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Wallen K. Protection or Pleasure: The Role of Genital Arousal in Sexual Intercourse. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:771-775. [PMID: 33140244 DOI: 10.1007/s10508-020-01869-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Kim Wallen
- Department of Psychology, Emory University, Atlanta, GA, 30322, USA.
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2
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Managing Female Sexual Pain. Urol Clin North Am 2021; 48:487-497. [PMID: 34602170 DOI: 10.1016/j.ucl.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Female sexual pain disorder or genito-pelvic pain/penetration disorder (GPPPD), previously known as dyspareunia, is defined as persistent or recurrent symptoms with one or more of the following for at least 6 months: marked vulvovaginal or pelvic pain during penetrative intercourse or penetration attempts, marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of penetration, and marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration. In this review, we discuss etiology, diagnosis, and treatment for common disorders that cause GPPD.
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3
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Tambling RR, Reckert A. Barriers to help seeking and provider preferences for sexual functioning concerns among undergraduates. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:633-643. [PMID: 31944927 DOI: 10.1080/07448481.2019.1705835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 09/03/2019] [Accepted: 12/12/2019] [Indexed: 06/10/2023]
Abstract
Researchers who have studied help-seeking for sexual health concerns have consistently documented that individuals, couples, and families underutilize sexual health services. Additionally, research has demonstrated that individuals endorse myriad barriers to seeking informal and formal help, especially for sexual health concerns. This study examined past, present, and future provider preferences for sexual functioning concerns. Participants: A sample of 347 undergraduate students at a large university in the Northeast United States. Methods: Participants responded to questionnaires about their help-seeking behaviors for formal and informal help sources. Results: Despite the occurrence of sexual functioning concerns in the current study, services that address sexual concerns were largely underutilized. However, barriers to seeking help and negative attitudes toward seeking help did not seem to be primary reasons for the underutilization of services for the current sample. Results also indicated that providers that focus specifically on the treatment of sexual functioning concerns are among the most underutilized services. Discussion: Implications for sexual health providers based on results are provided.
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Affiliation(s)
- Rachel R Tambling
- Department of Human Development and Family Science, University of Connecticut, Storrs, Connecticut, USA
| | - Ashley Reckert
- Department of Human Development and Family Science, University of Connecticut, Storrs, Connecticut, USA
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Cyr MP, Dumoulin C, Bessette P, Pina A, Gotlieb WH, Lapointe-Milot K, Morin M. Characterizing Pelvic Floor Muscle Function and Morphometry in Survivors of Gynecological Cancer Who Have Dyspareunia: A Comparative Cross-Sectional Study. Phys Ther 2021; 101:6124113. [PMID: 33522584 DOI: 10.1093/ptj/pzab042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/26/2020] [Accepted: 11/29/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVE More than one-half of gynecological cancer survivors are affected by pain during sexual intercourse, also known as dyspareunia. Oncological treatments may result in pelvic floor muscle (PFM) alterations, which are suspected to play a key role in dyspareunia. However, to our knowledge, no study has investigated PFM function and morphometry in this population. The aim of the study was to characterize and compare PFM function and morphometry between gynecological cancer survivors with dyspareunia and asymptomatic women. METHODS Twenty-four gynecological cancer survivors with dyspareunia and 32 women with a history of total hysterectomy but without pelvic pain (asymptomatic women) participated in this comparative cross-sectional study. PFM passive forces (tone), flexibility, stiffness, maximal strength, coordination, and endurance were assessed with an intra-vaginal dynamometric speculum. Bladder neck position, levator plate angle, anorectal angle, and levator hiatal dimensions were measured at rest and on maximal contraction with 3D/4D transperineal ultrasound imaging. RESULTS Compared with asymptomatic women, gynecological cancer survivors showed heightened PFM tone, lower flexibility, higher stiffness, and lower coordination and endurance. At rest, they had a smaller anorectal angle and smaller levator hiatal dimensions, indicating heightened PFM tone. They also presented fewer changes from rest to maximal contraction for anorectal angle and levator hiatal dimensions, suggesting an elevated tone or altered contractile properties. CONCLUSIONS Gynecological cancer survivors with dyspareunia present with altered PFM function and morphometry. This research therefore provides a better understanding of the underlying mechanisms of dyspareunia in cancer survivors. IMPACT Our study confirms alterations in PFM function and morphometry in gynecological cancer survivors with dyspareunia. These findings support the rationale for developing and assessing the efficacy of physical therapy targeting PFM alterations in this population.
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Affiliation(s)
- Marie-Pierre Cyr
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada.,Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Chantale Dumoulin
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Research Center of the Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
| | - Paul Bessette
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.,Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Annick Pina
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Walter H Gotlieb
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
| | - Korine Lapointe-Milot
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.,Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mélanie Morin
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada.,Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
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Bosisio M, Pâquet M, Bois K, Rosen NO, Bergeron S. Are Depressive Symptoms and Attachment Styles Associated with Observed and Perceived Partner Responsiveness in Couples Coping With Genito-Pelvic Pain ? JOURNAL OF SEX RESEARCH 2020; 57:534-544. [PMID: 31090447 DOI: 10.1080/00224499.2019.1610691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Partner responsiveness is thought to facilitate relationship adjustment in couples coping with genito-pelvic pain, such as provoked vestibulodynia (PVD). Recent studies suggest that attachment and depressive symptoms may act as a filter in the perception of partner responsiveness, and a barrier to the capacity of being responsive to a partner. Given studies suggesting higher depressive symptoms and relationship insecurities in women experiencing genito-pelvic pain compared to controls, investigating the role of these factors in partner responsiveness may help couples improve their wellbeing in the challenging context of PVD. The aim of this study was to examine the associations between depressive symptoms, attachment, and perceived and observed partner responsiveness in 50 couples coping with PVD. Participants took part in a videotaped discussion and completed self-report measures of depressive symptoms, attachment, and perceived partner responsiveness. Based on the actor-partner interdependence model, results indicated that when women and partners reported greater depressive symptoms and anxious attachment, they perceived each other as being less responsive. When partners experienced greater depressive symptoms, women and partners were rated, by a trained observer, as being less responsive to each other. Targeting depressive symptoms and relationship insecurity in couple therapy could increase responsiveness in couples coping with PVD.
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Affiliation(s)
| | | | - Katy Bois
- Department of Psychology, Université de Montréal
| | - Natalie O Rosen
- Departments of Psychology and Neuroscience, Dalhousie University
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Nimbi FM, Rossi V, Tripodi F, Luria M, Flinchum M, Tambelli R, Simonelli C. Genital Pain and Sexual Functioning: Effects on Sexual Experience, Psychological Health, and Quality of Life. J Sex Med 2020; 17:771-783. [PMID: 32063471 DOI: 10.1016/j.jsxm.2020.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 01/13/2020] [Accepted: 01/17/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Genital pain (GP) is a common symptom in women of reproductive age. The prevalence of GP is difficult to gauge as it has been underreported by both patients and clinicians and neglected in clinical studies despite wide recognition of the adverse effects to women's health. AIM The purpose of the present study was 3-fold: (i) to explore the self-reported presence and perception of GP and its association with sexual functioning, sexual distress, emotions, psychopathology, and quality of life (QoL); (ii) to explore if, controlling for the pain effect, women with Female Sexual Function Index (FSFI) scores indicating sexual dysfunction also reported worse outcomes regarding sexual distress, emotions, psychological health, and QoL than GP women with higher FSFI scores; and (iii) to evaluate the effects of GP duration, comparing women with GP with shorter (<6 months) duration of symptoms with women with longer (≥6 months) duration of symptom of GP on sexual functioning, distress, emotions, psychopathology and QoL. METHODS A total of 1,034 women (age ranges between 18 and 40 years) from the Italian general population completed a web survey on sexual health. OUTCOMES 6 self-report questionnaires exploring different biopsychosocial factors were assessed: the FSFI, the Female Sexual Distress Scale, the Positive and Negative Affect Schedule, the Short Form McGill Pain Questionnaire adapted for GP, the Short Form 36, and the Symptom Check List-90-Revised. RESULTS Women who reported GP (n = 319) indicated generally lower sexual function than women without GP (n = 648; P = .036). They reported a higher level of sexual distress (P < .001), more negative emotions related to sexual experiences (P = .001), lower scores in all QoL domains (P < .001), and higher levels of psychopathological symptoms (P < .001). Controlling for pain effects, women whose FSFI scores indicated sexual dysfunction (n = 150) reported higher rates of sexual distress than women whose FSFI scores indicated normal sexual function (n = 169; P < .001). The scores also indicated fewer positive (P < .001) and more negative emotions (P < .001) related to sexuality, lower QoL (P < .001) and significantly higher psychological burden (P < .001). Moreover, women experiencing GP for ≥6 months reported significantly lower means on the FSFI total score (P < .05; especially in the desire, satisfaction, and pain domains), distress (P < .001), and emotions (P < .05) than women experiencing GP duration <6 months. No significant differences were found on the QoL and the psychopathological symptoms. CLINICAL IMPLICATIONS GP is significantly pervasive, but a high percentage of sexual problems and related emotional suffering is overlooked. Raising awareness about this issue is critical, both among clinicians and the general public. STRENGTHS & LIMITATIONS The present study highlighted important characteristics of GP from a community sample; the results indicate problems related to pain experiences and their repercussions on sexual, psychological, affective health, and QoL. Major limitations are related to the use of self-report measures via a web-based study. CONCLUSION The results provide evidence of a lack of awareness regarding pain experiences as they relate to sexual functioning in women; clinicians would be advised to more fully investigate sexual functioning and psychosocial variables associated with GP during routine consultation beginning with the first onset of the symptoms. Nimbi FM, Rossi V, Tripodi F, et al. Genital Pain and Sexual Functioning: Effects on Sexual Experience, Psychological Health, and Quality of Life. J Sex Med 2020; 17:771-783.
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Affiliation(s)
- Filippo Maria Nimbi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy; Institute of Clinical Sexology, Rome, Italy.
| | | | | | - Mijal Luria
- Center for Sexual Health, Obstetrics and Gynecology, Hadassah University Hospital, Mt Scopus, Jerusalem, Israel
| | - Matthew Flinchum
- Department of Counseling & Psychology, Texas A&M University Central Texas, Killeen, TX, USA
| | - Renata Tambelli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Chiara Simonelli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy; Institute of Clinical Sexology, Rome, Italy
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Patanwala I, Lamvu G, Mizera M, Fisk M, Blanton E. Learning restrictive sexual values may be associated with dyspareunia. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026519900108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The primary objective of this study is to assess whether the degree of religiosity or certain moral teachings are associated with dyspareunia. Methods: A cross-sectional survey with 24 questions was designed that incorporated the previously validated Duke Religiosity Index questionnaire, medical and sexual history, and demographic information. The index measures organizational, non-organizational, and intrinsic religiosity. Participants were recruited from Ob/Gyn and Family Medicine clinics and from a large university in our community. Results: A total of 901 surveys were included in final analysis. Among our study population, the prevalence of dyspareunia was 19.4%. Participants were categorized by the presence or absence of the primary outcome, dyspareunia. There were no differences in the scores of organized religiosity, p = 0.73 (2.98 ± 0.47 vs 3.04 ± 1.55), non-organized religiosity, p = 0.57 (2.62 ± 1.71 vs 2.82 ± 1.82), or intrinsic religiosity p = 0.64 (10.53 ± 3.63 vs 10.47 ± 4.06) in women with and without dyspareunia, respectively. No associations were found between dyspareunia and a participant’s current or childhood religious affiliation. However, women who were taught “sex is bad” while growing up had a higher rate of dyspareunia compared to those who were not taught this belief, (27.0% vs 15.3%, p < 0.001). Similar results were found in women who were taught to “wait until marriage to have sex”; 21.6% experienced dyspareunia while only 13.2% of those who were not taught to wait experienced dyspareunia (p = 0.005). Conclusions: While degree of religiosity was not shown to be associated with dyspareunia, women who learned certain restrictive sexual values were at higher risk of experiencing painful intercourse.
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Affiliation(s)
- Insiyyah Patanwala
- Department of Obstetrics & Gynecology, Florida Hospital, Orlando, FL, USA
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Georgine Lamvu
- Division of Surgery, Gynecology Section, Veteran Affairs Medical Center, Orlando, FL, USA
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Megan Mizera
- College of Medicine, University of Central Florida, Orlando, FL, USA
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Matthew Fisk
- Department of Obstetrics & Gynecology, Florida Hospital, Orlando, FL, USA
| | - Emily Blanton
- Department of Obstetrics & Gynecology, Florida Hospital, Orlando, FL, USA
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA
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8
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Burri A, Hilpert P, Williams F. Pain Catastrophizing, Fear of Pain, and Depression and Their Association with Female Sexual Pain. J Sex Med 2019; 17:279-288. [PMID: 31812688 DOI: 10.1016/j.jsxm.2019.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 09/24/2019] [Accepted: 10/14/2019] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Painful sexual intercourse or dyspareunia is a common complaint among women, affecting 12-21% of premenopausal women. Recent studies have begun to focus on the role of fear avoidance and pain catastrophizing (PC) in genital pain and have consistently highlighted the importance of psych-affective factors in sexual pain. AIM To establish the importance of PC, fear of pain, and depression for the development and maintenance of female sexual pain. METHODS This longitudinal study was conducted in the United Kingdom to assess sexual pain at 2 different time points, in 2009 and 2013, in a convenience sample of N = 979 British women. MAIN OUTCOME MEASURE Well-validated questionnaires including the Pain Catastrophizing Scale, the Pain Anxiety Symptom Scale, and the Female Sexual Function Index (recent and lifelong version) were applied. RESULTS Multilevel modeling showed a strong increase of short-lived sexual pain over the 4 years (π01 = -0.33; P < .001). According to the moderation analyses, only depression influenced the change in short-lived pain over the 4 years (π11 = 0.46; P = .016). Similarly, only depression turned out to be independently associated with sexual pain when entered into the multiple regression model, as women reporting higher depression levels also reported more sexual pain (P < 0.05). CLINICAL IMPLICATIONS Clinicians should be aware that the mechanisms influencing short-lived sexual pain and changes in sexual pain seem to be different from the more enduring psychological factors that lead to the development and maintenance of "chronic" sexual pain. STRENGTHS & LIMITATIONS A very generic and unidimensional definition of sexual pain was used without information on pain frequency or intensity, and no information on the possible underlying (medical or psychological or both) causes was available. However, as far as we know this represents the first study to use repeated measures to assess how pain changes over a 4-year period and to explore the role of potential psychoaffective risk factors. CONCLUSION Among the variables studied, symptoms of depression seemed to be the only independent predictor of lifelong sexual pain, overriding potential influences of pain catastrophizing or fear of pain. Burri A, Hilpert P, Williams F. Pain Catastrophizing, Fear of Pain, and Depression and Their Association with Female Sexual Pain. J Sex Med 2020;17:279-288.
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Affiliation(s)
- Andrea Burri
- Institute for Sex Counselling and Sexual Sciences, Zurich, Switzerland; Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, United Kingdom.
| | - Peter Hilpert
- School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Frances Williams
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, United Kingdom
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Carter A, Ford JV, Luetke M, Fu TCJ, Townes A, Hensel DJ, Dodge B, Herbenick D. "Fulfilling His Needs, Not Mine": Reasons for Not Talking About Painful Sex and Associations with Lack of Pleasure in a Nationally Representative Sample of Women in the United States. J Sex Med 2019; 16:1953-1965. [PMID: 31551190 DOI: 10.1016/j.jsxm.2019.08.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/13/2019] [Accepted: 08/21/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Although much research has examined correlates of pain during sex, far less research has examined why women have sex despite having pain and why they avoid telling their partner. AIM The purpose of our study was to examine women's reports of painful sex, including location of pain, whether they told their partner, factors associated with not disclosing their pain, and their reasons for not disclosing. METHODS We used data from the 2018 National Survey of Sexual Health and Behavior, a probability-based online survey of 2,007 individuals ages 14 to 49 years. We limited our sample to adult women who reported a sexual experience that was painful in the past year (n = 382; 23.2%). The primary outcome in quantitative analyses was whether women told their partner they experienced pain during sex. Associations with social identities and sexual health were explored via logistic regression. Those who did not tell their partner about painful sex were asked why; their accounts were coded and analyzed qualitatively. MAIN OUTCOME MEASURE Women were asked, "To what extent was this sexual experience physically painful for you?" Those who reported any pain were asked, "Did you tell your partner that you were in pain during sex?" and, if applicable, "Why didn't you tell your partner that you were in pain during sex?" RESULTS Of those reporting pain during sex, most said it was "a little painful" (81.6%) and occurred at the vaginal entrance (31.5%), inside the vagina (34.4%), or at or around the cervix (17.4%). Overall, 51.0% (n = 193/382) told their partner about their pain. Adjusting for age and wantedness, women who reported little or no event-level sexual pleasure had nearly 3-fold greater odds of not telling a partner about painful sex (adjusted odds ratio = 3.24; 95% CI, 1.43-7.37). Normalizing painful sex, considering pain to be inconsequential, prioritizing the partner's enjoyment, and gendered interactional pressures were the predominant themes in women's narratives. CLINICAL IMPLICATIONS Providers should ask about painful sex, if the woman continues intercourse despite pain, and how she feels about this as a means of assessing any sexual and social pressures. STRENGTHS & LIMITATIONS Strengths include the use of social theory in nationally representative survey research to examine how contextual factors influence sexual health, but experiences were largely limited to heterosexual interactions. CONCLUSION Many women do not discuss painful sex with their partners, lack of pleasure is significantly more likely among this group, and gender norms and cultural scripts are critical to understanding why. Carter A, Ford JV, Luetke M, et al. "Fulfilling His Needs, Not Mine": Reasons for Not Talking About Painful Sex and Associations with Lack of Pleasure in a Nationally Representative Sample of Women in the United States. J Sex Med 2019; 16:1953-1965.
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Affiliation(s)
- Allison Carter
- Kirby Institute, University of New South Wales Sydney, Sydney, Australia.
| | - Jessie V Ford
- School of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Maya Luetke
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Tsung-Chieh Jane Fu
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Ashley Townes
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Devon J Hensel
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Sociology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Brian Dodge
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Debby Herbenick
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
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Jodouin JF, Bergeron S, Janssen E. The Mediating Role of Sexual Behavior in Event-Level Associations Between Sexual Difficulties and Sexual Satisfaction in Newlywed Mixed-Sex Couples. J Sex Med 2018; 15:1384-1392. [PMID: 30245023 DOI: 10.1016/j.jsxm.2018.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Many sexual difficulties encountered by couples in their day-to-day lives, although of insufficient intensity and persistence to warrant a clinical diagnosis of sexual disorder, are nevertheless frequent and a source of individual and relational distress. AIM The aim of this study was to assess the event-level associations between couples' everyday, subclinical sexual difficulties (specifically, low subjective sexual arousal, low physiological sexual arousal, and genito-pelvic pain), the range of sexual behaviors that these couples engage in, and their sexual satisfaction. METHODS 70 Newlywed participants (35 couples, average age = 25.6 years, SD = 3.2 years; average duration of relationship = 5.4 years, SD = 3.4 years) individually completed daily diaries about sexual difficulties, range of activities performed during sex, and sexual satisfaction over the course of 5 weeks. Analyses were guided by the actor-partner interdependence model. MAIN OUTCOME MEASURE The main outcome was sexual satisfaction, measured at the event-level on a 5-point Likert scale using a single-item question. RESULTS On days of sexual activity, men and women's difficulties with subjective sexual arousal were associated with lower sexual satisfaction in both partners (actor and partner effects). This association was mediated by the range of couples' sexual behaviors, such that lower subjective arousal was associated with a more restricted range of sexual activities, which in turn was associated with lower sexual satisfaction. Men's and women's difficulties with physiological sexual arousal, and women's genito-pelvic pain, were each associated with their own lower sexual satisfaction. No partner effects were observed for these sexual difficulties, nor were they mediated by the range of couples' sexual activities. CLINICAL IMPLICATIONS The study's results highlight how couples' sexual difficulties can interfere with same-day sexual satisfaction, and how for subjective sexual arousal, this interference is reflected by a more restricted range of sexual behaviors. STRENGTH & LIMITATIONS Strengths of the study include the daily diary methodology, which allowed a focus on event-level sexual activities with minimal retrospective bias. Further, the dyadic analyses allowed both intra-individual and inter-individual effects to be assessed. Limitations include the lack of a more general measure of sexual desire and of a more diverse sample, in terms of age, race, and sexual orientation. CONCLUSION These findings underscore the importance of treatments that include both partners, and that target the types as well as range of sexual activities in which couples engage. Jodouin J-F, Bergeron S, Janssen E. The Mediating Role of Sexual Behavior in Event-Level Associations Between Sexual Difficulties and Sexual Satisfaction in Newlywed Mixed-Sex Couples. J Sex Med 2018;15:1384-1392.
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Affiliation(s)
| | - Sophie Bergeron
- Département de Psychologie, Université de Montréal, Montreal, Quebec, Canada
| | - Erick Janssen
- Institute for Family and Sexuality Studies, University of Leuven, Leuven, Belgium; Kinsey Institute, Indiana University, Bloomington, IN, USA
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Zarski AC, Berking M, Hannig W, Ebert DD. Wenn Geschlechtsverkehr nicht möglich ist: Vorstellung eines internetbasierten Behandlungsprogramms für Genito-Pelvine Schmerz-Penetrationsstörung mit Falldarstellung. VERHALTENSTHERAPIE 2018. [DOI: 10.1159/000485041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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12
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Couple Sex Therapy Versus Group Therapy for Women with Genito-pelvic Pain. CURRENT SEXUAL HEALTH REPORTS 2018. [DOI: 10.1007/s11930-018-0154-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Dewitte M, Schepers J, Melles R. The Effects of Partner Presence and Sexual Stimulation on the Appraisal of Vaginal Pressure and Sexual Arousal. J Sex Med 2018; 15:539-549. [PMID: 29609913 DOI: 10.1016/j.jsxm.2018.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 01/29/2018] [Accepted: 02/02/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Sex research lacks experimental studies in which both partners participate in a laboratory procedure. This is relevant in the context of genital pain because painful vaginal sensations often occur in the presence of the partner. AIM To examine the effects of partner presence, sexual stimulation, and vaginal pressure on the appraisal of vaginal sensations and sexual arousal, ultimately aiming to increase the ecologic validity of laboratory designs. METHODS A community sample of 42 women and their male partners watched sexual and neutral films while separated or together. We induced gradually increasing vaginal pressure in the women using an intravaginal inflatable rubber balloon. OUTCOMES Women reported on pleasant and painful vaginal pressure and perceived genital arousal. Men and women reported on subjective sexual arousal. We also examined whether these appraisals were moderated by relationship satisfaction. RESULTS The appraisal of vaginal pressure varied as a function of relationship satisfaction. Less satisfied women reported more painful pressure than women who were highly satisfied and highly satisfied women appraised the pressure as more pleasant in the context of a sex film and in the presence (vs absence) of their partner. In men and women, although partner presence had a negative effect on subjective sexual arousal, the presence of the partner did increase women's perception of genital arousal when vaginal pressure was induced during a sex film, particularly when women felt highly satisfied with their relationship. Also, the effects on subjective sexual arousal were moderated by relationship satisfaction. For couples in which the woman was less satisfied, the induction of vaginal pressure resulted in higher subjective sexual arousal when the partner was absent compared with when he was present, whereas when the man felt less satisfied, partner presence had a positive effect on sexual arousal. CLINICAL IMPLICATIONS Interventions need to focus on the importance of sexual arousal during vaginal pressure stimulation and the way this is shaped by partner and relationship variables. Our results indicate that enhancing the relationship climate is an important target of intervention. STRENGTHS AND LIMITATIONS We did not include physical indices of genital arousal and did not use a clinical sample of women with genital pain. CONCLUSIONS The appraisal of vaginal sensations and sexual arousal are context-dependent responses that vary as a function of partner presence and sexual stimulation. Including both partners in the laboratory setting is important to create more valid models on sexual responding. Dewitte M, Schepers J, Melles R. The Effects of Partner Presence and Sexual Stimulation on the Appraisal of Vaginal Pressure and Sexual Arousal. J Sex Med 2018;15:539-549.
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Affiliation(s)
- Marieke Dewitte
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
| | - Jan Schepers
- Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
| | - Reinhilde Melles
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, The Netherlands
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Zarski AC, Berking M, Ebert DD. Efficacy of Internet-Based Guided Treatment for Genito-Pelvic Pain/Penetration Disorder: Rationale, Treatment Protocol, and Design of a Randomized Controlled Trial. Front Psychiatry 2018; 8:260. [PMID: 29403395 PMCID: PMC5786827 DOI: 10.3389/fpsyt.2017.00260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/14/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Genito-pelvic pain/penetration disorder (GPPPD) not only adversely affects women's sexuality and sexual satisfaction but is also associated with a wide range of psychosocial consequences such as reduced quality of life and well-being, mental health comorbidities, and relationship distress. Evidence for effective treatment options is scarce. AIM This article describes the rationale, treatment protocol, and study design for a randomized controlled trial examining the efficacy of an Internet-based guided intervention for GPPPD. METHOD Two hundred women who meet the criteria for GPPPD and have not been able to experience sexual intercourse for at least the last 6 months will be recruited and randomly assigned either to the intervention group (IG) or a 6-month waitlist control group. Assessments take place at baseline (T1), peritreatment after completion of Session 5 in IG (T2), after completion of Session 8 or 12 weeks after randomization (T3), and after 6 months (T4). Data will be analyzed on an intention-to-treat and a completer basis. MAIN OUTCOME MEASURES The primary outcome will be sexual intercourse involving the insertion of the partner's penis at posttreatment. Secondary outcomes include, e.g., improved non-intercourse penetration, sexual functioning, dyadic stress coping, reduced fear of sexuality and negative penetration-related cognitions. Fear of sexuality, penetration-related cognitions, and exercise intensity will be assessed as mediators of intercourse in the IG. Sexual dysfunctions of partners will be measured at baseline (T1) and investigated as a potential moderator of the primary treatment outcome. DISCUSSION Given the burden associated with GPPPD and the need for specialized treatment, there is a surprising lack of evidence-based treatment options. This study aims to assess whether Internet-based interventions could contribute to closing this treatment gap. CLINICAL TRIAL REGISTRATION German Register of Clinical Studies (DRKS): DRKS00010228.
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Affiliation(s)
- Anna-Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Institute of Psychology, Leuphana University Lüneburg, Lüneburg, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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McNicoll G, Corsini-Munt S, O Rosen N, McDuff P, Bergeron S. Sexual Assertiveness Mediates the Associations Between Partner Facilitative Responses and Sexual Outcomes in Women With Provoked Vestibulodynia. JOURNAL OF SEX & MARITAL THERAPY 2017; 43:663-677. [PMID: 27586889 DOI: 10.1080/0092623x.2016.1230806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Provoked vestibulodynia (PVD) is a recurrent idiopathic vulvo-vaginal pain associated with negative sexual and psychological consequences. Facilitative partner responses to pain are currently receiving empirical attention because they are positively associated with women's sexual outcomes. However, the mechanisms through which facilitative responses to pain are associated with these outcomes have not been examined. One potential mechanism is sexual assertiveness, which has been found to be associated with better sexual function and satisfaction in women with PVD. The present study examined whether women's sexual assertiveness mediated the association between women's perception of facilitative partner responses and women's sexual function and satisfaction. Women (N = 140) with PVD symptomatology completed self-reported questionnaires evaluating their perception of their partners' facilitative responses, and their own sexual assertiveness, sexual function, and sexual satisfaction. Dependent measures were sexual function measured by the Female Sexual Function Index and sexual satisfaction assessed by the Global Measure of Sexual Satisfaction Scale. Results indicated that women's higher sexual assertiveness mediated the association between their greater perceived facilitative partner responses and their improved sexual function and satisfaction. Findings suggest a potential mechanism through which partner responses may be associated with women's sexual outcomes.
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Affiliation(s)
- Gabrielle McNicoll
- a Department of Psychology , Université de Montréal, Montréal , Quebec , Canada
| | - Serena Corsini-Munt
- b Department of Psychology and Neuroscience , Dalhousie University , Halifax , Nova Scotia , Canada
| | - Natalie O Rosen
- b Department of Psychology and Neuroscience , Dalhousie University , Halifax , Nova Scotia , Canada
- c Department of Obstetrics and Gynaecology, IWK Health Centre , Dalhousie University , Halifax , Nova Scotia , Canada
| | - Pierre McDuff
- a Department of Psychology , Université de Montréal, Montréal , Quebec , Canada
| | - Sophie Bergeron
- a Department of Psychology , Université de Montréal, Montréal , Quebec , Canada
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Anderson AB, Rosen NO, Price L, Bergeron S. Associations Between Penetration Cognitions, Genital Pain, and Sexual Well-being in Women With Provoked Vestibulodynia. J Sex Med 2016; 13:444-52. [DOI: 10.1016/j.jsxm.2015.12.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/02/2015] [Accepted: 12/05/2015] [Indexed: 11/27/2022]
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Flink IK, Thomtén J, Engman L, Hedström S, Linton SJ. Coping with painful sex: Development and initial validation of the CHAMP Sexual Pain Coping Scale. Scand J Pain 2015; 9:74-80. [PMID: 29911654 DOI: 10.1016/j.sjpain.2015.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 05/16/2015] [Indexed: 10/23/2022]
Abstract
Background and purpose Recurrent vulvar pain is a common and debilitating condition which has received remarkably little attention in pain research. For instance, little is known about how these women cope with sexual activities, and there are no structured assessment tools. The purpose of this study was to explore coping strategies in this group, with a view to develop a measure to assess how women with vulvar pain cope with sexual activities. Methods The current study is based on a subsample from a longitudinal study about vulvar pain in a student sample consisting of women between 18 and 35 years old (N = 964). Only data from the ones reporting recurrent vulvar pain during the last six months (N = 289) were used in the analyses. First, the CHAMP Sexual Pain Coping Scale (CSPCS) was created, with the aim of assessing how women with vulvar pain cope with sexual activities. The scale was inspired by previous research on women with vulvar pain as well as well-known coping strategies in other pain populations. Second, the psychometric properties of the scale were explored by analyzing the factor structure and internal reliability. Third, validity features were examined in terms of criterion validity and construct validity. Results The analyses supported a three-factor solution, embracing the strategies endurance, avoidance and alternative coping. The internal reliability of the subscales turned out to be good, and the criterion validity was supported for all three subscales. The construct validity was clearly supported for the endurance and the avoidance subscales, but not for the alternative coping subscale. Conclusions The findings support the CSPCS as an instrument for assessing how women with vulvar pain cope with sexual activities. The strategies endurance, avoidance and alternative coping correspond with findings from earlier research. Endurance reflects a tendency to engage in and continue with sexual activities despite pain, while attempting to minimize or suppress thoughts of pain. Avoidance, on the other hand, involves efforts to stay away from sexual activities, in particular vaginal penetration, because of fear of pain. Alternative coping refers to endeavours to find alternative sexual activities that do not necessarily involve vaginal penetration. Even though this first study indicates that the CSPCS may be psychometrically sound, more studies are needed to confirm the psychometric properties and clinical application of this instrument. In particular, the construct validity of the alternative coping subscale needs to be further evaluated. Implications A valid instrument for assessing strategies for coping with sexual activities in this population has important clinical implications, since it provides a method that may enhance assessment procedures, be used in research, and stimulate the development of treatment.
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Affiliation(s)
- Ida K Flink
- Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
| | - Johanna Thomtén
- Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden.,Department of Psychology, Mid Sweden University, Östersund, Sweden
| | - Linnéa Engman
- Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
| | - Stina Hedström
- Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
| | - Steven J Linton
- Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
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Grimm D, Eulenburg C, Brummer O, Schliedermann AK, Trillsch F, Prieske K, Gieseking F, Selka E, Mahner S, Woelber L. Sexual activity and function after surgical treatment in patients with (pre)invasive vulvar lesions. Support Care Cancer 2015; 24:419-428. [DOI: 10.1007/s00520-015-2812-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/08/2015] [Indexed: 01/06/2023]
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Impett EA, Muise A, Rosen NO. Is It Good to Be Giving in the Bedroom? A Prosocial Perspective on Sexual Health and Well-Being in Romantic Relationships. CURRENT SEXUAL HEALTH REPORTS 2015. [DOI: 10.1007/s11930-015-0055-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Female Sexual Pain Disorders: a Review of the Literature on Etiology and Treatment. CURRENT SEXUAL HEALTH REPORTS 2015. [DOI: 10.1007/s11930-015-0053-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Psychophysical properties of female genital sensation. Pain 2013; 154:2277-2286. [DOI: 10.1016/j.pain.2013.05.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 05/13/2013] [Accepted: 05/16/2013] [Indexed: 01/30/2023]
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Elmerstig E, Wijma B, Swahnberg K. Prioritizing the partner's enjoyment: a population-based study on young Swedish women with experience of pain during vaginal intercourse. J Psychosom Obstet Gynaecol 2013; 34:82-9. [PMID: 23701494 DOI: 10.3109/0167482x.2013.793665] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The present study examines the prevalence of women who continue to have vaginal intercourse (VIC) despite pain, avoid telling the partner, and feign enjoyment. It also considers the reasons for this behavior. A sample of 1566 female senior high school students (aged 18-22 years) completed a questionnaire concerning their experiences and attitudes toward their body and sexuality. Forty-seven percent (270/576) of those women who reported pain during VIC continued to have VIC despite the pain. The most common reasons were that they did not want to spoil sex for or hurt the partner by interrupting VIC. Feigning enjoyment and not telling the partner about their pain were reported by 22 and 33%, respectively. Continuing to have VIC despite pain was associated with feelings of being inferior to the partner during sex, dissatisfaction with their own sex lives and feigning enjoyment while having pain. Pain during VIC is reported by every third young Swedish woman, and almost half of those still continue to have VIC. The major reason given is noteworthy - prioritizing the partner's enjoyment before their own - and indicates that young women who continue to have VIC despite pain take a subordinate position in sexual interactions.
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Affiliation(s)
- Eva Elmerstig
- Faculty of Health and Society, Malmö University, Sweden.
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Thomtén J, Linton SJ. A Psychological View of Sexual Pain among Women: Applying the Fear-Avoidance Model. WOMENS HEALTH 2013; 9:251-63. [DOI: 10.2217/whe.13.19] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Aim: The purpose of this paper is to examine how well research findings on dyspareunia (intercourse pain) fit the fear-avoidance (FA) model on pain. Results: The evidence suggests that the experience of pain in dyspareunia functions similarly to the pain reported in other pain conditions. There are also accumulating data showing that the central mechanisms of the FA model, such as catastrophizing, fear, hypervigilance and disability, are central to the experience of sexual pain. However, there are also some potential differences between sexual pain and other pain conditions that demand further attention in terms of the role of the partner, specific emotional consequences of avoidance and the effect of hypervigilance on sexual arousal. Conclusion: The results demonstrate the relevance of the FA model in sexual pain. They also imply that treatment methods for fear and avoidance in other pain conditions offer new avenues for treating sexual pain problems in the clinic. Future studies should focus on expanding how the mechanisms in the FA model contribute to sexual pain, as well as how treatments based on the model may be applied clinically.
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Affiliation(s)
- Johanna Thomtén
- Center for Health & Medical Psychology, Department of Behavioral, Social & Legal Sciences – Psychology, Örebro University, Sweden
| | - Steven J Linton
- Center for Health & Medical Psychology, Department of Behavioral, Social & Legal Sciences – Psychology, Örebro University, Sweden
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Rosen NO, Bergeron S, Lambert B, Steben M. Provoked vestibulodynia: mediators of the associations between partner responses, pain, and sexual satisfaction. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:129-141. [PMID: 22350124 DOI: 10.1007/s10508-012-9905-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 11/11/2011] [Accepted: 11/11/2011] [Indexed: 05/31/2023]
Abstract
Provoked vestibulodynia (PVD) is a chronic, recurrent vulvo-vaginal pain condition affecting 12% of the general population, and is associated with sexual dysfunction, psychological distress, and reduced quality of life. There is growing interest in the role of interpersonal variables in PVD, which have been widely neglected. In a sample of 175 couples, the present study examined the mediating roles of partner and participant catastrophizing and self-efficacy in the association between solicitous partner responses and pain intensity, and that of dyadic adjustment in the association between solicitous and negative partner responses and sexual satisfaction. Couples completed measures of partner responses, catastrophizing, self-efficacy, dyadic adjustment, and depression. Women also completed measures of pain, sexual satisfaction, and sexual function. Controlling for depression and solicitousness perceived by the other member of the couple, catastrophizing and self-efficacy partially mediated the association between higher solicitous responses and higher pain during intercourse, accounting for 26 and 25% of the variance in this association for participant and partner-perceived responses, respectively. For both participant and partners, only pain catastrophizing was a unique mediator. Controlling for depression, sexual function and partner-perceived responses, dyadic adjustment partially mediated the association between higher participant-perceived solicitous responses and higher sexual satisfaction, and between higher participant-perceived negative responses and lower sexual satisfaction, accounting for 26% of the variance in each association. The current findings suggest that catastrophizing and dyadic adjustment may constitute a route by which partner responses exacerbate pain and increase or decrease sexual satisfaction in PVD couples.
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Affiliation(s)
- Natalie O Rosen
- Department of Psychology, Université de Montréal, Montreal, QC, Canada.
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Fugl-Meyer KS, Bohm-Starke N, Damsted Petersen C, Fugl-Meyer A, Parish S, Giraldi A. Standard operating procedures for female genital sexual pain. J Sex Med 2012; 10:83-93. [PMID: 22970822 DOI: 10.1111/j.1743-6109.2012.02867.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Female genital sexual pain (GSP) is a common, distressing complaint in women of all ages that is underrecognized and undertreated. Definitions and terminology for female GSP are currently being debated. While some authors have suggested that GSP is not per se a sexual dysfunction, but rather a localized genial pain syndrome, others adhere to using clearly sexually related terms such as dyspareunia and vaginismus. AIM The aims of this brief review are to present definitions of the different types of female GSP. Their etiology, incidence, prevalence, and comorbidity with somatic and psychological disorders are highlighted, and different somatic and psychological assessment and treatment modalities are discussed. METHODS The Standard Operating Procedures (SOP) committee was composed of a chair and five additional experts. No corporate funding or remuneration was received. The authors agreed to survey relevant databases, journal articles and utilize their own clinical experience. Consensus was guided by systematic discussions by e-mail communications. MAIN OUTCOME/RESULTS: There is a clear lack of epidemiological data defining female GSP disorders and a lack of evidence supporting therapeutic interventions. However, this international expert group will recommend guidelines for management of female GSP. CONCLUSIONS GSP disorders are complex. It is recommended that their evaluation and treatment are performed through comprehensive somato-psychological multidisciplinary approach.
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Affiliation(s)
- Kerstin S Fugl-Meyer
- Department of Neurobiology, Care Sciences & Society, Karolinska Institutet and Department of Social Work, Karolinska University Hospital, Stockholm, Sweden.
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Landry T, Bergeron S. Biopsychosocial factors associated with dyspareunia in a community sample of adolescent girls. ARCHIVES OF SEXUAL BEHAVIOR 2011; 40:877-889. [PMID: 20567891 DOI: 10.1007/s10508-010-9637-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2009] [Revised: 04/19/2010] [Accepted: 04/19/2010] [Indexed: 05/29/2023]
Abstract
Although various biopsychosocial factors have been associated with dyspareunia, research to date has focused on retrospective reports of adult women, and lack of consensus regarding etiology remains. By targeting girls at the beginning of their reproductive life, this study aimed to examine the biomedical, behavioral, and psychosocial correlates of chronic painful intercourse in sexually active adolescents compared to pain-free girls. With written informed consent, data were obtained from 1425 girls (12-19 year olds) from seven metropolitan high schools using self-report questionnaires pertaining to gynaecologic/biomedical history, physical/psychological/sexual abuse, anxiety, depression, attitudes towards sexuality, and social support. While the chronic painful intercourse (n = 51) and pain-free comparison group (n = 167) did not differ significantly on biomedical variables, painful intercourse was associated with significantly more pain during tampon insertion, and avoidance of tampons was linked to a fourfold risk of experiencing pain during sex. Cases also reported engaging in significantly more detrimental vulvar hygiene habits than pain-free girls, whereas no significant group differences were observed for self-treatment using over-the-counter antifungal preparations. Sexual abuse, fear of physical abuse, and trait anxiety were identified as significant psychosocial correlates of chronic painful intercourse. A logistic regression further identified pain during first tampon insertion and trait anxiety as statistical predictors of adolescent pain during intercourse. In addition to a possible intrinsic dysfunction in central pain processing, findings suggest that psychological variables, such as anxiety, play a significant role in painful intercourse's very first manifestations in adolescent girls.
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Affiliation(s)
- Tina Landry
- Department of Psychology, Université du Québec à Montréal, C. P. 8888, succ. Centre-Ville, Montreal, QC H3C 3P8, Canada.
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Ahrold TK, Farmer M, Trapnell PD, Meston CM. The relationship among sexual attitudes, sexual fantasy, and religiosity. ARCHIVES OF SEXUAL BEHAVIOR 2011; 40:619-30. [PMID: 20364304 PMCID: PMC4419361 DOI: 10.1007/s10508-010-9621-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Revised: 02/26/2010] [Accepted: 03/05/2010] [Indexed: 05/13/2023]
Abstract
Recent research on the impact of religiosity on sexuality has highlighted the role of the individual, and suggests that the effects of religious group and sexual attitudes and fantasy may be mediated through individual differences in spirituality. The present study investigated the role of religion in an ethnically diverse young adult sample (N = 1413, 69% women) using religious group as well as several religiosity domains: spirituality, intrinsic religiosity, paranormal beliefs, and fundamentalism. Differences between religious groups in conservative sexual attitudes were statistically significant but small; as predicted, spirituality mediated these effects. In contrast to the weak effects of religious group, spirituality, intrinsic religiosity, and fundamentalism were strong predictors of women's conservative sexual attitudes; for men, intrinsic religiosity predicted sexual attitude conservatism but spirituality predicted attitudinal liberalism. For women, both religious group and religiosity domains were significant predictors of frequency of sexual fantasies while, for men, only religiosity domains were significant predictors. These results indicate that individual differences in religiosity domains were better predictors of sexual attitudes and fantasy than religious group and that these associations are moderated by gender.
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Affiliation(s)
- Tierney K. Ahrold
- Department of Psychology, University of Texas at Austin, 108 E. Dean Keeton, Austin, TX 78712, USA
| | - Melissa Farmer
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Paul D. Trapnell
- Department of Psychology, University of Winnipeg, Winnipeg, MB, Canada
| | - Cindy M. Meston
- Department of Psychology, University of Texas at Austin, 108 E. Dean Keeton, Austin, TX 78712, USA
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Smith KB, Pukall CF. A systematic review of relationship adjustment and sexual satisfaction among women with provoked vestibulodynia. JOURNAL OF SEX RESEARCH 2011; 48:166-191. [PMID: 21409713 DOI: 10.1080/00224499.2011.555016] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The main objective of this article was to conduct a systematic review of the literature examining relationship adjustment and sexual satisfaction among women with provoked vestibulodynia (PVD). Although only a small number of studies have included partners, the literature regarding partner's relationship adjustment and sexual satisfaction was also examined. Relevant articles were identified by a literature search conducted between August 2008 and May 2010. Studies were included if they contained at least one group or subset of participants with PVD or dyspareunia (i.e., painful sexual intercourse), and if they assessed relationship adjustment or sexual satisfaction as a primary outcome measure. Within this review, the methodological quality of 33 studies was systematically rated, and effect sizes were calculated when possible. Methodological type and quality greatly varied across the studies, as did the pain samples included and the outcomes reported. Nevertheless, the results of controlled studies indicate that PVD is associated with decreased sexual satisfaction. The controlled results also suggest, however, that PVD is not necessarily associated with general relationship maladjustment for women and their partners. Future research, using various methodologies, is needed to further understand intimate relationships among women with PVD and the impact that this condition may have on couples.
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Affiliation(s)
- Kelly B Smith
- Department of Psychology, Queen's University, Humphrey Hall, 62Arch St., Kingston, Ontario, Canada K7L 3N6
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Rosen NO, Bergeron S, Leclerc B, Lambert B, Steben M. Woman and Partner-Perceived Partner Responses Predict Pain and Sexual Satisfaction in Provoked Vestibulodynia (PVD) Couples. J Sex Med 2010; 7:3715-24. [DOI: 10.1111/j.1743-6109.2010.01957.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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