"If sex hurts, am I still a woman?" the subjective experience of vulvodynia in hetero-sexual women

Do perfectionism, body image concerns, and intimacy predict genitopelvic pain in the postpartum? A prospective study of new mothers

BACKGROUND

Genitopelvic pain following childbirth is common and likely to challenge the psychological, relational, and sexual well-being of new mothers. While genitopelvic pain generally decreases during the postpartum period, personal and interpersonal characteristics may explain why genitopelvic pain persists beyond the period of physical recovery in some mothers. Body image concerns, increased stress, and relationship challenges would be particularly salient during pregnancy and the postpartum period, which could put new mothers at greater risk of sexual difficulties. Also, mothers may display a negative appraisal regarding genitopelvic pain and doubt their ability to cope with it, which may contribute to the pain.

AIM

The current study aimed to examine the role of perfectionism, body image concerns, and perceived intimacy in the occurrence and change in genitopelvic pain in new mothers in postpartum.

METHODS

A total of 211 new mothers and their partners were recruited for a larger prospective dyadic study on the transition to parenthood.

OUTCOMES

Mothers completed a single item assessing genitopelvic pain, in addition to brief validated questionnaires measuring perfectionism, body image concerns, and perceived couple intimacy during pregnancy and at 4, 8, and 12 months postpartum.

RESULTS

Five multilevel modeling analyses revealed that adaptive perfectionism, maladaptive perfectionism, and body image concerns were associated with a higher occurrence of genitopelvic pain from 4 to 12 months postpartum. Mothers' and partners' perceived intimacy was not significantly related to new mothers' genitopelvic pain. None of the predictors modified the trajectory of genitopelvic pain over time.

CLINICAL IMPLICATIONS

Raising awareness among health care professionals regarding the role of perfectionism and body image concerns in genitopelvic pain may help them identify new mothers at risk of chronic genitopelvic pain, while offering a new avenue of intervention.

STRENGTHS AND LIMITATIONS

There has been little research examining the role of perfectionism, body image concerns, and intimacy in postpartum genitopelvic pain. Based on a longitudinal prospective approach, this study identified perfectionism and body image concerns as significant predictors of postpartum genitopelvic pain. However, prepregnancy genitopelvic pain, genitopelvic pain intensity, and sexual distress were not measured.

CONCLUSION

Adaptive and maladaptive perfectionism and body image concerns are associated with new mothers' genitopelvic pain up to 12 months postpartum.

"The sound of silence" Giving voice to endometriosis-related positional dyspareunia

Deep dyspareunia is one of the main symptoms of endometriosis. It appears to be submerged by a two-way disconnection between patients and their physicians. The aim of our review is to provide clear, ready-to-use advice on how to manage deep dyspareunia overcoming the gap in communication. Sexual history should always be taken as part of routine health care in these regards, using a patient-centered approach. An educational pelvic examination, which actively includes patients in the identification of painful areas, may prove useful to improve patients' understanding of their condition. Correlating painful pelvic areas with sexual positions and inviting patients to adopt alternative positions may represent a simple but extremely effective coping strategy to mitigate pain. Revealing and explaining to partners the nature of the pain is essential to allow them to take part in shared research of coping mechanisms, empowering the couple to make choices and changes. Couples who do not feel comfortable talking about intimacy by themselves may find that including a psychotherapist or a sexual therapist, may be a good way to start communication. Investigating and managing dyspareunia during medical encounters is a medical and ethical duty all healthcare practitioners should pursue.

Not all lasers are the same: a scoping review evaluating laser therapy for vulvodynia

INTRODUCTION

Lasers are commonly used for treating various vaginal/vulvar conditions. To date, there is to our knowledge no available literature review on the effects of different types of lasers for the treatment of women with vulvodynia, a condition that causes chronic pain in the vulvar area.

OBJECTIVES

We sought to review the literature and summarize the existing published evidence regarding the effects of lasers for the treatment of women with vulvodynia.

METHODS

A scoping review with a systematic search was conducted that included studies investigating the use of laser treatment in women with vulvodynia. The National Heart, Lung, and Blood Institute Study Quality Assessment Tools were used for the quality assessment. The type of laser, effects on pain and function, and participants' perceived improvement as well as adverse events were analyzed.

RESULTS

Eight studies investigating laser therapy were included in the analysis: 1 randomized controlled trial, 5 before-after studies, 1 nonrandomized intervention study, and 1 case report. Several types of laser therapies were identified, ranging from mild noninvasive photobiomodulation to more invasive ablative procedures. Of the 6 studies that included pain outcomes, 3 studies showed statistically significant improvements from baseline to follow-up, and 3 demonstrated a reduction in pain from subjectively interpreted data. Similarly, each of the 2 studies investigating sexual function also reported an improvement (based only on subjective interpretation). Of the 2 studies with a comparison group, neither study was adequately powered to detect between-group differences. Furthermore, 57%-78% of participants reported improvement, with 1 study showing a greater statistically significant improvement in the low-level laser therapy patient group compared to the sham laser group. Outcomes and adverse events varied depending on the type of laser used.

CONCLUSIONS

Although these studies demonstrated some benefits of laser therapy for the treatment of vulvodynia, these findings should be interpreted with caution given the scarcity of the included studies that were robust and sufficiently powered. Future research should focus on conducting well-designed randomized controlled trials to evaluate the efficacy of different types of lasers in the treatment of vulvodynia.

A conceptual model for managing sexual pain with somatocognitive therapy in women with provoked vestibulodynia and implications for physiotherapy practice

Somatocognitive therapy is a multimodal physiotherapy treatment developed in the early 2000s to alleviate the burden of chronic pelvic pain. In recent years, somatocognitive therapy has been further developed to treat women with provoked vestibulodynia. This prevalent gynecological pain condition is a subgroup of chronic pelvic pain and the most common form of vulvodynia. Provoked vestibulodynia is a neglected multifactorial pain condition of unknown cause, adversely affecting women's sexual life, relation to their partners and their psychological health. Pain is located at the vulvar vestibule and is provoked by touch or pressure such as sexual intercourse. In the management of sexual pain, somatocognitive therapy combines bodily exploration, pain education, cognitive coping strategies and structured homework to improve sexual function and reduce pain. To support these processes, developing a sound therapeutic alliance with the patient is essential. The aim of this article is to provide a conceptual model for managing provoked vestibulodynia with somatocognitive therapy, including a theoretical rational for this treatment. We base our conceptual model on the biopsychosocial model, i.e., considering the complex interplay of biomedical, emotional/cognitive, psychosexual and interpersonal factors in provoked vestibulodynia management. In addition, implications for practice and a detailed description of somatocognitive therapy for provoked vestibulodynia will be provided, to allow replication in clinical practice and in clinical trials.

Associations between recalled childhood gender nonconformity and adult sexual dysfunction in Denmark: baseline assessment in the Project SEXUS cohort study

BACKGROUND

Sexual dysfunctions may negatively affect an individual's self-perceived womanhood or manhood, but whether gender nonconformity in childhood or adolescence can influence adult sexual functioning has not been examined so far.

AIM

To explore the possible link between recalled childhood gender nonconformity and sexual dysfunctions in adulthood in a large sample.

METHODS

We analyzed baseline questionnaire data from Project SEXUS, a nationally representative cohort study on sexual health among 15- to 89-year-old Danish citizens. Our sample included sexually active participants aged ≥18 years who were queried about gender nonconformity in childhood or adolescence (N = 21 390). To capture sexual dysfunctions, we assessed (1) difficulties with lubrication, orgasm, vaginal cramps precluding sexual intercourse, and/or genital pain during partnered sexual activity in women and (2) difficulties with erection, premature ejaculation, orgasm, and/or genital pain during partnered sexual activity in men. Furthermore, we assessed whether such difficulties were perceived as problematic. The 6-item Female Sexual Function Index and the 5-item International Index of Erectile Function served as standardized measures. Polytomous logistic regression analyses yielded demographically weighted adjusted odds ratios (aORs) with 95% CIs for associations between childhood gender nonconformity and sexual dysfunctions, controlling for age, sociodemographics, health-related factors, and other potential confounders.

OUTCOMES

Sexual difficulties and dysfunctions, as well as scores on the Female Sexual Function Index and International Index of Erectile Function.

RESULTS

Age-adjusted odds ratios indicated that sexual dysfunctions were significantly more common among childhood gender-nonconforming than conforming participants. After controlling for additional potential confounders, most sexual dysfunctions-notably, vaginal cramps in women (aOR, 2.12; 95% CI, 1.25-3.60) and genital pain dysfunction in men (aOR, 2.99; 95% CI, 1.79-4.99)-remained significantly increased among childhood gender-nonconforming respondents.

CLINICAL IMPLICATIONS

Findings suggest that self-perceived gender nonconformity in childhood or adolescence may negatively affect sexual functioning in adult life. If confirmed by future studies, they may warrant a clinical emphasis on such issues in sexologic treatment and care.

STRENGTHS AND LIMITATIONS

Our study is the first to report associations between childhood gender nonconformity and adult sexual dysfunction, building on data from a large-scale, nationally representative cohort study. The retrospective assessment of childhood gender nonconformity via one item might have neglected significant dimensions of this construct.

CONCLUSION

The present study is the first to show that individuals who recall being gender nonconforming in childhood or adolescence may be at a greater risk of experiencing sexual dysfunctions, particularly sexual pain disorders, as adults.

"It's All in Your Head": A Meta-Synthesis of Qualitative Research About Disenfranchising Talk Experienced by Female Patients with Chronic Overlapping Pain Conditions

Interactions between female patients with chronic pain and their medical providers in which providers question or contest the "realness" or nature of their illness experience (e.g. "It's all in your head") have been reported extensively in the extant qualitative literature, particularly for poorly understood ("contested") chronic pain syndromes. Many terms have been offered to describe this talk (e.g. invalidating, dismissive), resulting in conceptual fragmentation and isolated silos of research which together report about one communicative phenomenon. To rectify this fragmentation, the present study offers a meta-synthesis which explores, analyzes, and integrates the findings of 82 qualitative interview studies representing the patient-provider communication experiences of 2,434 female patients living with one or more of 10 chronic overlapping pain conditions (COPCs). COPCs are costly, gendered, and poorly understood. From the meta-synthesis, three key concepts are identified: (1) Functions of disenfranchising talk: Discrediting, silencing, and stereotyping; (2) Effects of disenfranchising talk: Harmed agency, credibility; access to care, support, and resources; and perception of patient-provider relationship; and (3) Responses to disenfranchising talk: Submission, critique, and resistance. Findings confirm the centrality of gender in the experience of disenfranchising talk, underscore the need to adopt an intersectional approach to the study of this talk along additional axes of race and class, and offer heuristic value toward conceptually unifying research about female COPC patients' experiences of disenfranchising talk from providers.

Prevalence and predictors of sexual distress in married reproductive-age women: A cross-sectional study from Iran

Background and Aim

Although various surveys have been conducted for sexual problems, there is a lack of population-based studies on sexual distress in Iran. Thus, we sought to determine the prevalence and predictive factors of sexual distress in this population.

Methods

Overall, 1000 married women aged 16-49 years were enrolled in this study using the two-stage cluster sampling method. To identify sexual distress, the female sexual distress scale-revised (FSDS-R) was completed. The predictive factors were assessed using a checklist.

Results

A total of 318 women (31.8%) suffered from sexual distress. Among socio-demographic factors, satisfaction with marriage (p = 0.001), among personal factors history of infertility and fear of contracting sexually transmitted infections (p < 0.01), and among sexual and interpersonal factors satisfaction with the level of sexual desire (p = 0.01), pain during sexual intercourse (p < 0.01), premature ejaculation disorders in the partner (p < 0.05), and sexual satisfaction (p < 0.001) were significantly associated with sexual distress.

Conclusion

Clinicians should evaluate sexual distress comprehensively and consider all the related dimensions. The high overall prevalence of sexual distress, with or without an identifiable dysfunction, signals the importance of health professionals being adequately prepared to discuss sexual health concerns.

Attitudes toward Help-Seeking for Sexual Problems among College Women

Prior research has indicated that 65-70% of college age women have experienced at least one sexual problem. Sexual problems are associated with higher rates of depression, anxiety, and relationship distress; however, few college age women seek professional help for sexual difficulties. The present study used the Theory of Planned Behavior to explore how adherence to traditional feminine norms and self-stigma are associated with intention to seek professional psychological help for a sexual difficulty. Results of structural equation modeling analysis demonstrated approximate fit in a sample of 259 college women. The structural model indicated that self-stigma and stronger endorsement of specific feminine gender norms (i.e., romantic relationship, sexual fidelity, sweet and nice) were found to be associated with less intention to seek help for a sexual problem. We discuss future research directions and implications for clinical services.

'My partner will think I'm weak or overthinking my pain': how being superwoman inhibits Black women's sexual pain disclosure to their partners

Black women experience persistent sexual pain that may often last longer than White women. Despite the value of sexual communication to alleviate sexual pain concerns, many women do not disclose sexual pain to their partners. Limited research explores barriers to disclosing sexual pain to partners among Black women. This study seeks to fill this gap. Relying on an integration of Sexual Script theory and Superwoman Schema, the study explored the barriers that premenopausal, cisgender Black women from the Southern USA perceived when disclosing sexual pain to their primary partners. We identified five common themes from women's open-ended responses to an online survey: (a) distressing emotions associated with disclosure; (b) limited knowledge and communication skills; (c) protecting partner's feelings and ego; (d) invading privacy; and (e) taking sole responsibility for managing sexual pain. Findings suggest a combination of intrapsychic, interpersonal and cultural factors influence Black women's perceived ability to have direct and open dyadic communication about sexual pain with their partners. Implications for Black women's sexual health and relationship outcomes are discussed.

Current Practices in Brazil on Diagnosis and Management of Women With Vulvodynia

OBJECTIVE

Vulvodynia (VVD) is a frequent and harrowing condition for which diagnosis and management remain insufficient. Our study aimed to describe and compare vulvovaginal signs and symptoms of Brazilian women with VVD and controls and describe previous medical assessment, past treatments, and vulvar pain relief among women with VVD.

METHODS

This cross-sectional descriptive study included Brazilian women with (n = 151) and without VVD (n = 106). All women were assessed for vaginal infection, vulvar pain intensity by means of a cotton swab test based on a numerical rate scale, and answered the Female Sexual Function Index questionnaire and a structured instrument about current vulvar symptoms. Previous treatments were assessed in the VVD group, and vulvar pain relief achieved with previous treatments was qualified through a 4-point Likert scale.

RESULTS

Volunteers were mainly White, with mean age of 30 years. Vulvovaginal signs and symptoms were significantly more frequent in women with VVD (p < .05), and vulvar pain duration was 5.8 (±4) years. More than 50% consulted with three or more physicians, and 49% remained without a conclusive diagnosis. Previous diagnosis and treatment of vulvovaginal infection were often reported by women with VVD. Most of the tried prescriptions were self-reported as providing only low vulvar pain relief.

CONCLUSIONS

Prolonged duration of vulvar pain, multiple visits to health care professionals, and poor relief of pain are common aspects in the clinical history of women with VVD. In addition to pain, vulvar fissure, edema, erythema, vaginal discharge, and foul odor are common and should be considered to avoid misdiagnosis. Appropriate treatments to VVD are still poorly reported.

The experiences of women seeking help for vaginismus and its impact on their sense of self: An integrative review

BACKGROUND

There is low social awareness of vaginismus despite it being a relatively common female sexual dysfunction that makes vaginal penetration painful, difficult, and/or impossible. While existing literature on vaginismus has had a clinical focus on the affected genitalia, there is a lack of research on women's help-seeking experiences of vaginismus from their perspective.

OBJECTIVES

This integrative review's objective was to explore: women's help-seeking experiences of vaginismus, and how such help-seeking experiences impact their sense of self.

DESIGN

Cooper's five-step integrative review approach was followed to develop a research question, a search strategy, selection criteria, and data evaluation, analysis, and presentation.

DATA SOURCES AND METHODS

A systematic search of the literature was completed in the following seven databases in January 2023: PsycINFO, ProQuest Central, PubMed, Scopus, CINAHL, Cochrane, and Embase. Out of the 373 articles found through database searches and additional citation searching, 22 studies were included in this review for meeting the eligibility criteria of having an empirical design, being written in English, and examining women's help-seeking experiences for vaginismus and its impact on their sense of self.

RESULTS

Thematic analysis was used to summarize the findings from the included studies which were informed by 1671 participants. Help-Seeking Process, Medical Management, Help-Seeking and Sense of Self, and Holistic Care Recommendations from the Findings emerged as four major themes with corresponding subthemes.

CONCLUSION

This review indicates that women continue to face difficulties in seeking and receiving help for vaginismus even through the healthcare system. However, the studies did not explicitly discuss how women's help-seeking for vaginismus impacted their sense of self. This highlights an epistemological gap on how women's help-seeking for their vaginismus impacts their sense of self, which can affect their treatment responses. Recommendations are provided for future healthcare and research to improve health outcomes for women with vaginismus.

'I don't live in my body somehow': metaphorical talk in women's accounts of vaginismus and dyspareunia

Vaginismus and dyspareunia are common sexual difficulties; they often take a long time to be appropriately diagnosed, and their origins remain unclear. This paper examines the metaphors used by women to describe bodily experiences associated with vaginismus and dyspareunia, and highlights the contribution this form of analysis can make to the study of sexuality and sexual difficulties. A secondary analysis was conducted on primary data from biographic interviews exploring women's experiences of sexual pain and difficulties with sexual intercourse. Metaphor analysis was used to analyse a data subset of 28 interviews translated from German into English. Metaphorical concepts lying at the basis of the metaphors used were identified and grouped into three themes: characterisation of sexual difficulties; split body and 'self'; and sexual agency and objectification. Results are discussed with in the context of literature regarding the function of metaphors and the utility of metaphor analysis for research, and healthcare research and interventions more generally.

Validation of the Body Appreciation Scale-2 in cisgender, heterosexual and sexual and gender minority adolescents and sexuality-related correlates

Body dissatisfaction has received considerable scientific attention, while research about positive body image has been neglected, particularly among adolescents. The aims of the present study were to examine (1) the factor structure of the Body Appreciation Scale-2 (BAS-2) in a large sample of cisgender, heterosexual and sexual and gender minority adolescents, (2) measurement invariance across language, gender and sexual orientation-based groups, (3) convergent validity with sexuality-related outcomes and (4) one-year temporal stability. Results of a confirmatory analysis among 2419 adolescents (M_age=14.6 years, SD=0.62; 52.6% girls) corroborated the proposed one-dimensional factor structure of the scale. The BAS-2 demonstrated adequate reliability and one-year temporal stability. The scale was partially invariant across gender and fully invariant across language and cisgender heterosexual and sexual and gender minority adolescents. Boys (cis and trans) had higher levels of body appreciation than girls (cis and trans), while no significant differences were observed between heterosexual and sexual minority adolescents. The BAS-2 correlated positively with sexual satisfaction and sexual body-esteem as well as negatively with sexual distress. Our findings support the validity and reliability of the BAS-2 in French and English for measuring body appreciation in adolescents.

Pelvic organ prolapse: The lived experience

BACKGROUND

Up to 50% of women will develop pelvic organ prolapse (POP) over their lifetime. Symptoms include pain, bulge, urinary, bowel and sexual symptoms affecting all aspects of a woman's life. This study explores the lived experience of women with POP.

METHODOLOGY

A qualitative study was undertaken. Following institutional ethical approval women from an online peer support group (n = 930 members) were recruited to participate in semi-structured interviews. Inclusion criteria stipulated women (> 18years), pre-menopausal, at least one-year post-partum, diagnosed with POP and aware of their diagnosis. Semi-structured interviews were undertaken with a clinician specialising in pelvic health. A battery of questions was designed to elicit discussion on their experience of being diagnosed with POP and its impact on daily life and relationships. Interviews were carried out via Zoom, recorded and transcribed. Thematic analysis was undertaken.

FINDINGS

Fourteen women (32-41 years), para 1-3 participated. All had at least one vaginal birth; three had vacuum, four had forceps operative births. All had Grade 1-3 POP. Interviews lasted 40-100 minutes. Three core themes with subthemes were identified; biological/physical, psychological and social. Women were particularly affected in terms of sport and exercise participation, their own perceptions of their ability as mothers and fear of their condition worsening. They described societal attitudes, reporting stigma around POP and women's pelvic health in general, expectations placed on women to put up with their symptoms and an idealised perception of new motherhood.

CONCLUSIONS

The impact of POP from a biopsychosocial perspective reflects other chronic conditions. Prevention, early education and supports for developing strong self-management approaches would be beneficial for long term management of this condition.

What do women want? Migrant and refugee women's preferences for the delivery of sexual and reproductive healthcare and information

OBJECTIVE

Migrant and refugee women experience inequities in sexual and reproductive health (SRH) care, reflected in the low uptake of SRH services. It is essential for healthcare providers and educators to be aware of women's preferences for SRH information and service delivery, to provide culturally responsive care. Identifying migrant and refugee women's preferences for SRH information and service delivery is the objective of this study.

DESIGN

This study investigated this issue, in communities of migrant and refugee women living in Australia and Canada. Eighty-four individual interviews and 16 focus groups comprising 85 participants were conducted (total n = 169), with migrant and refugee women aged 18 years and over from Afghanistan, India (Punjab), Iraq, Somalia, South Sudan, Sri-Lanka (Tamil), Sudan and various South American (Latina) backgrounds. Nine individual interviews were also undertaken with community interviewers, who were migrant or refugee women themselves.

RESULTS

Thematic analyses identified that migrant and refugee women are enthusiastic to learn about SRH across the lifespan, using a variety of modalities including group education delivered by community leaders; online and written material; and information provided by general practitioners. Participants emphasised the need for empathetic SRH care, which encompassed longer times for consultations, being seen as experts of their own bodies, privacy and healthcare provided by women practitioners. Greater engagement with migrant and refugee men was positioned as an additional solution to addressing SRH concerns of women.

CONCLUSION

Insights from this study can help facilitate the co-design and evaluation of acceptable and sustainable programs to address inequities in SRH experienced by migrant and refugee women.

The scarlet V: how women with dyspareunia negotiate postfeminist discourses of sexual agency

Young women must often contend with cultural scripts dictating neoliberal/postfeminist ideals of female sexual agency, including the ability to act in accord with one's personal sexual self-interest. The aim of this study was to explore how young women (n = 26) living with dyspareunia (pain experienced during penetrative sexual activity) negotiate these ideals. We found that in addition to discussing traditional discourses that assign value to women in accordance with their perceived sexual virtue, women judged themselves according to the degree to which their behaviour reflected sexual agency. Women perceived to be sexually agentic were, for the most part, lauded, while those perceived to lack sexual agency were either denigrated (in the case of high sexual activity) or seen as deficient (in the case of low sexual activity). The inability to be penetrated without pain significantly limited women's sexual repertoires. Contrasting their sexual agency with that of other women and of their past selves, women expressed feelings of disempowerment. Conceptualising agency as a spectrum rather than something that one has or lacks, as well as actively cultivating the potentialities of sexual 'transgression', may allow young women to resist heteronormative sexual hierarchies - including those rooted in a a postfeminist ethos.

Moderators of the Relationship Between Pain and Pain-Related Sexual Disability in Women with Provoked Vestibulodynia Symptoms

BACKGROUND

Previous studies have demonstrated the deleterious effects of pain anxiety (ie, the degree to which one fears pain), stress, and solicitous partner responses (ie, expressions of sympathy and attention to one's partner's pain) on pain and pain-related disability, but little is known about whether these variables moderate the robust pain-pain-related disability relationship in individuals with provoked vestibulodynia (PVD).

AIM

We investigated whether pain anxiety, stress, and solicitous partner responses moderated the relationship between penetrative pain and pain-related sexual disability in women with PVD symptoms.

METHODS

Participants with PVD symptoms (N = 65, age range = 18-73 years) completed an online survey assessing pain anxiety (Pain Anxiety Symptoms Scale-20), perceived stress (Perceived Stress Scale), solicitous partner responses (WHYMPI Solicitous Responses Scale), penetrative pain (Female Sexual Function Index), and pain-related sexual disability (Pain Disability Index). Moderated regression analyses were performed using pain anxiety, stress, and solicitous partner responses as moderators of the relationship between penetrative pain, and pain-related sexual disability.

OUTCOMES

Outcomes in the current study included the moderating effect of pain anxiety, perceived stress, and solicitous partner responses on the relationship between penetrative genital pain and pain-related disability in sexual behavior.

RESULTS

Higher genital pain from penetrative intercourse and higher pain anxiety significantly predicted higher pain-related sexual disability, but perceived stress was not significantly related to sexual disability. Solicitous partner responses were significantly positively correlated with pain-related sexual disability. None of the moderators significantly moderated the pain-pain-related sexual disability relationship.

CLINICAL IMPLICATIONS

For women with PVD, pain anxiety and solicitous partner responses to their pain may exacerbate their pain-related sexual disability, signifying that pain anxiety and solicitous partner responses represent important targets of therapeutic intervention for women with PVD.

STRENGTHS AND LIMITATIONS

The present study extended past research on the relationships between psychological and behavioral factors and pain in women with PVD symptoms by demonstrating the deleterious relationship between pain anxiety, solicitous responses, and pain-related sexual disability. However, the study was correlational in nature, which precludes conclusions about the effect of pain anxiety, and solicitous partner responses on pain-related sexual disability.

CONCLUSION

High pain anxiety and frequent solicitous partner responses to an individual's pain predicted higher pain-related sexual disability, suggesting that it may be possible to improve the quality of life of PVD sufferers through interventions that aim to decrease pain anxiety, and solicitous partner responses, in addition to interventions that aim to decrease pain per se. Maunder L, Dargie E, Pukall C. Moderators of the Relationship Between Pain and Pain-Related Sexual Disability in Women with Provoked Vestibulodynia Symptoms. J Sex Med 2022;19:809-822.

Care Seeking for Chronic Vulvar Pain Among a Large, Population-Based Sample of Reproductive-Aged Women

Background: Chronic vulvar pain is a prevalent but often misdiagnosed and undertreated condition that adversely impacts quality of life. A large proportion of women report not seeking care for chronic vulvar pain, but little is known about the factors that underlie care-seeking decisions. Materials and Methods: We used a large, population-based survey of women aged 18-40 years to assess a history of chronic vulvar burning, pain on contact, or itching that had lasted ≥3 months. The survey also captured demographic characteristics and comorbidities. Women were asked if they had ever sought care for their chronic vulvar condition. Demographic characteristics and comorbidities were evaluated across pain categories and by care-seeking behaviors. Results: A higher proportion of women who described their pain as burning only and both burning and pain on contact had sought care for their pain (69.2% and 85.2%, respectively) compared with pain on contact only (41.8%). Women who described their pain as pain on contact only were also less likely to see multiple providers and to have ever received treatment for their pain. Care seekers were more likely to be married, have a college education, have a normal body mass index, and have multiple gynecologic comorbidities. Conclusions: Our study suggests that care-seeking behavior varies by pain type. Less than half of women who characterized their pain as pain on contact had sought medical care. Those who did seek care reported seeing fewer providers than those who experienced burning. Providers may wish to proactively ask patients about pain on contact.

“A day-to-day struggle”: A comparative qualitative study on experiences of women with endometriosis and chronic pelvic pain

Chronic pelvic pain (CPP) in women is a term that encompasses a range of conditions, including endometriosis, vulvodynia, painful bladder syndrome and adenomyosis. Given the impact on penetrative sex, fertility and potentially motherhood, CPP may also impact on women's identities as a wife or partner, a mother, and a woman. The aim of this study was to explore similarities and differences in experiences of women with endometriosis and non-endometriosis related CPP. A total of 17 participants aged between 21 and 48 years old participated in three focus groups. Using reflexive thematic analysis three main themes were found: the struggling woman, the unheard woman and the self-silenced woman. Women, regardless of the cause of their CPP, reported significant impacts on their intimate relationships, fertility, and parenting but those with non-endometriosis CPP often reported greater trouble communicating about pelvic pain in the workplace due to the “taboo” nature of discussing their vulval pain. Many participants described how a societal normalisation of pelvic pain resulted in women silencing their experiences, rendering their pain invisible. While women wanted to resist such silencing through information and support seeking, women with non-endometriosis CPP described fewer avenues to accessing credible informational resources or networks for support.

Development and Validation of a Scale for Assessing the Interference of Chronic Primary Pain Conditions in Sexual Functioning: The Sex-Pain Questionnaire

Chronic pain represents one of the main health public problems worldwide and significantly affects the sexual life of patients. However, no specific instruments of evaluation have been found that address this population. This study presents the SEX-PAIN Questionnaire, developed for identifying chronic pain's interference with sexual functioning among people with chronic pain. Methods. The validation has been carried out with a sample of 303 Spanish non-hospitalized patients with chronic pain diagnosis aged between 20 and 71 years old (Mage = 49.49; SD = 10.7). Exploratory Factor Analysis (EFA) yielded 2-factor structure: Sexual and Relationship Dissatisfaction, and Chronic Pain Impact on Sexual Life. This structure was later verified through Confirmatory Factor Analysis (CFA). Internal consistency (Omega) of each factor was .72 and .96, respectively. This study presents the psychometric properties of a new measure addressed to patients with chronic pain. This 17-items self-administered instrument can be a useful measure of the chronic pain's interference with sexual functioning among chronic pain patients. It represents the first original questionnaire known in Spanish language to date. This measure could potentially help researchers and clinicians to obtain key information to design appropriate healthcare interventions.Supplemental data for this article is available online at https://doi.org/10.1080/0092623X.2022.2039336 .

Sexual Health Dysfunction After Radiotherapy for Gynecological Cancer: Role of Physical Rehabilitation Including Pelvic Floor Muscle Training

Introduction

The present study aims to describe: 1. How the side effects of radiotherapy (RT) could impact sexual health in women; 2. The effectiveness of physical rehabilitation including pelvic floor muscle training (PFMT) in the management of sexual dysfunction after RT.

Materials and Methods

Search keys on PubMed, Web of Science, Scopus, PEDro, and Cochrane were used to identify studies on women treated with radical or adjuvant RT and/or brachytherapy for gynecological cancers with an emphasis on vulvo-vaginal toxicities and PFMT studies on sexual dysfunction for this group of women.

Results

Regarding the first key question, we analyzed 19 studies including a total of 2,739 women who reported vaginal dryness, stenosis, and pain as the most common side effects. Reports of dosimetric risk factors and dose-effect data for vaginal and vulvar post-RT toxicities are scant. Only five studies, including three randomized controlled trials (RCTs), were found to report the effect of PFMT alone or in combination with other treatments. The results showed some evidence for the effect of training modalities including PFMT, but to date, there is insufficient evidence from high-quality studies to draw any conclusion of a possible effect.

Conclusions

Gynecological toxicities after RT are common, and their management is challenging. The few data available for a rehabilitative approach on post-actinic vulvo-vaginal side effects are encouraging. Large and well-designed RCTs with the long-term follow-up that investigate the effect of PFMT on vulvo-vaginal tissues and pelvic floor muscle function are needed to provide further guidance for clinical management.

A Network Analysis of Selected Psychosocial Factors in Vulvodynia and Its Subtypes

OBJECTIVE

Psychosocial factors are related to pain and sex-related outcomes in provoked vulvodynia and possibly in mixed and spontaneous vulvodynia. However, a broader behavioral framework, such as the psychological flexibility model, has received limited attention in this context. Recently, additional psychosocial variables have also emerged that appear relevant to vulvodynia, including perceived injustice, body-exposure anxiety during intercourse, and unmitigated sexual communion. The present study applied network analysis to explore relations between psychological flexibility, newly emerging psychosocial variables relevant to vulvodynia, and their associations with vulvodynia outcomes. The study also explored potential differences across vulvodynia subtypes.

DESIGN

An online cross-sectional study of 349 participants with vulvodynia (112 provoked, 237 spontaneous/mixed) was carried out.

METHODS

Participants completed self-report questionnaires, including questions on pain and sexual outcomes, depression, facets of psychological flexibility, body-exposure anxiety during intercourse, unmitigated sexual communion, and perceived injustice. Networks were computed for the total sample and for provoked and mixed/spontaneous vulvodynia subsamples.

RESULTS

Perceived injustice, pain acceptance, and depression were "central" factors among the included variables, in all models. Psychological flexibility processes were relevant for all networks. Depression was more central in the network for mixed/spontaneous vulvodynia; body-exposure anxiety during intercourse was most central for the provoked subtype.

CONCLUSIONS

Among the included variables, perceived injustice, pain acceptance, depression, and psychological flexibility appear to be important in vulvodynia. As different factors are significant across subtypes, tailored treatment approaches are suggested.

Managing Female Sexual Pain

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.

The role of psychological flexibility, perceived injustice and body image in Vulvodynia: A longitudinal study

BACKGROUND

Women with Vulvodynia experience pain, related impacts on sex and daily functioning, and depression. While psychosocial factors are associated with outcomes in Vulvodynia, longitudinal data are limited, especially in mixed/spontaneous Vulvodynia. Broad psychological models such as psychological flexibility (PF) and content-specific factors, such as body-exposure anxiety (BEA) and avoidance during sexual activities and perceived injustice, have not been adequately investigated in Vulvodynia. The aim of this study was to explore whether these factors assessed at baseline predict pain severity, pain interference, sexual functioning and satisfaction and depression 3 months later.

METHODS

A longitudinal study of 349 women with Vulvodynia was conducted. Participants completed online self-report measures of pain-related and sexual outcomes, depression, BEA, perceived injustice and facets of PF (present moment awareness, pain acceptance, committed action) at baseline and after 3 months, overlapping with the Coronavirus disease 2019 (COVID-19) pandemic.

RESULTS

Seventy percent of women responded at both assessments (n = 244). There were significant decreases in pain severity, pain interference, present moment awareness, committed action and a significant increase in depression at 3 months. All the baseline psychosocial factors significantly correlated with at least one outcome at 3 months. When adjusting for baseline outcome and demographics, committed action significantly positively predicted depression at 3 months and pain acceptance significantly positively predicted pain interference at 3 months.

CONCLUSIONS

Among women with Vulvodynia, pain acceptance and committed action are prospectively associated with pain interference and depression. The reliability and generalizability of these results needs to be established given the overlap with the COVID-19 pandemic. Future studies should investigate whether targeting these factors enhances outcomes in Vulvodynia.

SIGNIFICANCE

This longitudinal study explored the role of PF, perceived injustice and body image during sexual activities in predicting pain severity, pain interference, sexual functioning, sexual satisfaction and depression in women with Vulvodynia. The study findings reveal that two facets of PF (committed action and pain acceptance) predicted pain interference and depression over time. It may be important to incorporate these processes in treatments developed for Vulvodynia.

"A Woman Should Still Be a Woman" - A Grounded Theory of the Origins of Sexual Pain and Difficulties with Intercourse

The origin of women's sexual pain and difficulties with intercourse is still under-researched. The aim of this study was to examine women's constructions of origins. Twenty-eight participants previously diagnosed with vaginismus or dyspareunia were recruited via patient lists and private practices. Interviews had a semi-structured biographic-narrative format; transcripts were analyzed using Grounded Theory. Participants' narratives were constructed based on two major processes: Negotiating Womanhood and Othering the Body. They were integrated in an explanatory model. Identified processes permeated women's subjective experience and construction of the origin of their sexual difficulties, and were related to societal discourses and women's embodied experience.

Middle-aged Lebanese women's interpretation of sexual difficulties: a qualitative inquiry

BACKGROUND

The study explores women's perception and experience of sexual difficulties. The need to address the subject was triggered by the scarcity of research that reflects on women's subjective views on sexual difficulties. This is particularly crucial for middle-aged women who frequently experience hormonal and psychosocial changes that may affect their sexual life.

METHODS

Using in-depth individual and focus groups interviews, 52 Lebanese women aged 40-55 years discussed their thoughts, feelings and behaviours concerning sexual difficulties. Women were recruited purposefully from clinical and non-clinical settings to get maximum sampling variation that provided rich information and deep understanding of the subject. Recordings were transcribed verbatim and analysed about the framework analysis. Many strategies were adopted to ensure rigour.

RESULTS

Women's narratives led to four themes: women's inability to communicate sexual desires and concerns; male sexual difficulties; marital conflicts; and sexual difficulties as context-bound. Women's sexual difficulties are driven by double standards and inhibiting sexual socialisation. Once married, many women had very challenging sexual experiences. They were obliged to silently bear their husbands' poor sexual performance to protect their masculinity and thus their social image and identity. Women's narratives also showed that marital conflicts, daily life problems as well as physical and psychological burdens further challenged their sexual wellbeing and contributed to their sexual difficulties.

CONCLUSION

The study makes a unique contribution to voicing women's views and concerns as sexuality is insufficiently researched and reported in Lebanon. It emphasises the multidimensional nature of female sexual difficulties, particularly the gender-based norms that inhibit their sexual selves and profoundly affect their sexual wellbeing and capacity to claim their sexual likes and dislikes. Findings have implications on research and practice to help women prevent and overcome their sexual difficulties.

Exploring Relationships Between Genito-Pelvic Pain/Penetration Disorder, Sex Guilt, and Religiosity Among College Women in the U.S

INTRODUCTION

Despite a growing body of research on psychosocial factors in Genito-Pelvic Pain/Penetration Disorder (GPPPD) during sexual intercourse, there are few studies examining adolescent and young adult women's experiences with painful sex and the effects of religiosity, sexual education, and sex guilt.

AIM

The purpose of the study was to examine the occurrence of GPPPD among sexually active female college students, including psychosocial factors of religiosity and religious practice, sexual education, sex guilt, and sexual distress.

METHODS

Data were collected from 974 college women from a university in the Northeastern U.S. We limited our sample to sexually active women (n = 593, 60.9%; mean age: 18.96) who responded to the questionnaire item, "In general, do you feel pain with sexual intercourse?" Participants completed the Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS), Revised Mosher Sex Guilt Scale, Abbreviated Santa Clara Strength of Religious Faith Questionnaire, 10-item Gender Role Beliefs Scale, and measures on sexual wellness and practice and sexual education experiences. Data were analyzed using standard bivariate and regression analyses as well as path analysis.

MAIN OUTCOME MEASURES

Women were asked, "In general, do you feel pain with sexual intercourse?" and categorized into one of three pain groups: occasional (10%-25% of the time), frequent (50% or more), and no pain (less than 10%).

RESULTS

GPPPD with sex was prevalent among young college women, with 113 (19.1%) reporting frequent pain and 143 (24.1%) occasional pain (control n = 337, 56.8%). Numerous statistically significant factors were identified, including frequency of sex, ability to orgasm, sensations during intercourse, presence of a steady sexual partner, expectations of painful sex, sex guilt, and sexual distress. Sex guilt acted as full mediator between religiosity and painful sex.

IMPLICATIONS

Healthcare providers should proactively initiate conversations with young female patients about painful intercourse to identify issues and normalize language on pain with sex. Educators are urged to teach evidence-based information on pain-free and guilt-free sexual experiences inside and outside religious contexts.

CONCLUSION

Painful sex affects adolescent and young adult women at a similar rate as non-college adult women and while religiosity does not directly impact young women's GPPPD, religiosity does lead to painful sex if it causes sex guilt. Further research is needed into the mechanisms of religion-based sexual shaming and among religiously conservative women who practice abstinence until marriage. Azim KA, Happel-Parkins A, Moses A, et al. Exploring Relationships Between Genito-Pelvic Pain/Penetration Disorder, Sex Guilt, and Religiosity Among College Women in the U.S. J Sex Med 2021;18:770-782.

Exploring the Effect of a Promotion and Prevention Regulatory Focus on Subjective Responses to Vaginal Sensations in a Laboratory Research Design

BACKGROUND

Self-regulation is an important process to explain sexual, emotional, and pain-related responses in the context of genital pain. Although highly relevant, self-regulatory focus theory is not well integrated into the literature on genital pain.

AIM

This study explored the impact of a promotion and prevention regulatory focus on genital pain responding. Sex would typically endorse a promotion focus, whereas pain during sex is likely to provoke a prevention focus oriented toward harm avoidance and safety.

METHOD

We induced gradually increasing vaginal pressure in a sample of 56 women using an intra-vaginal balloon that simulated potentially painful vaginal sensations. Women were first primed with a promotion vs prevention focus by making them list their ideals vs responsibilities as a sexual partner. We measured trait regulatory focus, pleasant and painful vaginal pressure sensations, sexual arousal, expectations, and approach-avoidance motivational tendencies.

MAIN OUTCOME

The effect of trait and state promotion and prevention regulatory focuses on the appraisal of vaginal pressure and sexual arousal.

RESULTS

When primed with a prevention compared with a promotion focus, women with a predominant prevention orientation reported less sexual arousal, less pleasant vaginal pressure appraisals, and lower approach tendencies regarding sexual stimuli. Women who experienced a match between their state and trait promotion focus appraised the vaginal pressure as less painful. No significant effects of regulatory focus were found on the expectancy measures.

STRENGTHS AND LIMITATIONS

We provided first evidence on self-regulatory motivation in the context of genital pain responses using an experimentally controlled laboratory design. Our sample was small and consisted of young students without (a clinical diagnosis of) genital pain, which limits our conclusions on the effect of promotion vs prevention regulation on genital pain responses.

CLINICAL IMPLICATIONS

Future research is needed to examine the clinical value of self-regulation and regulatory fit and to identify possible ways to target self-regulatory motivation in clinical interventions of genital pain.

CONCLUSION

Self-regulatory focus theory has clear potential to explain the sexual and motivational correlates of genital pain. Dewitte M and Kindermans H. Exploring the Effect of a Promotion and Prevention Regulatory Focus on Subjective Responses to Vaginal Sensations in a Laboratory Research Design. J Sex Med 2021;18:303-314.

Psychological Inflexibility as a Predictor of Sexual Functioning Among Women with Vulvovaginal Pain: A Prospective Investigation

Objective

Persistent vulvovaginal pain affects many women and often has adverse effects on sexual functioning. Psychological inflexibility related to pain is associated with distress and functional disability across different types of chronic pain conditions, but little is known about the role of psychological inflexibility in vulvovaginal pain. The present study examines psychological inflexibility related to pain as a predictor of sexual functioning over time among women with vulvovaginal pain.

Methods

Questionnaires including measures of psychological inflexibility, pain severity, and sexual functioning were administered to female university students at two points in time. One hundred thirty women with vulvovaginal pain responded to the questionnaire at baseline and at follow-up after 10 months. A multiple regression model was used to explore psychological inflexibility and pain severity as predictors of sexual functioning at follow-up.

Results

Higher levels of psychological inflexibility and more severe pain at baseline were associated with poorer sexual functioning 10 months later. In analysis adjusting for baseline levels of sexual functioning, psychological inflexibility was the only significant predictor of sexual functioning at follow-up.

Conclusions

The findings provide preliminary evidence that psychological inflexibility is associated with sexual adjustment over time among women with vulvovaginal pain and point to the relevance of further examinations of the psychological inflexibility model in the context of vulvovaginal pain.

Vulvodynia Viewed From a Disease Prevention Framework: Insights From Patient Perspectives

INTRODUCTION

Persons with vulvodynia (a chronic vulvar pain condition) suffer many barriers to diagnosis and treatment, several of which may be exacerbated by the sociocultural and geographical context in which they live.

AIM

We drew on the experiences of patients with vulvodynia who were living in small urban and rural communities to learn what they perceived as the major barriers to diagnosis and treatment as well as to probe for possible solutions.

METHODS

For this qualitative case study, we conducted 3 focus groups with a total of 10 participants, drawn from patients seen at our academic tertiary referral center, with a goal of understanding their lived experience with vulvodynia.

MAIN OUTCOME MEASURES

The patient dialogue was coded into themes and temporally grouped to illustrate struggles and victories in diagnosis and treatment.

RESULTS

Participants confirmed that healthcare provider knowledge and attitudes as well as system challenges (specialist and allied healthcare provider availability) are major barriers to timely diagnosis. Of novel interest are other factors that exacerbate distress and delay diagnosis such as patients' inadequate knowledge of sexual functioning and sociocultural messages regarding "normal" sexual activity. Our work suggests that a disease prevention framework that includes comprehensive sexual education before or at the onset of sexual activity may be of benefit in reducing the burden of vulvodynia when added to strategies to increase healthcare provider knowledge and improve access to effective treatments.

CONCLUSION

While healthcare provider knowledge and attitudes are often at the forefront of barriers to diagnosis, our study suggests that to minimize patient distress and expedite diagnosis, resources must also be directed to promoting comprehensive sexual health education. Webber V, Miller ME, Gustafson DL, et al. Vulvodynia Viewed From a Disease Prevention Framework: Insights From Patient Perspectives. Sex Med 2020;8:757-766.

The gender context of pain

Pain is a major source of global suffering, with women bearing the greatest burden. Alongside biology, psychological and social factors, including gender, help explain these differences. However, there has been no direct attempt to develop a unified social psychological model of men and women's pain. By drawing on approaches to both gender and pain, a gender context model of pain is presented. It proposes that pain is partly influenced by the gender context in which it occurs, which operates at both individual and interpersonal levels. The model is used to structure an appraisal of the existing evidence around gender and pain, and explore whether the model helps explain why such variation occurs. It is argued that despite evidence for an association between gender and pain, there are empirical gaps that need to be addressed. Implications and directions for future investigations into sex, gender and pain are considered.

“The most lonely condition I can imagine”: Psychosocial impacts of endometriosis on women’s identity

Endometriosis is a condition which affects around 1–2% of women worldwide and has profound effects on their everyday lives. Previous research has tended to focus on physical symptoms (such as chronic pain); how women manage changes to their identity and relationships as a result of endometriosis has received less attention. This paper discusses qualitative data examining how women negotiate changes to identity while living with endometriosis, in a social context where women are expected to minimise their symptoms and conform to feminine role expectations. We conducted thematic analysis of 34 replies to an online survey seeking qualitative text responses. The women identified disruptions to personal identity as a result of living with endometriosis. They talked about not feeling like themselves (Theme 1) and about reactions from medical and social connections prompting feelings that they were going “mad” (Theme 2). Participants also expressed feeling as though they were a burden to loved ones (Theme 3), which often resulted in self-silencing (Theme 4). Findings are discussed in the context of Western expectations of women’s roles in social relationships and suggest that professionals who support women with endometriosis should be aware of strategies such as self-silencing which may reduce effective self-care.

Are Depressive Symptoms and Attachment Styles Associated with Observed and Perceived Partner Responsiveness in Couples Coping With Genito-Pelvic Pain ?

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.

Vulvodynia

Vulvodynia is a condition that occurs in 8-10% of women of all ages and is characterized by pain at the vulva that is present during sexual and/or non-sexual situations. Diagnosis is established through careful medical history and pelvic examination, including the cotton-swab test. The onset and maintenance of vulvodynia involves a complex interplay of peripheral and central pain mechanisms, pelvic floor muscle and autonomic dysfunction, anxiety, depression and childhood maltreatment as well as cognitive-affective, behavioural and interpersonal factors. Given the absence of empirically supported treatment guidelines, a stepwise approach of pelvic floor physical therapy and cognitive behavioural therapy as well as medical management is suggested, with surgery as the last option. Vulvodynia has a negative effect on the quality of life of women and their partners, and imposes a profound personal and societal economic burden. In addition, women with vulvodynia are more likely to report other chronic pain conditions, which further alters their quality of life. Future efforts should aim to increase girls', women's and healthcare professionals' education and awareness of vulvodynia, phenotype different subgroups of women based on biopsychosocial characteristics among more diverse samples, conduct longitudinal studies and improve clinical trial designs.

Self-Focused Reasons for Having Sex: Associations Between Sexual Goals and Women's Pain and Sexual and Psychological Well-being for Couples Coping With Provoked Vestibulodynia

BACKGROUND

For couples coping with provoked vestibulodynia (PVD), interpersonal sexual goals are associated with sexual and psychological functioning as well as women's pain during intercourse, however, self-focused sexual goals (eg, having sex for personal pleasure, having sex to avoid feeling bad about oneself) have not been studied in this clinical population.

AIM

The purpose of this study was to examine the associations between self-focused approach and avoidance sexual goals and women's pain during intercourse and sexual satisfaction and depressive symptoms for both women and their partners.

METHODS

Women diagnosed with PVD (N = 69) and their partners completed measures of self-focused sexual goals, sexual satisfaction, and depressive symptoms. Women also reported on pain experienced during sexual intercourse.

OUTCOMES

Outcomes included the Global Measure of Sexual Satisfaction, the Beck Depression Inventory-II, and a Numerical Rating Scale of pain during sexual intercourse.

RESULTS

When women reported higher self-focused approach sexual goals, they also reported lower pain intensity. Women's higher self-focused avoidance sexual goals were associated with their own higher depressive symptoms, whereas men's higher self-focused approach goals were associated with their own higher depressive symptoms. When controlling for frequency of sexual intercourse, there were no significant associations between women or partners' sexual goals and sexual satisfaction.

CLINICAL IMPLICATIONS

Within a clinical context where many interpersonal pressures for sex exist, interventions should target self-focused sexual goals alongside interpersonal sexual goals to improve pain and psychological adjustment.

STRENGTHS & LIMITATIONS

This is the first study to examine self-focused sexual goals among women with PVD and their partners. This study is cross-sectional, and the direction of associations cannot be inferred. Couples were in mixed-sex relationships, and results may not generalize to same-sex couples.

CONCLUSION

Findings suggest that self-focused goals are relevant to the psychological adjustment of women with PVD and their male partners and for women's pain. Corsini-Munt S, Bergeron S, Rosen NO. Self-Focused Reasons for Having Sex: Associations Between Sexual Goals and Women's Pain and Sexual and Psychological Well-being for Couples Coping With Provoked Vestibulodynia. J Sex Med 2020;17:975-984.

Biased Partner Perceptions of Women's Pain Self-Efficacy in Postpartum Pain During Intercourse: A Dyadic Longitudinal Examination

Postpartum pain during intercourse is a prevalent and distressing problem that has substantial consequences for affected couples. Partner perceptions-such as how partners perceive women's pain self-efficacy-contribute to an individual's pain experience. This study examined whether partners under- or over-estimate women's intercourse pain self-efficacy at 3-months postpartum and the implications of this bias for women's pain and couples' sexual functioning at 3- and 6-months postpartum. Women who reported pain during intercourse and their partners (N = 89 couples) completed online measures assessing pain self-efficacy (own or partner perceptions), pain intensity, and sexual functioning at 3- and 6-months postpartum. Analyses were based on the Truth and Bias Model of Judgement and Response Surface Analysis. Partners were accurate in their estimates of women's pain self-efficacy (ie, their estimates were positively correlated with women's), but they also underestimated it by perceiving women to be less efficacious than women themselves reported. When couples showed greater agreement for lower levels of pain self-efficacy at 3 months, women reported greater pain intensity and both partners reported poorer sexual functioning at 3- and 6-months postpartum. Findings may inform interventions that promote pain self-efficacy to improve partner support and couples' sexual functioning. PERSPECTIVE: When women report-and their partners perceive-low levels of women's self-efficacy for managing painful intercourse, women report greater postpartum pain during intercourse and couples indicate poorer sexual functioning. These findings suggest that interventions aimed at promoting couples' agreement at high pain self-efficacy may improve their adjustment to postpartum pain.

Relationship Context Moderates Couple Congruence in Ratings of Sexual Arousal and Pain During Vaginal Sensations in the Laboratory

Genital pain is a social experience that needs to be studied as a dyadic interaction between partners. The present study relied on a sample of 42 heterosexual couples to examine the level of congruence between both partners' ratings of pain and sexual arousal in response to experimentally induced vaginal pressure that served as a simulation of vaginal sensations during penetration. We also inferred the men's ability to estimate their partner's level of pain and sexual arousal. Because the relationship has shown to influence pain estimations, we considered the moderating role of perceived partner responsiveness and relationship satisfaction. We found higher disagreement in pain ratings when vaginal pressure was induced in the context of a sexual film compared to a neutral film, with men overestimating the level of pain in women. Also sexual arousal ratings diverged between partners, with men underestimating their partners' level of sexual arousal during the induction of vaginal pressure, regardless of whether they were watching a sexual or neutral film. Importantly, the level of congruence between actual and estimated ratings of pain and sexual arousal depended on how relationally satisfied men and women were and how validated and supported women felt by their male partner. These results make an important contribution to the growing literature on the social determinants of sexual pain experiences.

"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

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.

Persons with Complex Regional Pain Syndrome Renegotiate Social Roles and Intimacy: A Qualitative Study

Objective

Persons with complex regional pain syndrome often experience allodynia, where touch is painful. Allodynia is associated with poor prognosis, but the impacts on roles, activities, social relationships, and intimacy remain unclear. There is a need to examine intimacy in complex regional pain syndrome from a lived experience perspective.

Methods

We conducted a secondary analysis of cognitive debriefing interview data from 44 persons with complex regional pain syndrome who completed a patient-reported questionnaire. Using interpretive description and thematic analysis, we analyzed items and responses addressing allodynia, relationships, and intimacy.

Results

Two themes were developed to understand intimacy related to the pain experience: a renegotiated social identity and participation and a reinvented intimate self. These themes included elements of a) loss of control, b) loss of shared experiences, c) feeling that their condition was misunderstood, d) a need for self-preservation, e) altered self-concept, and e) the concept of intimacy is broader than sexuality. Our findings suggest that complex regional pain syndrome has pervasive impacts on relationships and intimacy that merit discussion with their health care team.

Conclusions

Persons with persistent pain need to be supported in roles and activities that allow them to express intimacy in their everyday lives.

Current usage of qualitative research in female pelvic pain: a systematic review

PURPOSE

Qualitative research has received growing attention in the multidisciplinary investigation of patients' perceptions about chronic diseases. The purpose of this systematic review was to characterize the usage of qualitative research in women with chronic pelvic pain (CPP).

METHODS

We performed a structured search in Web of Science, Pubmed, and EMBASE platforms until June 2019. The search combined the keywords: "pelvic pain", "endometriosis", "dyspareunia", "dysmenorrhea", "vaginismus", "focus groups", "qualitative research", "hermeneutics", "grounded theory", and "women". Qualitative studies on female CPP were included and the main findings combined using thematic synthesis.

RESULTS

We found 1211 citations, of which 52 were included in this review. The majority of included studies were based on phenomenological design. The main method for data collection was semi-structured interviews. Endometriosis was the theme of 23 studies, chronic pelvic pain of eight, dysmenorrhea of eight, dyspareunia of four, interstitial cystitis of two, vaginismus of two, vulvodynia of two, and pelvic inflammatory disease of one study. We found a wide variety of contributions. Among them, the impact of the disease on women's lives was the commonest.

CONCLUSION

Qualitative research has the potential to reveal and explain several aspects of CPP in women. The medical community may better accept knowledge gained from these studies if the methods are described more transparently in published articles.

Genito-Pelvic Pain Through a Dyadic Lens: Moving Toward an Interpersonal Emotion Regulation Model of Women's Sexual Dysfunction

Researchers and clinicians alike widely acknowledge the inherently interpersonal nature of women's sexual dysfunctions given that both partners impact and are impacted by these difficulties. Yet theoretical models for understanding the role of interpersonal factors in women's sexual dysfunctions are severely lacking and have the potential to guide future research and inform more effective interventions. The most widely studied sexual dysfunction in women that has espoused a dyadic approach by including both members of affected couples is genito-pelvic pain/penetration disorder (GPPPD). In this article we use the example of GPPPD to introduce a novel interpersonal emotion regulation model of women's sexual dysfunction. We first review current knowledge regarding distal and proximal interpersonal factors in GPPPD. Then, we describe our theoretical model and consider relevant pain and sex-related research on emotion regulation processes-emotional awareness, expression, and experience-in the context of GPPPD, including sexual function, satisfaction, and distress. Next, we review how existing theories from the fields of chronic pain and sex and relationships research have informed our model and how our model further builds on them. Finally, we discuss the implications of our model and its applications, including to other sexual dysfunctions in women.

Negotiating sexual agency in marriage: The experience of migrant and refugee women

In this study, adult migrant and refugee women's negotiation of sexual agency in the context of marriage is explored. In Sydney, Australia and Vancouver, Canada, 78 semistructured individual interviews, and 15 focus groups, comprised of 82 participants, were conducted with women who had recently migrated from Afghanistan, Iraq, Somalia, South Sudan, Sudan, Sri Lanka, and South America. Women's negotiation of sexual agency was evident with respect to husband choice, disclosure of sexual desire, pleasure, pain, and sexual consent. While some participants took up subjugated sexual subject positions reflecting dominant cultural or religious discourses, many women also resisted these discourses to enact sexual agency.

Women's Experiences of Vulvodynia: An Interpretative Phenomenological Analysis of the Journey Toward Diagnosis

Vulvodynia is the experience of idiopathic pain characterized by burning, soreness, or throbbing in the external female genitalia or vulva and is estimated to be experienced by 4-16% of the female population, yet only half of women seek help regarding their symptoms. Of the women who do seek help, only around 2% obtain a diagnosis. Therefore, the aim of the current study was to explore the experiences of women with vulvodynia on their journey toward diagnosis, by using semi-structured interviews and an interpretative phenomenological analysis (IPA) methodology. Eight women were interviewed, and their experiences were analyzed and interpreted into three master themes, each with constituent sub-themes: (1) The Journey Is a Battle, (2) "What Is Vulvodynia?": Ambivalence Toward Diagnosis, and (3) Patriarchy, Women, and Sex. Overall, women perceived a healthcare system which was dismissive and shaming, with an inadequate knowledge of vulvodynia. This in turn impacted on women's psychological well-being. Psychological understanding, one-to-one therapy, and consultation and training for healthcare professionals may help to improve the psychological well-being of women with vulvodynia.