The results of this prospective open clinical trial (N = 76) indicate that a cognitive-behavioral group program for women with vulvar vestibulitis syndrome (VVS) affects sexuality, pain control, vaginal muscle control, and vestibular pain and that these changes may mediate changes in pain during intercourse. Improvements in sexual functioning and vestibular pain during treatment seem to be particularly important factors in determining short and longer term treatment outcome. These findings are consistent with a cognitive-behavioral conceptualization of VVS.