A systematic review of relationship adjustment and sexual satisfaction among women with provoked vestibulodynia

A Network Analysis of the Fear Avoidance Model of Genital Pain

Using a novel data-driven network approach, this study aimed to examine the interconnection between the key elements of the Fear-Avoidance Model of female genital pain - sexual arousal, fear-avoidant cognitions, and motivational coping - and its associated factors to predict the intensity and frequency of genital pain across women over time. Network modeling allowed for a comprehensive evaluation of the Fear-Avoidance model while capturing the dynamic features of genital pain. We estimated a cross-sectional and a temporal, contemporaneous, and between-persons network model on convenience-based data of 543 female students (mean age = 23.7 years, SD = 3.6) collected at three time points. Results showed that lubrication, pain catastrophizing, pain avoidance, fear-avoidance beliefs, sexual satisfaction, anxiety, and frequency of coital and non-coital sex predicted pain, with lubrication being the most consistent predictor across estimations. The network of women with recurrent genital pain showed a similar pattern as the network of the total sample, except that pain avoidance and fear-avoidance beliefs rather than pain catastrophizing predicted pain directly, and frequency of coital and non-coital sexual activities played a more prominent role. These results suggest that the main problem of genital pain centers around women not being sufficiently aroused during intercourse and inadequate ways of pain coping, which are critical targets of cognitive-behavioral therapy treatment and should be developed further.

Interpersonal Experiences with Persistent Genital Arousal: Connections between Symptom Disclosure, Partner Responses, and Catastrophizing on Relationship Adjustment and Symptom Severity

Increased research attention to interpersonal factors in genitopelvic pain conditions, such as vulvodynia, have led to more comprehensive understanding of couple dynamics in pain, sexual, and relationship outcomes. There has been very little examination of interpersonal factors in Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia (PGAD/GPD), a distressing condition involving persistent sensations of arousal and often pain. The aims of the present study were to examine whether individuals disclose their symptoms to intimate partners and whether interpersonal variables (e.g., partner responses, symptom disclosure, and catastrophizing) are related to relationship adjustment and symptom severity. Seventy-six individuals with symptoms of PGAD/GPD participated in a one-time anonymous online survey. Over three-quarters (85.5%) of the sample disclosed their symptoms to their partners in some way. Greater supportive partner responses and lower symptom catastrophizing were related to better relationship adjustment among participants with PGAD/GPD symptoms. Greater symptom catastrophizing also predicted greater PGAD/GPD symptom severity. Partner responses were not related to PGAD/GPD symptom severity. Although interpersonal factors have been linked to symptom severity in chronic pain and genitopelvic pain conditions, the results of the current study suggest that interpersonal factors may play a slightly different role in PGAD/GPD symptom experiences and in the conceptualization of PGAD/GPD more broadly.

Fear Learning in Genital Pain: Toward a Biopsychosocial, Ecologically Valid Research and Treatment Model

Although fear learning mechanisms are implicated in the development, maintenance, exacerbation, and reduction of genital pain, systematic research on how fear of genital pain emerges, spreads, persists, and reemerges after treatment is lacking. This paper provides an overview of the literature on pain-related fear, integrates the ideas on learning and sexual arousal responding, and specifies the pathways through which compromised learning may contribute to the development and persistence of genital pain. In order to refine theories of genital pain and optimize treatments, we need to adopt a biopsychosocial framework to pain-related fear learning and uncover potential moderators that shape individual trajectories. This involves examining the role of physiological processes, subjective experiences, as well as partner and relational cues in fear acquisition, excessive generalization and impaired safety learning, extinction of fear, counterconditioning, and return of fear. Recent methodological advances in fear conditioning and sex research are promising to enable more symptom-specific and ecologically valid experimental paradigms.

Estimating the prevalence of dyspareunia according to mode of delivery: a systematic review and meta-analysis

The present study aimed to examine the prevalence of dyspareunia in the post-partum period in relation to the mode of delivery. In this systematic review and meta-analysis, published articles until February 2020 were searched through the related key term based on mesh term in national and international databases. In the initial search, 1391 articles were found that after removing duplicate, unrelated or non-English and non-Persian articles, finally 20 studies with a sample size of 11354 of women who had given birth were introduced in this study. The prevalence of dyspareunia following vaginal delivery, C-section, and instrumental delivery with 95%CI was 42%(31-56%), 26%(19-34%), and 37%(28-46%) respectively. In addition, the prevalence of dyspareunia in primiparous was higher than multiparous (34%vs.24%), in breastfeeding women was higher than non-breastfeeding women (48%vs.33%), in women who non-used hormonal contraceptive methods were higher than who used hormonal contraceptive methods (43%vs.35%) and its prevalence was similar in women with and without episiotomy. The results indicated that vaginal delivery, breastfeeding, used hormonal contraceptive and primiparity have an impact on dyspareunia. Thus, considering the high prevalence of dyspareunia, and its impact on the quality of life of couples in the postpartum period, attention to, planning, and designing effective interventions in this regard are essential.IMPACT STATEMENTWhat is already known on this subject? Dyspareunia is one of the common experiences of women in the post-partum period. One of the most important factors affecting dyspareunia in the post-partum period is the mode of delivery.What do the results of this study add? The present study adds to examine the prevalence of dyspareunia in the postpartum period in terms of the mode of delivery. So far, no study has been found which comprehensively and systematically estimating the prevalence of dyspareunia in relation to the type of delivery mode in women who have given birth recently. In addition to the type of delivery the prevalence of dyspareunia was estimated based on parity, breastfeeding, episiotomy and consumption of hormonal contraceptive status.What are the implications of these findings for clinical practice and/or further research? This finding will be a small step to familiarise physicians and midwives as well as people with the relationship between delivery mode and dyspareunia. In addition, in the absence of medical indications and the possibility of choosing the mode of delivery selectively, help them decide and choose the appropriate method of termination of labour and ultimately improve the mental and physical health of the birthing person, family and community.

Behavioral sex therapy and medications associated in the treatment of provoked vulvodynia: efficacy on pain and sexuality in three illustrative cases

This paper tests the hypothesis that medications combined with behavioral sex therapy might lessen pain and restore sexuality in women with provoked vulvodynia. Three women affected by vulvodynia, otherwise healthy, in heterosexual relationship were treated at the Department of Obstetrics and Gynecology in a university hospital. In consecutive sessions of behavioral sex therapy, oral tricyclic antidepressants and vulvar applications of estrogen and hydrocortisone creams were prescribed in association with vaginal dilators and sensate focus exercises. The outcome supports the hypothesis that combined medications and sexual behavior interventions may be effective in lessening pain and restoring sexuality in women with provoked vulvodynia. The different dyadic balances observed in this small case series suggest how to best use this protocol. The positive results appear to be mostly due to behavioral sex therapy that was the new element added to the combination of pharmacological agents commonly used to treat provoked vulvodynia.

An Exploration of Dyadic Relationship Approach-Avoidance Goals and Relationship and Sexual Satisfaction in Couples Coping with Endometriosis

Endometriosis affects women of reproductive age and is associated with higher levels of sexual and relational distress. Despite the relational context of endometriosis, the research pertaining to dyadic relationship goals is lacking. An exploration of the relationship goals of couples coping with endometriosis can facilitate the understanding of potential protective mechanisms that mitigate the relational components of the condition. Guided by the approach-avoidance theoretical framework, the current cross-sectional study aimed to examine the role relationship goals play in sexual and relationship satisfaction in couples coping with endometriosis. Approach goals relate to the pursuit of a positive outcomes, whereas avoidance goals relate to the avoidance of negative outcomes. Women with endometriosis and their partners (N = 61) completed an online survey measuring relationship goals and relationship and sexual satisfaction. The study results indicated that, for women, their own and their partner's higher relationship approach goals were linked to higher sexual satisfaction. For partners of women with endometriosis, their own higher relationship approach goals were associated with their own higher relationship satisfaction. Higher relationship avoidance goals in both women with endometriosis and partners were associated with higher relationship satisfaction. The study's findings highlight relationship goals as relevant to the relational and sexual experience of couples coping with endometriosis. When treating women with endometriosis, the inclusion of partners and consideration of factors beyond the physical illness are important for a holistic management approach.

Persistent Genital Arousal in Relationships: A Comparison of Relationship, Sexual, and Psychological Well-Being

BACKGROUND

Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia (PGAD/GPD) is characterized by sensations of physiological genital sexual arousal (and/or other types of genitopelvic dysesthesia) that occur in the absence of subjective feelings of sexual desire.

AIMS

The aim of this study was to compare relationship, sexual, and psychological well-being in partnered individuals with and without distressing symptoms of PGAD/GPD.

METHODS

The sample (N = 65 individuals with vulvas and vaginas, N = 11 individuals with penises) of 152 partnered individuals (N = 76 with and 76 without PGAD/GPD symptoms) participated in a one-time anonymous online survey.

OUTCOMES

The questionnaires assessed relationship satisfaction (Couple Satisfaction Index-Short Form, CSI); sexual satisfaction (Global Measure of Sexual Satisfaction, GMSEX); sexual functioning (Female Sexual Functioning Index, FSFI, or International Index of Erectile Functioning, IIEF); sexual distress (Sexual Distress Scale, SDS); and psychological well-being, as determined by the presence of depression and/or anxiety symptoms (Hospital Anxiety and Depression Scale, HADS).

RESULTS

Among individuals with vulvas and vaginas, those with PGAD/GPD symptoms reported significantly lower relationship and sexual satisfaction, greater sexual distress, and more symptoms of depression and anxiety than their counterparts in the control group. In addition, these individuals with PGAD/GPD symptoms also reported significantly worse sexual functioning (arousal, orgasm, satisfaction, and pain), and they were significantly more distressed about each aspect of their sexual functioning difficulties compared to those in the control group. Among the small sample of individuals with penises (N = 11), descriptive analyses revealed that total sexual functioning scores did not differ across the PGAD/GPD symptom and control groups. In addition, 64.5% of the total sample with PGAD/GPD symptoms managed unwanted genital arousal by avoiding sex with their partner, while 55.3% managed their symptoms by having sex with their partner, and some individuals with PGAD/GPD used both strategies.

CLINICAL IMPLICATIONS

The finding that PGAD/GPD symptoms impact relationships indicates that treatment for PGAD/GPD should include consideration of the well-being of one's intimate relationship(s).

STRENGTHS & LIMITATIONS

This study added to the small literature on experiences of PGAD/GPD in relationships, and it was the first to assess sexual satisfaction. Limitations include the small sample of individuals with penises, and the cross-sectional, correlational design, which does not allow for causal conclusions to be drawn.

CONCLUSION

Results emphasize the importance of continued research of this population (and their partners) in order to improve diagnosis, intervention, and recognition within the medical community. Mooney KM, Poirier É, Pukall CF., Persistent Genital Arousal in Relationships: A Comparison of Relationship, Sexual, and Psychological Well-Being. J Sex Med 2022;19:234-248.

#postbabyhankypanky: An Empirically Based Knowledge Sharing Initiative About Sex and the Transition to Parenthood

Despite the many sexual concerns experienced by new parents, and their reported desire for more information on this topic, both parents and healthcare providers remain reticent to broach the subject. The goal of this project was to disseminate evidence-based knowledge from our prior research in a way that was accessible, engaging, and would spark further interest and communication for both new parents and healthcare providers. We convened a multidisciplinary advisory group that also involved community parents who provided feedback at all phases of this project. We developed five brief YouTube videos, each featuring a core research finding. Following an empirically supported strategic knowledge translation plan, we disseminated the videos to our target audiences (i.e., expectant and new parents, healthcare providers, educators, and other stakeholders) using social media from February 2018 to November 2019. Data were collected using YouTube analytics and an online survey (convenience sample: N = 225 parents; N = 161 healthcare providers). From the date of the launch, the videos had a reach of 91,766 views from 14 countries, with viewers watching an average of 90% of a video. Overall, quantitative and qualitative survey results suggested that the videos were acceptable and appropriate, and respondents were more confident and comfortable discussing sexual issues (with their partner/with their patients) and would like more information about postpartum sexuality after watching the videos. YouTube videos are an acceptable and effective way to disseminate evidence aimed at raising awareness of factors affecting sexuality in the transition to parenthood.

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.

Couple Interventions for Chronic Pain: A Systematic Review

OBJECTIVE

Couple interventions for chronic pain have been shown to more effectively reduce pain intensity for individuals with chronic pain (ICPs) than individual behavioral interventions or usual care. This systematic review identified randomized controlled trials of couple interventions to highlight strategies that could be incorporated into psychotherapy with ICPs and their romantic partners.

METHODS

The authors identified articles reporting randomized controlled trials of couple interventions for chronic pain. Three databases were searched (ie, PubMed, Embase, and PsycInfo), resulting in 18 studies and 22 articles.

RESULTS

Couple interventions resulted in statistically significant improvements in pain intensity compared with other conditions in 8% to 40% of the studies depending on the comparator group (i.e., control, individual intervention, another couple intervention), and in statistically significant improvements on a pain-related outcome compared with other conditions in 31% to 50% of the studies depending on the comparator group (ie, control, individual intervention, another couple intervention). Educating couples about pain was the most common strategy (83%). Jointly administered relaxation or meditation skills were included in nearly half of the interventions (48%). Many interventions taught cognitive-behavioral skills jointly to couples (39%) or to the ICP with partner encouragement (30%). Teaching couples how to request and provide assistance (30%), and encouraging partners to avoid reinforcing pain behaviors (39%), occurred frequently. ICPs and their partners were often asked to set goals (30%).

DISCUSSION

This review outlined strategies included in couple interventions for chronic pain that are derived from the cognitive-behavioral therapy, acceptance and commitment therapy, and operant behavioral traditions, but delivered relationally. Therapists working with ICPs and their partners may integrate these strategies into their practice to help couples who are managing chronic pain.

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.

Loneliness Mediates the Relationship Between Pain During Intercourse and Depressive Symptoms Among Young Women

Previous research suggests that women who experience pain during intercourse also experience higher rates of depressive symptoms. Loneliness might be one factor that contributes to this relationship. We hypothesized that women who experience more severe and interfering pain during intercourse would report higher rates of loneliness and higher rates of depressive symptoms. Further, we hypothesized that loneliness would mediate the relationship between pain during intercourse and depressive symptoms. A total of 104 female participants (85.6% white, 74.03% partnered, 20.9 [3.01] years old) completed an online survey including demographic information, PROMIS Vaginal Discomfort Measure, PROMIS Depression Measure, and Revised UCLA Loneliness Scale. Pearson correlations and bootstrapped mediation analysis examined the relationships among pain during intercourse, loneliness, and depressive symptoms. Pain during intercourse, loneliness, and depressive symptoms were all significantly correlated (p < .05). Results of the mediation analysis indicated that loneliness was a significant mediator of the relationship between pain during intercourse and depressive symptoms (indirect effect = 0.077; 95% CI 0.05-0.19). After accounting for loneliness, pain during intercourse was not significantly related to depressive symptoms, suggesting that loneliness fully mediated the relationship between pain during intercourse and depressive symptoms. These findings are consistent with previous studies highlighting that pain during intercourse is related to depressive symptoms. The current study adds to that literature and suggests that more frequent and severe pain during intercourse leads to more loneliness, which then leads to increased depressive symptoms. This line of work has important implications for treating women who experience depressive symptoms and pain during intercourse.

When Self-Worth Is Tied to One's Sexual and Romantic Relationship: Associations with Well-Being in Couples Coping with Genito-Pelvic Pain

Contingent self-worth (CSW; the pursuit of self-esteem via a particular domain in one's life) impacts well-being based on one's perceived success or failure in the contingent domain. In a community sample, individuals with sexual problems reported greater sexual CSW-self-worth dependent on maintaining a sexual relationship-than those without problems. Couples coping with provoked vestibulodynia (PVD), a genito-pelvic pain condition, perceive failures in their sexual relationship, which could be associated with more pain and poorer well-being. In contrast, relationship CSW-self-worth dependent on the overall romantic relationship-may act as a buffer against adverse outcomes. Eighty-two women with PVD and their partners completed online standardized measures of sexual and relationship CSW, sexual distress and satisfaction, relationship satisfaction, and depressive symptoms, and women reported their pain intensity. Analyses were based on the actor-partner interdependence model. Women with PVD who reported greater sexual CSW experienced more sexual distress and pain. Additionally, when partners reported greater sexual CSW, they were less sexually and relationally satisfied and more sexually distressed, and women had greater depressive symptoms and lower relationship satisfaction. In contrast, when partners reported higher relationship CSW, they were more sexually and relationally satisfied and less sexually distressed, and women reported lower depressive symptoms and greater relationship satisfaction. Results suggest that couples' (particularly partners') greater sexual CSW is linked to poorer sexual, relational, and psychological well-being in couples affected by PVD, whereas partners' greater relationship CSW is associated with better well-being. Thus, sexual and relationship CSW may be important treatment targets for interventions aimed at improving how couples adjust to PVD.

Recovering from provoked vestibulodynia: Experiences from encounters with somatocognitive therapy

Although provoked vestibulodynia (PVD) represents a significant challenge for many young women in the Western world, little is known about how these women experience therapeutic efforts. The aim of this paper is to enhance our knowledge of the way that the therapeutic process is experienced by women with PVD undergoing somatocognitive therapy (SCT). The study enhances insight into this recently developed therapy through a detailed description of the physiotherapy approach. The empirical data are based on interviews with six women who participated in SCT. The empirical data analysis is guided by thematic analysis. Our findings demonstrate how the women experience SCT as a bodily process of wholeness. The process of wholeness relates to new experiences in the women's own bodies, awareness of muscular and mental tension and relaxation, breathing patterns, and perceptions focusing on pain. The findings are presented as three interrelated themes: 1) sensitizing the body as an interconnected unit; 2) incorporating the painful pubic region into the body; and 3) developing a new understanding of oneself. The women who participated in this study found that SCT contributed significantly to the process of their recovery from PVD.

Understanding the Sexual Satisfaction of Women With Provoked Vestibulodynia and Their Partners: Comparison With Matched Controls

Provoked vestibulodynia (PVD)-a recurrent, localized vulvar pain-interferes with couples' sexual relationships as evidenced by lower sexual satisfaction compared to controls. Little is known about what components of sexual satisfaction contribute to this lower satisfaction. Using the Interpersonal Exchange Model of Sexual Satisfaction (IEMSS), we compared the sexual exchanges (sexual rewards and costs, relative sexual rewards and costs, balance of sexual rewards and costs, balance of relative sexual rewards and costs, equality of sexual rewards and costs) and sexual satisfaction of 50 women with PVD and their male partners to 50 matched-control couples. We also compared women with PVD and their partners on these same components. Participants completed standardized measures of sexual exchanges and sexual satisfaction. Women with PVD and their partners reported lower relative sexual rewards, a less favorable balance of relative sexual rewards to costs, and lower sexual satisfaction than controls, although differences were larger for women. Women with PVD also reported lower levels of sexual rewards, higher levels of sexual costs, a less favorable balance of sexual rewards to costs, and lower equality of sexual costs, than control women. Findings identify IEMSS exchange components that may contribute to overall lower satisfaction in couples affected by PVD.

Vulvodynia: a consideration of clinical and methodological research challenges and recommended solutions

Vulvodynia, an idiopathic chronic vulvar pain, is a prevalent genital pain condition that results in significant impairment to sexual, relational, and psychological functioning of affected women and their romantic partners. Despite its high prevalence, there remain gaps in knowledge and health care access for women coping with vulvodynia, given its varied clinical presentation and no widely accepted treatment protocol. The past several decades have seen important advancements in understanding vulvodynia and developing effective treatments; however, progress has been impeded due to clinical and methodological challenges in conducting research with this vulnerable population. This review presents a brief overview of vulvodynia correlates, consequences, etiology, and treatment, and then turns its attention to considering the clinical and methodological challenges that hinder vulvodynia research. Identifying these barriers alongside potential mitigating solutions is essential to developing empirically supported treatments for all women affected by vulvodynia, across all age and minority groups. Potential solutions will require researchers to broaden eligibility criteria, examine subgroups of women, and expand definitions of treatment outcomes, and may be best facilitated by more active collaboration among research groups and across relevant disciplines. Engagement in these solutions may contribute to more representative findings and the development and dissemination of empirically based treatment options for this complex pain condition.

Maintaining Affection Despite Pain: Daily Associations Between Physical Affection and Sexual and Relationship Well-Being in Women with Genito-Pelvic Pain

Provoked vestibulodynia (PVD) is a recurrent, genito-pelvic pain condition that affects 8-12 % of women and has negative implications for sexual and relationship functioning. Many women with PVD report avoiding physical affection because they are concerned that affectionate behavior will lead to painful sexual activity. In community samples, physical affection is associated with improved sexual and relational well-being; however, no research has assessed the influence of physical affection on well-being in women with PVD. The current study examined day-to-day, within-person associations between affectionate behavior (hugging/kissing, cuddling) and sexual satisfaction, relationship satisfaction, sexual functioning, and pain intensity in women with PVD. Seventy women diagnosed with PVD completed an 8-week daily survey. Data were analyzed using multilevel modeling. All outcomes were assessed on days involving sexual activity (n = 401 days). Physical affection was assessed on days with and without sexual activity. Hugging/kissing was positively associated with sexual satisfaction, relationship satisfaction, and sexual functioning within any given day and when predicting the next day. Hugging/kissing was unrelated to pain intensity. Cuddling was not associated with any outcomes. Results persisted for affection that occurred on days with and without sexual activity. Findings suggest physical affection is beneficial for the sexual and relationship well-being of women with PVD. These results may inform interventions that encourage women coping with PVD to engage in more daily physical affection with their partners.

Interpersonal Goals and Well-Being in Couples Coping with Genito-Pelvic Pain

In the context of genito-pelvic pain, consideration of interpersonal goals is particularly relevant given that couples' distress is often predicated upon the relational setting. However, relationship goals have not been examined in this population. We investigated (1) the associations between relationship goals and women's pain during intercourse as well as the sexual, relational, and psychological well-being of women with provoked vestibulodynia (PVD) and their partners and (2) the moderating role of sexual goals in these associations. Women with PVD (N = 134) and their partners completed measures of relationship goals, sexual goals, sexual satisfaction, relationship satisfaction, and depressive symptoms. Women also reported on their average pain intensity during intercourse. Women with stronger relationship approach goals reported more sexual satisfaction. When the partner pursued more relationship approach goals, both women and partners reported more sexual and relationship satisfaction and partners reported less depression. Stronger relationship avoidance goals in the partner were associated with less sexual satisfaction in women. Several significant interactions showed that the combination of relationship and sexual approach goals was associated with greater relationship and sexual satisfaction, and fewer depressive symptoms, whereas the combination of relationship and sexual avoidance goals was related to lower relationship satisfaction as well as to greater pain during intercourse for women. Targeting relationship approach and avoidance goals as well as those goals specific to sexual activity may improve the quality and efficacy of couples-based psychological interventions for PVD.

Coping with pain in intimate situations: Applying the avoidance-endurance model to women with vulvovaginal pain

BACKGROUND AND AIMS

Chronic vulvovaginal pain is strikingly common and has a serious impact on women's lives. Nevertheless, there are few longitudinal studies focusing on mechanisms involved in the pain development. One area of interest is how women cope with sexual activities and how this affects their pain. In this study, avoidance and endurance coping behaviors were explored as possible mediators of the relation between catastrophizing and pain, cross-sectionally and longitudinally.

METHODS

251 women (18-35 years old) with vulvovaginal pain were recruited in university settings and filled out questionnaires about their pain, catastrophizing and coping behaviors at two occasions, with five months in between. Multiple mediation models were tested, exploring avoidance and endurance as mediators of the relation between catastrophizing and pain.

RESULTS

The results showed that avoidance was an influential mediator of the link between catastrophizing and pain. Using multiple mediation models we found that although the indirect effects of both avoidance and endurance were significant cross-sectionally, only avoidance was a significant mediator in the combined model exploring associations over time.

CONCLUSIONS

This study indicates that the strategies women with vulvovaginal pain use for coping with sexual activities are important for the course of pain. Avoidance and, to a lesser degree, endurance strategies were identified as important mediators of the effects of catastrophizing on pain. When exploring the links over time, only avoidance emerged as a significant mediator.

IMPLICATIONS

In this longitudinal study, catastrophizing was linked to vulvovaginal pain, via avoidance and endurance of sexual activities. Hence, targeting catastrophizing early on in treatment, as well as addressing coping, may be important in clinical interventions.

Provoked vestibulodynia: current perspectives

Provoked vestibulodynia (PVD) refers to vulvar pain of at least 3 months duration, localized to the vestibule, provoked by touch and sexual activity and occurring in the absence of a clear identifiable cause. The clinical spectrum ranges from mild with distressing discomfort through to severe and disabling pain. Current understanding is that PVD is one of many chronic pain conditions characterized by sensitization of peripheral and central nociceptive pathways, with pain arising due to dysfunctional neuronal activity in the absence of painful stimuli. Pathophysiology is not well understood but is likely a complex interplay of environmental, genetic, psychological and immune factors. Care is multidisciplinary and follows general principles of chronic pain management with the addition of specific therapy tailored to address pelvic floor overactivity, and sexual and relationship difficulties. More recently, the therapeutic use of placebo is gaining traction in chronic pain research and is a very promising adjunctive therapy. The majority of women with PVD are managed outside of tertiary clinic settings, and care depends on availability and affordability of specialized services; however, much can be done by the primary health provider. PVD is common, and highly treatable, especially with early intervention, but unfortunately, many clinicians are unaware of this condition, and the biggest hurdle for women accessing treatment is obtaining a diagnosis. With treatment, most women can expect significant improvement, often with fairly simple interventions, although some women will benefit from referral to specialized centers. The aims of this article are twofold: firstly, to summarize current literature concerning PVD pathophysiology and management; secondly, to provide a framework for clinicians unfamiliar with vulvar medicine to understand and manage PVD.

Painful sex (dyspareunia) in women: prevalence and associated factors in a British population probability survey

Objective

To estimate the prevalence of painful sex among women in Britain, and to explore associated sexual, relationship and health factors that should be considered in assessment.

Design

Multi‐stage, clustered and stratified population probability sample survey, using computer‐assisted self‐interview. Sample frame was the British Postcode Address File.

Setting

Participants interviewed at home between 2010 and 2012.

Sample

A total of 15 162 adults aged 16–74 years (8869 women). Data reported from 6669 sexually active women.

Methods

Age‐adjusted logistic regressions to examine associations between painful sex and indicators of sexual, relational, mental and physical health.

Main outcome measure

Physical pain as a result of sex for ≥3 months in the past year, plus measures of symptom severity.

Results

Painful sex was reported by 7.5% (95% CI 6.7–8.3) of sexually active women, of whom one‐quarter experienced symptoms very often or always, for ≥6 months, and causing distress. Reporting painful sex was strongly associated with other sexual function problems, notably vaginal dryness (age adjusted odds ratio 7.9; 6.17–10.12), anxiety about sex (6.34; 4.76–8.46) and lacking enjoyment in sex (6.12; 4.81–7.79). It was associated with sexual relationship factors [such as not sharing same level of interest in sex (2.56; 1.97–3.33)], as well as with adverse experiences such as non‐volitional sex (2.17; 1.68–2.80). Associations were also found with measures of psychological and physical health, including depressive symptoms (1.68; 1.28–2.21).

Conclusion

Painful sex is reported by a sizeable minority of women in Britain. Health professionals should be supported to undertake holistic assessment and treatment which takes account of the sexual, relationship and health context of symptoms.

Tweetable abstract

Painful sex—reported by 7.5% of women in Britain—is linked to poorer sexual, physical, relational and mental health.

Painful sex–reported by 7.5% of women in Britain–is linked to poorer sexual, physical, relational and mental health.

This article includes Author Insights, a video abstract available at https://vimeo.com/rcog/authorinsights14518.

Development and Validation of the Sexual Contingent Self-Worth Scale

Sexual contingent self-worth (CSW) refers to self-worth that is dependent on maintaining a sexual relationship, and has not been studied previously. This novel construct may have implications for sexual, relationship, and psychological well-being, because it could affect the cognitions, affect, and behaviors of individuals in sexual relationships. The purpose of this study was to develop the Sexual Contingent Self-Worth Scale and examine its reliability and validity in community samples. Two separate online studies (N = 329 and N = 282) included men and women who were in committed, sexually active relationships. The Sexual CSW Scale was adapted from a validated measure of relationship CSW. In Study 1, participants completed the Sexual CSW Scale, whereas in Study 2, participants also responded to standardized measures of related constructs. In addition, participants completed the Sexual CSW Scale again two weeks later in Study 2. Factor analysis yielded two subscales: (a) sexual CSW dependent on positive sexual events in the relationship and (b) sexual CSW dependent on negative sexual events. Results indicated good construct validity, incremental validity, internal consistency, and test-retest reliability for the Sexual CSW Scale. This research contributes to the fields of both CSW and sexuality by introducing a novel domain of CSW.

Talking About Sex When Sex Is Painful: Dyadic Sexual Communication Is Associated With Women's Pain, and Couples' Sexual and Psychological Outcomes in Provoked Vestibulodynia

Provoked vestibulodynia (PVD) is a recurrent vulvovaginal pain condition associated with psychological and sexual consequences for affected women and their partners, including lower quality of dyadic sexual communication compared to pain-free couples. Although greater sexual communication is associated with positive sexual and relational outcomes for both pain-free couples and couples experiencing painful sex, little is known about its role in women's pain and psychological outcomes, especially in a relational context. The present study examined associations between dyadic sexual communication and pain, sexual satisfaction, sexual functioning, and depressive symptoms in a sample of 107 couples in which the woman was diagnosed with PVD via a standardized gynecological assessment. Women completed a measure of pain intensity, and both members of the couple completed measures of their dyadic sexual communication, sexual satisfaction, sexual functioning, and depressive symptoms. Analyses were guided by the actor-partner interdependence model. Women and partners' own perceptions of greater dyadic sexual communication were associated with their own greater sexual satisfaction and sexual functioning, and lower depressive symptoms. Partners' perceptions of greater dyadic sexual communication were also associated with women's lower pain and greater sexual satisfaction. Results point to the importance of dyadic coping conceptualizations for both individual and interpersonal outcomes in PVD. Dyadic sexual communication may be a key treatment target for interventions aimed at improving the pain and psychological and sexual impairments of women with PVD and their partners.

Observed and Perceived Disclosure and Empathy Are Associated With Better Relationship Adjustment and Quality of Life in Couples Coping With Vulvodynia

Vulvodynia is a common idiopathic vulvovaginal pain condition that adversely affects the quality of life and intimate relationships of afflicted couples. Cross-sectional interpersonal factors, including how couples with vulvodynia communicate with each other, have been linked to women's pain and couples' relationship well-being. The current study investigated the observed and perceived associations between disclosure and empathic response, and couples' relationship adjustment, as well as women's pain during intercourse, and quality of life. Fifty women (M age = 24.50, SD = 4.03) diagnosed with vulvodynia and their partners (M age = 26.10, SD = 5.70) participated in a filmed discussion of the impact of this condition on their lives. Disclosure and empathic response were assessed by a trained observer and self-reported by participants immediately following the discussion. Analyses were based on the Actor-Partner Interdependence Model. Greater observed empathic response and perceived disclosure in women were associated with their higher quality of life. When women demonstrated greater empathic response, they and their partners reported higher relationship adjustment. In addition, when partners perceived greater empathic response, women reported higher relationship adjustment. There were no significant associations between disclosure or empathic response and women's pain during intercourse. Disclosure and empathic response may help women sustain the quality of their lives, and couples maintain the quality of their overall relationship while coping with the challenges that vulvodynia poses to their intimate connection. Increasing disclosure and empathic response might be a valuable target for enhancing the efficacy of couple-based interventions for vulvodynia.

Distressing Sexual Problems and Dyadic Adjustment in Heterosexuals, Gay Men, and Lesbian Women

Empirical studies have focused on dyadic adjustment and sexual satisfaction in men and women. Nevertheless, little is known regarding the role of dyadic adjustment in sexual problems among individuals in same-sex and mixed-sex dyads. The aim of the current study was to analyze the differences in dyadic adjustment between gay and heterosexual men, and lesbian and heterosexual women, with and without distressing sexual problems. One hundred and sixty men (80 gay and 80 heterosexual) and 184 women (92 lesbian and 92 heterosexual) completed an online survey. Participants responded to the Dyadic Adjustment Scale-Short Version and to questions about self-perceived sexual problems and associated levels of distress. A 2 (gender) × 2 (sexual orientation) × 2 (group with or without sexual problems) univariate analysis of covariance was performed. The findings suggested that individuals with distressing sexual problems, regardless of gender or sexual orientation, scored significantly lower on the Dyadic Adjustment Scale. Additionally, lesbian women, regardless of having or not having a distressing sexual problem, scored significantly higher on the Dyadic Adjustment Scale, compared to heterosexual women. No gender differences were found. Overall, our findings emphasize the negative association between dyadic adjustment and distressing sexual problems, regardless of gender and sexual orientation.

Coping with painful sex: Development and initial validation of the CHAMP Sexual Pain Coping Scale

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.

Attachment, Sexual Assertiveness, and Sexual Outcomes in Women with Provoked Vestibulodynia and Their Partners: A Mediation Model

Provoked vestibulodynia (PVD) is a prevalent women's sexual pain disorder, which is associated with sexual function difficulties. Attachment theory has been used to understand adult sexual outcomes, providing a useful framework for examining sexual adaptation in couples confronted with PVD. Research to date indicates that anxious and avoidant attachment dimensions correlate with worse sexual outcomes in community and clinical samples. The present study examined the association between attachment, pain, sexual function, and sexual satisfaction in a sample of 101 couples in which the women presented with PVD. The actor-partner interdependence model was used in order to investigate both actor and partner effects. This study also examined the role of sexual assertiveness as a mediator of these associations via structural equation modeling. Women completed measures of pain intensity and both members of the couple completed measures of romantic attachment, sexual assertiveness, sexual function, and satisfaction. Results indicated that attachment dimensions did not predict pain intensity. Both anxious and avoidant attachment were associated with lower sexual satisfaction. Only attachment avoidance predicted lower sexual function in women. Partner effects indicated that higher sexual assertiveness in women predicted higher sexual satisfaction in men. Finally, women's sexual assertiveness was found to be a significant mediator of the relationship between their attachment dimensions, sexual function, and satisfaction. Findings highlight the importance of examining how anxious and avoidant attachment may lead to difficulties in sexual assertiveness and to less satisfying sexual interactions in couples where women suffer from PVD.

Approach and Avoidance Sexual Goals in Couples with Provoked Vestibulodynia: Associations with Sexual, Relational, and Psychological Well-Being

INTRODUCTION

Provoked vestibulodynia (PVD) is a prevalent vulvovaginal pain condition that is triggered primarily during sexual intercourse. PVD adversely impacts women's and their partners' sexual relationship and psychological well-being. Over 80% of women with PVD continue to have intercourse, possibly because of sexual goals that include wanting to pursue desirable outcomes (i.e., approach goals; such as a desire to maintain intimacy) and avoid negative outcomes (i.e., avoidance goals; such as avoiding a partner's disappointment).

AIM

The aim of this study was to investigate associations between approach and avoidance sexual goals and women's pain, as well as the sexual, relational, and psychological well-being of affected couples.

METHODS

Women with PVD (N = 107) and their partners completed measures of sexual goals, sexual satisfaction, relationship satisfaction, and depression. Women also completed measures of pain during intercourse and sexual functioning.

MAIN OUTCOME MEASURES

(1) Global Measure of Sexual Satisfaction Scale, (2) Dyadic Adjustment Scale-Revised or the Couple Satisfaction Index, (3) Beck Depression Inventory-II, (4) numerical rating scale of pain during intercourse, and (5) Female Sexual Function Index.

RESULTS

When women reported higher avoidance sexual goals, they reported lower sexual and relationship satisfaction, and higher levels of depressive symptoms. In addition, when partners of women reported higher avoidance sexual goals, they reported lower relationship satisfaction. When women reported higher approach sexual goals, they also reported higher sexual and relationship satisfaction.

CONCLUSIONS

Targeting approach and avoidance sexual goals could enhance the quality and efficacy of psychological couple interventions for women with PVD and their partners.

Dyadic sexual communication in pre-menopausal women with self-reported dyspareunia and their partners: associations with sexual function, sexual distress and dyadic adjustment

INTRODUCTION

While there is increasing interest in studying aspects of communication processes in sex research, the association between dyadic sexual communication and relationship and sexuality outcomes has not yet been examined in pre-menopausal women with dyspareunia.

AIM

To examine the associations between dyadic sexual communication and pain, sexual distress, sexual function and dyadic adjustment in women with self-reported dyspareunia and their male partners.

METHODS

Pre-menopausal women (n=38; M age=24.92, SD=6.12) with self-reported dyspareunia from a community sample and their partners (n=38; M age=26.71, SD=6.59) completed an online survey. The Actor-Partner Interdependence Model was used in order to investigate both actor and partner effects.

MAIN OUTCOME MEASURES

Both members of the couple completed: (i) the Dyadic Sexual Communication Scale and (ii) the Dyadic Adjustment Scale; women also completed (iii) the Female Sexual Function Index, (iv) the Female Sexual Distress Scale, and (v) a Visual Analogue Scale on pain during intercourse; and men also completed (vi) the International Index of Erectile Functioning.

RESULTS

Controlling for relationship duration, women's better dyadic sexual communication was significantly associated with their higher levels of sexual function (P=0.028), lower levels of sexual distress (P=0.003) and higher levels of dyadic adjustment (P=0.005), but not with their pain or men's sexual function or dyadic adjustment. Controlling for relationship duration, men's better dyadic sexual communication was associated with their higher levels of dyadic adjustment (P=0.027) but not with their sexual function, nor with women's sexual function or dyadic adjustment.

CONCLUSIONS

These findings contribute to the theoretical knowledge on interaction processes in couples with dyspareunia and suggest that it may be important to enhance open and direct communication about sexual matters in couples with dyspareunia.

Fear Avoidance and Pain Catastrophizing among Women with Sexual Pain

Aim: Among women under 30 years of age, around 20% report recurrent sexual pain. Although the amount of studies investigating sexual pain has increased, little is known about the role of psychosocial factors. The present study used the fear-avoidance model from musculoskeletal pain as a theoretical frame of reference, and examined fear-avoidance beliefs, avoidance behaviors, pain catastrophizing and symptoms of anxiety and depression among women (18–35 years) reporting sexual pain. Methods: The study was cross-sectional, based on a sample of 133 women, where 37 women (27.8%) reported sexual pain often or always. Results: Women with pain reported higher levels of fear avoidance and pain catastrophizing as well as depression and anxiety, with fear avoidance and pain catastrophizing reaching similar levels as has been reported in other long-term pain populations. The level of anxiety and depression did not reach clinical levels. Fear-avoidance beliefs and pain catastrophizing were related to sexual pain and to pain intensity in the regression analysis. Conclusion: The data are in line with, and give further support to, a fear-avoidance perspective in female sexual pain, emphasizing the role of fear and avoidance of pain/sex.

Relationship satisfaction moderates the associations between male partner responses and depression in women with vulvodynia: a dyadic daily experience study

Vulvodynia is a prevalent vulvovaginal pain condition that interferes with women's psychological health. Given the central role of sexuality and relationships in vulvodynia, relationship satisfaction may be an important moderator of daily partner responses to this pain and associated negative sequelae, such as depression. Sixty-nine women (M age=28.12 years, SD=6.68) with vulvodynia and their cohabiting partners (M age=29.67 years, SD=8.10) reported their daily relationship satisfaction, and male partner responses on sexual intercourse days (M=3.74, SD=2.47) over 8 weeks. Women also reported their depressive symptoms. Relationship satisfaction on the preceding day moderated the associations between partner responses and women's depressive symptoms in several significant ways: (1) On days after women reported higher relationship satisfaction than usual, their perception of greater facilitative male partner responses was associated with their decreased depression; (2) on days after women reported lower relationship satisfaction than usual, their perception of greater negative male partner responses was associated with their increased depression; (3) on days after men reported higher relationship satisfaction than usual, their self-reported higher negative responses were associated with decreased women's depression, and higher solicitous responses were associated with increased women's depression, whereas (4) on days after men reported lower relationship satisfaction than usual, their self-reported higher negative responses were related to increased women's depression, and higher solicitous responses were associated with decreased women's depression. Targeting partner responses and relationship satisfaction may enhance the quality of interventions aimed at reducing depression in women with vulvodynia.

Sexual communication, dyadic adjustment, and psychosexual well-being in premenopausal women with self-reported dyspareunia and their partners: a controlled study

INTRODUCTION

Although research that takes into account partner and relationship factors in dyspareunia is slowly emerging, little is known about how these couples communicate about their sexuality. Additionally, partner psychosexual adjustment has not been examined in a controlled fashion.

AIM

This study aimed to compare dyadic sexual communication, dyadic adjustment, psychological adjustment, and sexual well-being of women with self-reported dyspareunia and their partners with those of pain-free control women and their partners.

METHODS

Premenopausal women (n = 38; mean [M] age = 24.92) with self-reported dyspareunia, their partners (n = 38; M age = 26.71), as well as pain-free control women (n = 44; M age = 25.86) and their partners (n = 44; M age = 27.95) completed an online survey measuring dyadic sexual communication, dyadic adjustment, anxiety, depression, sexual functioning, and sexual distress.

MAIN OUTCOME MEASURES

Assessments of women and men's (i) dyadic sexual communication; (ii) dyadic adjustment; (iii) anxiety; (iv) depression; (v) sexual functioning; and (vi) women's sexual distress were the main outcome measures.

RESULTS

Compared with pain-free controls, women with dyspareunia reported significantly poorer dyadic sexual communication, a difference not found between partners of women with dyspareunia and control partners. Compared with partners of control women, those of women with dyspareunia reported significantly more impaired sexual functioning. No differences in dyadic adjustment were found between women with dyspareunia and pain-free control women, or between their respective partners. Finally, compared with control women, those with dyspareunia reported significantly more impaired psychological and sexual well-being.

CONCLUSIONS

Findings suggest that dyspareunia impacts not only the psychosexual adjustment of affected women but also that of their partners. It seems relevant to include both members of the couple in future research and treatment for dyspareunia.

Sexual function, relationship adjustment, and the relational impact of pain in male partners of women with provoked vulvar pain

INTRODUCTION

Despite the impact of provoked vulvar pain on women's sexuality and the partnered sexual context in which the pain typically occurs, partners have not been included widely in research.

AIMS

To examine sexual and relationship functioning of male partners of women with provoked vulvar pain symptoms using a controlled design and to assess the impact of the pain on their relationship.

METHODS

Fifty male pain partners and 56 male controls completed questionnaires to assess sexual communication, sexual functioning/satisfaction, sexual esteem, relationship adjustment, and psychological health. Participants also completed numeric rating scales to assess the importance of sex to them and the extent to which they felt their relationship matched a satisfying relationship. To assess the relational impact of vulvar pain, pain partners were asked to indicate whether the pain had impacted their relationship, and, if yes, rated this impact.

MAIN OUTCOME MEASURES

Main outcome measures included the Dyadic Sexual Communication Scale, the International Index of Erectile Function, the Sexuality Scale, the Dyadic Adjustment Scale, the 12-Item Short-Form Health Survey, and numeric rating scales.

RESULTS

Pain partners reported significantly poorer sexual communication and erectile function and less sexual satisfaction compared with controls. They also reported significantly less affectional expression within their relationships and were more likely than controls to report a discrepancy between their relationship and their idea of a satisfying relationship. Almost 73% (n = 32/44) of pain partners reported a negative relational impact of vulvar pain. No significant differences in sexual desire, orgasmic function, sexual esteem, relationship satisfaction and consensus, psychological health, or importance of sex were found between groups.

CONCLUSIONS

Provoked vulvar pain partners appear negatively impacted with regard to some sexual and physical aspects of their relationship. As one of the few controlled studies to investigate partner functioning in the context of provoked vulvar pain, this study has future research implications and supports the involvement of partners in treatment.

Living with genital pain: Sexual function, satisfaction, and help-seeking among women living in Sweden

Background and aims Female genital pain is a debilitating problem that negatively affects several aspects of the life of women. Several studies present figures of prevalence indicating that the problem affects nearly 20% of young women. However, many women fail to consult health care and the estimated prevalence therefore remains insecure. Historically, genital pain was commonly viewed as either physiological or psychosexual. Although the current field of research and clinical expertise in general agree upon a biopsychosocial conceptualization, less is known about the manifestation of the problem in everyday life and the experience of seeking health care among afflicted women. The objectives of the present study was to examine genital pain in a general female population living in Sweden cross-sectionally in terms of prevalence, sexual function, sexual satisfaction and help seeking, and to identify possible predictors of genital pain among women. Methods The study was a population-based study using a postal questionnaire administered to 4052 women (age 18--35). Of these 944 (response rate: 23%) took part in the study. Results Genital pain of six months duration was reported by 16.1% of the women. Women with pain more commonly reported fungal infections, other pain problems, sexual dysfunctions and symptoms of anxiety than pain-free women and in addition lower sexual satisfaction. There were no differences in sexual frequency. Pain was most commonly reported during sexual intercourse, but many women also experienced pain during non-sexual activities, with pain durations of several hours after the pain eliciting activity was interrupted. Of those reporting pain, 50% had sought care for their pain. The most common was to counsel a doctor and to receive topical treatment. However, the experienced effects of the treatments were on average low. In the explanatory model, fungal infections, and sexual dysfunctions were associated with genital pain. Conclusions The study had a low response rate, but still indicates that genital pain is common and negatively affects several aspects of women' life, not just sexual activities. Although many women report pro-longed pain experiences, many fail to consult health care and among those who seek care the effects of treatment are on average poor. There are strong associations between sexual dysfunctions (lack of sexual arousal, vaginal muscle tension hindering intercourse) and genital pain that, based on previous findings in this field of research, might be viewed in terms of circular maintaining processes. Implications Female genital pain is not just limited to the sexual context, but often negatively affects several situations in women' life. The size of the problem calls for immediate development of preventive interventions and treatment programs that focus on sexual education and to encourage a healthy sexuality among women and their partners. There is a need to identify methods in order to assemble evidence based interventions of female genital pain. Such methods are currently lacking, resulting in poor treatment options for women with pain.