Genito-pelvic pain/penetration disorder (GPPPD) presents a complex interplay of physiological and psychological factors, often accompanied by negative beliefs and cognitions about vaginal penetration. These negative beliefs can exacerbate anticipatory anxiety and contribute to sexual dysfunction in affected individuals. Graded Motor Imagery (GMI) has emerged as a promising intervention for managing pain in persistent pain conditions. However, the extent to which it addresses and mitigates the influence of negative beliefs about vaginal penetration remains unclear. This study aimed to elucidate the impact of such beliefs, assessed through the Vaginal Penetration Cognition Questionnaire (VPCQ), on the outcomes of a GMI program among women diagnosed with GPPPD.

In this randomized controlled trial, we sought to explore the association between negative beliefs about vaginal penetration and the effectiveness of a GMI program in managing GPPPD symptoms. Ethical considerations, as outlined in the Declaration of Helsinki, guided the recruitment, and conduct of the study. Participants provided informed consent and completed baseline assessments, including the VPCQ, prior to randomization into either the intervention or control groups. The intervention group underwent a six-week GMI program, tailored to address pelvic floor disorders, while the control group initially received no intervention. Pain intensity, measured using the Visual Analogue Scale (VAS), and sexual function, assessed through the short version of the Female Sexual Function Index (FSFI-6), were evaluated pre- and post-intervention. Statistical analysis involved mixed model two-way repeated measures ANOVA to explore within-subject and between-subject differences. Correlations between VPCQ scores and outcomes were examined using Pearson's correlation coefficient.

Analysis of data from 83 participants revealed significant reductions in pain intensity within the GMI group (p<0.05), irrespective of participants' beliefs about vaginal penetration. However, sexual function did not exhibit significant improvements in either group. Notably, correlation analysis demonstrated a significant negative association (p<0.05) between VPCQ scores and sexual function (FSFI) specifically in the control group. This finding suggests that higher scores on the VPCQ, indicating more negative beliefs about vaginal penetration, were associated with lower levels of sexual function.

The findings underscore the effectiveness of the GMI program in alleviating pain intensity among women with GPPPD, regardless of their negative beliefs about vaginal penetration. However, negative beliefs about vaginal penetration significantly correlated with impaired sexual function in the control group. These results highlight the potential impact of addressing negative cognitions about vaginal penetration on improving sexual outcomes in women with GPPPD.

While the GMI program demonstrates efficacy in reducing pain intensity in women with GPPPD, addressing negative beliefs about vaginal penetration may be crucial for enhancing sexual function. Future interventions should consider incorporating strategies to target and modify these beliefs to improve overall outcomes and quality of life for individuals living with GPPPD.