"It's all my fault": a qualitative study of how heterosexual couples experience living with vulvodynia

"I wish I knew then what I know now" - pain science education concepts important for female persistent pelvic pain: a reflexive thematic analysis

ABSTRACT

Pain science education (PSE) provides people with an understanding of "how pain works" grounded in the biopsychosocial model of pain; it has been demonstrated to improve outcomes in musculoskeletal pain conditions. Preliminary evidence suggests PSE may be effective for female individuals with persistent pelvic pain, but how the content of PSE needs to be modified for this group remains to be determined. A reflexive thematic analysis of qualitative data was performed to identify PSE concepts that female individuals with persistent pelvic pain consider important and why. Twenty individual, semistructured interviews were conducted with adult females who had engaged with PSE and had self-identified as having "improved" pelvic pain. Most participants had been diagnosed with endometriosis (n = 16). Four themes were generated capturing PSE concepts considered important by female individuals with "improved" pelvic pain: (1) "A sensitised nervous system leads to overprotective pain" validated their pelvic pain as being real; (2) "Pain does not have to mean the body is damaged (although sometimes it does)" provided reassurance that pelvic pain does not mean their condition is worsening; (3) "How I think, feel, and 'see' my pain can make it worse" enabled participants to find optimal ways to manage their pain; and (4) "I can change my pain… slowly" provided hope that pelvic pain can improve and empowered them to pursue pain improvement as a viable goal. This study generated 4 PSE learning concepts that were important to female individuals with improved pelvic pain and may be incorporated into PSE curricula for female individuals with pelvic pain.

Navigating Conflicting Ideals of Masculinity: A Qualitative Study of the Experiences of Male Partners of Women with Vulvodynia

Vulvodynia, a long-term genital pain disorder with a high lifetime prevalence, profoundly impacts both the affected women and their partners. However, the experiences of these partners have been under-researched. Using Braun and Clarke's thematic analysis, this qualitative study explored the experiences of male partners of women with vulvodynia. In individual interviews with seven men (20-32 years), four themes were identified: "Trying to be a good and caring partner," "Fear of sexual and emotional rejection," "Feelings of insecurity and being misled," and "Keeping up the façade." Despite efforts to support their partners, the men often faced rejection, leading to insecurities about their attractiveness, the relationship's future, and their ability to conform to social expectations. They coped by concealing insecurities from their partners and overemphasizing traditional masculinity among peers. We discuss these results using sexual script theory, suggesting that gendered sexual scripts play a significant role in relationships with vulvodynia, with prevailing cultural assumptions regarding masculinity challenging men's ability to be simultaneously caring and sexual. As a result, the men found themselves negotiating two contrasting ideals associated with masculine behavior: those of good caregiver and assertive, virile sexual partner. Our research suggests that male partners of women with vulvodynia tend to be left alone to deal with the resulting ambivalence and distress. Supporting these men could benefit both parties in managing vulvodynia.

Our Body Our Health (Jirkeena, Caafimaadkeena): Somali Women's Narratives on Sexual Health

Women across the globe have been subject to female genital cutting (FGC), with the highest rates in Somalia. FGC can result in sexual concerns, especially sexual pain and lower pleasure. Due to ongoing civil war and climate disasters, there is a large number of Somali immigrants and refugees living in countries where healthcare providers may be unfamiliar with the impact of FGC. In this qualitative study, sixty Somali women between the ages 20 and 45 and living in the U.S. shared their perspectives on how FGC has affected their sexual lives, including how they have coped with any complications attributed to FGC. Participants were recruited through convenience sampling and interviewed by a bilingual community researcher in either Somali or English. Data were analyzed through a participatory analysis process by academic and community researchers. Themes included sexual desire, arousal, and pleasure; sexual satisfaction; sexual pain at first intercourse; coping with sexual pain at first intercourse; long-term sexual pain, coping with long-term sexual pain. Results are discussed with a focus on agency of the participants, role of partners, and implications for healthcare professionals.