · doi:10.1016/j.pain.2011.01.035 · Cited by 85 · see citing works
Self-citationMorin, M., Dumoulin, C. L., Bergeron, S., Mayrand, M., Khalifé, S., Waddell, G., Dubois, M., Girard, I., Bureau, Y.-A., Ouellet, S., et al. (2020) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2020.08.038 · Cited by 83 · see citing works
Self-citationPredicting the Outcome of Surgical Treatment of Vulvar Vestibulitis
Bornstein, J. (1997) · Obstetrics and Gynecology · doi:10.1016/s0029-7844(97)00102-6 · Cited by 70 · see citing works
A Psychological View of Sexual Pain among Women: Applying the Fear-Avoidance Model
Thomtén, J., & Linton, S. J. (2013) · Women s Health · doi:10.2217/whe.13.19 · Cited by 69 · see citing works
Granot, M., Friedman, M., Yarnitsky, D., Tamir, A., & Zimmer, E. Z. (2004) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2003.09.060 · Cited by 65 · see citing works
Sexual Activities and Attitudes of Women With Vulvar Dysesthesia
Reed, B. G., Advincula, A. P., Fonde, K. R., Gorenflo, D. W., & Haefner, H. K. (2003) · Obstetrics and Gynecology · doi:10.1016/s0029-7844(03)00571-4 · Cited by 58 · see citing works
Hoffman, D. (2011) · Current Pain and Headache Reports · doi:10.1007/s11916-011-0215-1 · Cited by 58 · see citing works
Chisari, C., & Chilcot, J. (2017) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2016.12.010 · Cited by 58 · see citing works
Provoked Vestibulodynia—Medical Factors and Comorbidity Associated with Treatment Outcome
Heddini, U., Bohm‐Starke, N., Nilsson, K. W., & Johannesson, U. (2012) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2012.02665.x · Cited by 55 · see citing works
Pelvic Floor Physical Therapy for Vulvodynia
Prendergast, S. A. (2017) · Obstetrics and Gynecology Clinics of North America · doi:10.1016/j.ogc.2017.05.006 · Cited by 53 · see citing works
Murina, F., Felice, R., Francesco, S. D., & Oneda, S. (2018) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2018.06.026 · Cited by 53 · see citing works
Morin, M., Dumoulin, C. L., Gravel, D., Bourbonnais, D., & Lemieux, M. (2007) · Neurourology and Urodynamics · doi:10.1002/nau.20334 · Cited by 49 · see citing works
Self-citationMorin, M., Gravel, D., Bourbonnais, D., Dumoulin, C. L., & Ouellet, S. (2008) · Neurourology and Urodynamics · doi:10.1002/nau.20603 · Cited by 48 · see citing works
Self-citationMercier, J., Morin, M., Tang, A., Reichetzer, B., Lemieux, M., Samir, K., Zaki, D., Gougeon, F., & Dumoulin, C. L. (2020) · Climacteric · doi:10.1080/13697137.2020.1724942 · Cited by 47 · see citing works
Self-citationBenoît-Piau, J., Bergeron, S., Brassard, A., Dumoulin, C. L., Khalifé, S., Waddell, G., & Morin, M. (2018) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000604 · Cited by 45 · see citing works
Self-citationBody image in women with primary and secondary provoked vestibulodynia: A controlled study
Maillé, D. L., Bergeron, S., & Lambert, B. (2015) · The Journal of Sexual Medicine · doi:10.1111/jsm.12765 · Cited by 44 · see citing works
Self-citationBrotto, L. A., Sadownik, L. A., Thomson, S., Dayan, M., Smith, K. B., Seal, B. N., Moses, M., & Zhang, A. (2013) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e31829ea118 · Cited by 42 · see citing works
Morin, M., Dumoulin, C. L., Bergeron, S., Mayrand, M., Khalifé, S., Waddell, G., & Dubois, M. (2015) · Contemporary Clinical Trials · doi:10.1016/j.cct.2015.11.013 · Cited by 38 · see citing works
Self-citationMorin, M., Gravel, D., Bourbonnais, D., Dumoulin, C. L., Ouellet, S., & Pilon, J.-F. (2009) · Journal of Electromyography and Kinesiology · doi:10.1016/j.jelekin.2009.10.004 · Cited by 35 · see citing works
Self-citationSutton, K. S., Pukall, C. F., Wild, C. J., Johnsrude, I. S., & Chamberlain, S. M. (2015) · The Journal of Sexual Medicine · doi:10.1111/jsm.12863 · Cited by 34 · see citing works
Current Uses of Surgery in the Treatment of Genital Pain
King, M., Rubin, R. S., & Goldstein, A. T. (2014) · Current Sexual Health Reports · doi:10.1007/s11930-014-0032-8 · Cited by 31 · see citing works
Disease-Related Microstructural Differences in the Brain in Women With Provoked Vestibulodynia
Gupta, A., Woodworth, D. C., Ellingson, B. M., Rapkin, A. J., Naliboff, B. D., Kilpatrick, L. A., Stains, J., Masghati, S., Tillisch, K., Mayer, E. A., et al. (2018) · Journal of Pain · doi:10.1016/j.jpain.2017.12.269 · Cited by 23 · see citing works
Milnacipran in Provoked Vestibulodynia
Brown, C., Bachmann, G. A., Foster, D., Rawlinson, L. A., Wan, J. Y., & Ling, F. W. (2014) · Journal of Lower Genital Tract Disease · doi:10.1097/lgt.0000000000000057 · Cited by 22 · see citing works
Aerts, L., Bergeron, S., Corsini‐Munt, S., Steben, M., & Pâquet, M. (2015) · The Journal of Sexual Medicine · doi:10.1111/jsm.12907 · Cited by 19 · see citing works
Self-citationFontaine, F., Dumoulin, C. L., Bergeron, S., Mayrand, M., Khalifé, S., Wadell, G., & Morin, M. (2018) · The Journal of Sexual Medicine · doi:10.1016/j.jsxm.2018.06.001 · Cited by 18 · see citing works
Self-citationIntroital primary and secondary dyspareunia: Multimodal clinical and surgical control
Lambert, B., Bergeron, S., Desrosiers, M., & Lepage, Y. (2011) · Sexologies · doi:10.1016/j.sexol.2011.10.001 · Cited by 14 · see citing works
Self-citationPhillips, N. A., Brown, C., Bachmann, G. A., Wan, J. Y., Wood, R. W., Ulrich, D. L., Bachour, C., & Foster, D. (2016) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2016.06.047 · Cited by 14 · see citing works
Brokenshire, C., Pagano, R., & Scurry, J. (2014) · Journal of Lower Genital Tract Disease · doi:10.1097/lgt.0b013e31829fae32 · Cited by 13 · see citing works
Current evidence on catastrophizing and fear avoidance beliefs in low back pain patients
Brox, J. I. (2014) · The Spine Journal · doi:10.1016/j.spinee.2014.08.454 · Cited by 11 · see citing works
Sexual Behaviors in Women with Primary and Secondary Provoked Vestibulodynia: A Controlled Study
Lambert, B., Desrosiers, M., Chagnon, M., & Lepage, Y. (2013) · Advances in Sexual Medicine · doi:10.4236/asm.2013.33010 · Cited by 4 · see citing works
Cordeiro, E. S., Bardin, M. G., Morin, M., et al. (2019) · The Journal of Sexual Medicine · doi:10.1016/j.jsxm.2019.03.554 · Cited by 1 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Internet-based treatment for provoked vulvodynia: Factors associated with treatment outcomes
Hess Engström, A., Flink, I., Kero, V., Bohm-Starke, N., & Skalkidou, A. (2025) · The Journal of Sexual Medicine · doi:10.1093/jsxmed/qdae158 · Cited by 3 · see citing works
- Authors
- Bélanger, C., Dumoulin, C., Bergeron, S., Mayrand, M.-H., Khalifée, S., Waddell, G., Dubois, M.-F., PVD Group, & Morin, M.
- Affiliations
- Université de Sherbrooke (CA)
- Institut Universitaire de Gériatrie de Montréal (CA)
- Université de Montréal (CA)
- Centre Hospitalier de l’Université de Montréal (CA)
- McGill University Health Centre (CA)
- Corresponding author
- Bélanger, Clémence
- Venue
- The Clinical Journal of Pain
- Published
- 2022-03-08
- Volume
- 38
- Issue
- 5
- Pages
- 360-367
- ISSN
- 0749-8047 (ISSN-L)
- 1536-5409
- OpenAlex
- W4220714273
- Cited by
- 9
- References
- 62
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 1 · 2022: 1
- FWCI
- 1.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research (115028_1)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- provoked vestibulodynia, physiotherapy, treatment response, predictors of treatment response, pelvic floor muscle function, pelvic floor muscle tone, fear of pain, pain catastrophizing, pain characteristics, sexual function, biofeedback, manual therapy, dilators, women
- MeSH terms
- Fear, Female, Humans, Pain, Surveys and Questionnaires, Pelvic Floor, Physical Therapy Modalities, Vulvodynia
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
