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

Psychosocial Factors Associated With Vulvodynia

OBJECTIVES

We set out to identify the psychosocial factors associated with vulvodynia and the effects on sexuality, mental health, and quality of life.

MATERIALS AND METHODS

PubMed, LILACS, Embase, CINAHL, Web of Science, Scopus, and PsycINFO were searched in August 2023. Two authors selected and extracted the data independently. The risk of bias was assessed using the Newcastle-Ottawa Scale for Observational Studies. To rank the strength of evidence, the Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE) approach was utilized.

RESULTS

A total of 3,182 articles were identified. Twenty-two observational studies (8 cohorts and 14 case-controls) met the eligibility criteria and were included, comprising 2,624 patients. Vulvodynia has been associated with psychological factors (anxiety and depression) and social factors (childhood exposure to physical and sexual abuse, posttraumatic stress, and domestic abuse). Concerning sexual function, the most frequent outcomes were dyspareunia and sexual dysfunction. Only one study assessed quality of life, which showed that women with chronic vulvar pain had greater difficulty performing physical activities and experienced negative moods and feelings. The assessment of the risk of bias showed that the average quality of studies was good to excellent. However, the studies failed to select the nonexposed cohort or control group to describe the results, and often, the study population was rather small, which made it impossible to carry out a meta-analysis.

CONCLUSIONS

The certainty of evidence for the associations between anxiety and depression, vulvodynia, and sexual functioning suggests that combating these factors could improve overall quality of life in vulvodynia patients.

Under Pressure: Men's and Women's Sexual Performance Anxiety in the Sexual Interactions of Adult Couples

Most research on sexual performance anxiety has focused on men's experiences and links to erectile functioning and premature ejaculation, with little research attention given to women's experiences or to relationship dynamics. At times, sexual performance anxiety has been examined in the context of dysfunction, but rarely as a focus in its own right. Study 1 asked 51 participants reporting sexual performance anxiety to describe the cognitive and affective components of their experiences, coping strategies, and perceived impact on their relationship using open-ended responses from online surveys. Through directed content analysis, Study 1 revealed that men and women experience a range of cognitive and affective processes with predominant feelings of inadequacy, and overall promoting more approach coping strategies. Study 2 used quantitative surveys to examine whether sexual performance anxiety was associated with higher sexual distress and lower sexual and relationship satisfaction in a sample of 228 community-based couples. Guided by the Actor-Partner Interdependence Model, multilevel modeling analyses indicated that higher sexual performance anxiety was linked to higher sexual distress and lower sexual and relationship satisfaction in both individuals and their partners. This work advances knowledge of sexual performance anxiety to women's experiences, not just men's, and to couples' experiences. Effective treatment for those suffering from this anxiety may incorporate education around sexual beliefs and expectations.

Coping with provoked vestibulodynia in a relational context-A cluster analysis of coping patterns and their associations with relational cognitions and goals

BACKGROUND

Provoked vestibulodynia (PVD) is a common pain condition, negatively impacting the relationships and sexual lives of sufferers. Women's coping behaviour has been associated with psychosexual outcomes, yet coping patterns in clinical PVD samples are unexplored, and it is not known how women's coping relates to their relational context.

METHOD

Women (N = 128) with PVD answered questionnaires about psychosexual function, pain coping (avoidance and endurance), relational- and pain catastrophizing, sexual goals and perceived partner responses. Cluster analysis was used to explore coping patterns; clusters were validated on measures of pain and psychosexual function and compared on catastrophizing, sexual goals and partner responses using multivariate analyses of variance.

RESULTS

The analysis yielded four clusters: endurance; combined high avoidance and endurance; avoidance; and combined low. The group with high levels of both avoidance and endurance coping displayed the worst psychosexual outcomes and high levels of pain- and relational catastrophizing, approach and avoidance goals and perceived negative partner responses.

CONCLUSION

There are distinct patterns of coping among women with PVD, and these coping patterns are associated with psychosexual outcomes and relational cognitions and goals, and perceived partner responses. Women who alternate between avoidance and endurance are more distressed and report worse psychosexual functioning. This pattern needs to be identified and addressed in the treatment of PVD.

SIGNIFICANCE STATEMENT

This study extends previous findings on vulvar pain coping patterns to a clinical population of women with PVD. It is further the first study to address the relationship between relational variables, such as partner responses and relational catastrophizing and different coping patterns. Thus, the contribution of this study is the contextualizing of coping patterns among women with PVD. The results showed that a combined pattern of avoidance and endurance coping is associated with high distress, poor psychosexual outcomes, and indications of insufficient relational coping, highlighting the need for clinical assessment and intervention to target both women's individual coping patterns and their relational context.

Motivation When Desire Is Low: Associations Between Sexual Motivation and Sexual Intimacy, Sexual Satisfaction, and Sexual Distress for Men with Hypoactive Sexual Desire Disorder and Their Partners

Hypoactive sexual desire disorder (HSDD) in men, characterized by chronically low sexual desire, is associated with poor sexual well-being, such as lower sexual satisfaction and higher sexual distress. Additionally, despite their low desire, men with HSDD often report wanting sexual intimacy and validation within their sexual lives/relationships. Studies that apply self-determination theory to sexual relationships demonstrate that adopting more autonomous (e.g., engaging in sex for its inherent pleasure) and less controlled (e.g., engaging in sex for some external reward or consequence) motives for engaging in sex is associated with greater sexual well-being for both members of the couple. Given that autonomous motivation in relationships is associated with intimacy and sexual satisfaction, and lower sexual distress, having sex for autonomous reasons may allow men with HSDD and their partners to feel more sexually intimate despite their lower sexual desire, whereas having sex for controlled reasons may hinder sexual intimacy and satisfaction and augment sexual distress. In this dyadic cross-sectional study, we examined the associations between types of sexual motivation and sexual intimacy, sexual satisfaction, and sexual distress for men with HSDD and their partners (n = 64 couples). Men with HSDD who reported having sex for more autonomous reasons reported more sexual satisfaction and both partners reported more sexual intimacy. Men with HSDD who had sex for more controlled reasons had partners who felt less sexual intimacy and satisfaction, and both partners were more sexually distressed. Promoting autonomous sexual motivation and decreasing controlled motivation may help couples navigating HSDD to feel closer in their relationship, more sexually satisfied, and less sexually distressed.

What Does a Pregnancy Loss Mean for Sex? Comparing Sexual Well-Being Between Couples With and Without a Recent Loss

It is unclear whether sexual well-being, which is an important part of individual and relational health, may be at risk for declines after a pregnancy loss given the limits of prior work. Accordingly, in a cross-sectional study, we used structural equation modeling to (1) compare sexual well-being levels-satisfaction, desire, function, distress, and frequency-of both partners in couples who had experienced a pregnancy loss in the past four months (N = 103 couples) to their counterparts in a control sample of couples with no history of pregnancy loss (N = 120 couples), and (2) compare sexual well-being levels of each member of a couple to one another. We found that gestational individuals and their partners in the pregnancy loss sample were less sexually satisfied than their control counterparts but did not differ in sexual desire, problems with sexual function, nor sexual frequency. Surprisingly, we found that partners of gestational individuals had less sexual distress than their control counterparts. In the pregnancy loss sample, gestational individuals had lower levels of sexual desire post-loss than their partners but did not differ in sexual satisfaction, problems with sexual function, nor sexual distress. Our results provide evidence that a recent pregnancy loss is associated with lower sexual satisfaction and greater differences between partners in sexual desire, which may be useful information for clinicians working with couples post-loss. Practitioners can share these findings with couples who may find it reassuring that we did not find many aspects of sexual well-being to be related to pregnancy loss at about three months post-loss.

Romantic Attachment and Sexual Satisfaction Trajectories Among Couples Transitioning to Parenthood

The transition to parenthood (TTP) is an exciting yet destabilizing time for couples. First-time parents may experience changes in their sexual satisfaction during the TTP, but little is known about the factors associated with these changes. Romantic attachment might help understand why some new parents experience a decrease in sexual satisfaction while others do not. This prospective and dyadic study aimed to examine new parents' sexual satisfaction trajectories through the moderator role of prenatal attachment anxiety and avoidance in these trajectories. A total of 221 primiparous Canadian couples completed four online questionnaires from the second trimester of pregnancy to 12 months postpartum. Dyadic latent growth curve analyses revealed that although pregnant people present lower prenatal sexual satisfaction than their partners, both parents show an increase in their sexual satisfaction from pregnancy to 12 months postpartum. For both parents, partners' attachment anxiety was related to one's own steeper increase in sexual satisfaction from pregnancy to 12 months postpartum. Finally, both parents' attachment avoidance was related to their own lower sexual satisfaction during pregnancy. These findings will help educate and support expectant parents about anticipated fluctuations in sexual satisfaction.

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

INTRODUCTION

Vulvodynia, a chronic genital pain disorder with a high lifetime prevalence among women, has a significant negative impact on both women and their partners. Although there is a growing body of literature on the experiences of women with vulvodynia, there has been little research on the condition's implications for partners and romantic relationships. The aim of this study is to explore how heterosexual couples experience living with vulvodynia.

MATERIAL AND METHODS

Eight Norwegian women diagnosed with vulvodynia by gynecologists were recruited with their partners (couples aged 19-32 years). Data was collected via individual semi-structured interviews and analyzed using inductive thematic analysis.

RESULTS

Three main themes were identified in the analysis: Mysterious disorder, Social exclusion and Sexual expectations. The results show that the couples struggle with understanding the pain, as well as navigating their social and sexual lives. We discuss these findings in light of a new theoretical model: the fear-avoidance-endurance model of vulvodynia.

CONCLUSIONS

Heterosexual couples living with vulvodynia experience communication difficulties with partners, health professionals, and their social network. This sustains avoidance and endurance behavior, increasing pain and dysfunction over time and giving rise to feelings of powerlessness and loneliness. Social expectations regarding male and female sexuality also promote guilt and shame for both parties in couples affected by vulvodynia. Our results suggest that heterosexual couples living with vulvodynia, as well as health professionals treating them, should be helped to communicate more effectively in order to break vicious circles of maladaptive avoidance and endurance behavior.

Motives between the Sheets: Understanding Obligation for Sex at Midlife and Associations with Sexual and Relationship Satisfaction

Reasons for sex are associated with sexual and relational outcomes. This study investigated reasons for sex at last sex, with a focus on obligation (an avoidance motivation) and doing something nice for a partner (an approach motivation), and their associations with sexual and relationship satisfaction, while controlling for marital duration, age, and sexual desire. We investigated these reasons among married, midlife Canadian women (n = 324), men (n = 275), and 25 non-binary/gender queer participants 40 to 59 years of age. Participants were recruited from a Qualtrics analytics panel and completed an online questionnaire. Obligation was reported as a reason for having sex by 12.4% of women and 1.8% of men; "doing something nice" was reported by 10.2% of women and 9.5% of men. In regression analyses, women who reported having sex for obligation had significantly lower relationship satisfaction and sexual satisfaction than women who did not report this reason. In contrast, having sex to do something nice for one's partner was associated with higher sexual satisfaction among women. Findings indicate that having sex when feeling obligated may be associated with negative sexual and relational outcomes among midlife women.

Treating Sexual Dysfunctions Among Survivors of Child Sexual Abuse: An Overview of Empirical Research

Sexual problems are very prevalent among survivors of child sexual abuse (CSA). Yet, various approaches to therapy do not seem to address this issue when treating these individuals. Traditional sex therapy may also not suit the experiences of CSA survivors, as CSA was not considered when the most well-known and frequently used techniques were developed. The present review sought to identify (1) theory-based therapeutic approaches that address sexual problems among CSA survivors and offer treatment protocols (including an outline of specific therapy stages, sessions, or techniques) to treat these sexual problems and (2) identify therapeutic approaches that include a protocol for treating sexual problems among CSA survivors that was empirically tested and validated. In total, six approaches for treating sexual dysfunctions among CSA survivors that provide detailed guidelines for implementing the approach within sex therapy for CSA survivors were identified in the literature. Only two of the studies conducted a randomized controlled trial to test the intervention. This overview concludes with important issues to address when treating sexual problems among CSA survivors and a call for additional evidence-based practices for treating sexual problems among survivors of CSA.

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.

Predictors of vaginal penetration in women with Provoked Vestibulodynia

This study examined whether time, treatment type, baseline individual differences, and treatment satisfaction affected the vaginal intercourse trajectories of women with Provoked Vestibulodynia (PVD) before and after psychological treatment. Women (N = 130) who received CBT or MBCT completed questionnaires prior to and 2-4 weeks, 6-, and 12-months following treatment. The odds of women engaging in vaginal penetration increased by 31% at each assessment. Baseline individual differences and treatment satisfaction predicted maintenance of or re-engagement in vaginal penetration at post-treatment. Findings suggest that women who refrain from vaginal intercourse after treatment differ from women who continue or resume this activity.

Associations between treatment goals, patient characteristics, and outcome measures for patients with musculoskeletal disorders in physiotherapy practice

Background

Goal setting is linked to person-centred care and is a core component in physiotherapy, but the associations between goal classes, patient characteristics and outcome measures for musculoskeletal disorders has not been investigated. The study’s purpose was to examine 1) how goals used in clinical practice for patients with musculoskeletal disorders (MSD) are distributed in classes based on ICF, 2) if goal classes were associated with patient characteristics and 3) whether goal classes were associated with treatment outcome.

Methods

Data analysis from a longitudinal observational study (N = 2591). Goals were classified in symptom, function/structure, activity/participation and non-classifiable. Associations between patient characteristics and goal classes were examined using x² and one-way ANOVA. Association between goal classes and outcomes were examined using multiple logistic and linear regression models. Outcomes are reported at 3 months or end of treatment if prior to 3 months.

Results

There was a high variability in goals used for patients with MSD. 17% had symptom goals, 32.3% function/structure, 43.4% activity/participation and 7.4% non-classifiable goals. We found significant associations between goal classes and age, gender, severity, region of pain/diagnosis and emotional distress (all p < .001). Activity/participation goals were associated with better outcomes on GPE (OR 1.80, 95% CI 1.23–2.66). Non-classifiable goal was associated with poorer outcomes on pain intensity (B .87, 95% CI .32–1.43).

Conclusion

There is an association between goal classes and patient characteristics. Including activity/participation in the main goal was associated with better outcomes for GPE and having a non-classifiable goal was associated with poorer outcomes for pain intensity.

Trial registration

The project is approved by the Regional committee for Medical and Health Research Ethics in Norway (REC no. 2013/2030). https://clinicaltrials.gov/ct2/show/NCT03626389.

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.

Swiping for the right reasons: Approach and avoidance goals are associated with actual and perceived dating success on Tinder

Tinder, the mobile dating app, is widely used for meeting potential dating partners, but little research has investigated the dating experiences of users. In two studies, we applied the approach-avoidance theory of social motivation to understand the association between people’s goals for Tinder use and their perceived and actual dating success. In Study 1 we found that higher approach goals for using Tinder, such as to develop intimate relationships, were associated with more positive beliefs about people on Tinder, and in turn, associated with reporting greater perceived dating success, initiating more conversations on Tinder, and going on more second dates with people from Tinder. In contrast, people who had higher avoidance goals when using Tinder, such as aiming to avoid embarrassment, reported feeling more anxious when using Tinder and in turn, perceived less dating success and reported fewer second dates. In Study 2—a preregistered replication of Study 1—we largely replicated the effects from Study 1. Additional analyses in both studies revealed that the results were not accounted for by attractiveness of the user and were consistent between men and women, but differed based on the age of the user. The associations between approach goals and dating success were stronger for younger, compared to older users and the association between avoidance goals and dating success were stronger for older, compared to younger, users. The findings have implications for understanding the role of motivation in dating success on Tinder and reveal novel mechanisms for the associations between dating goals and dating success.

Sexual communal motivation in couples coping with low sexual interest/arousal: Associations with sexual well-being and sexual goals

Women coping with female sexual interest/arousal disorder (FSIAD) report lower sexual and relationship satisfaction compared to healthy controls. In community samples, high sexual communal strength (i.e., the motivation to meet a partner's sexual needs) is associated with higher sexual desire and satisfaction, but high unmitigated sexual communion (i.e., the prioritization of a partner's needs to the exclusion of one's own needs) is associated with lower sexual satisfaction. People higher in sexual communal strength report engaging in sex for approach goals (i.e., to enhance intimacy in their relationship), but not for avoidance goals (i.e., to avert conflict or a partner's disappointment) and this is one reason why they report greater sexual desire. In the current sample of 97 women diagnosed with FSIAD and their partners we investigated the association between sexual communal strength and unmitigated sexual communion and sexual well-being (i.e., sexual desire, sexual satisfaction and sexual distress) and sexual goals (i.e., approach and avoidance goals). Women who reported higher sexual communal strength were more likely to pursue sex for approach goals and their partner reported greater sexual satisfaction. When partners reported higher sexual communal strength, they reported higher sexual desire, but when they reported higher unmitigated sexual communion, they reported higher sexual distress. Additional associations emerged for couples who engage in sex more (compared to less) frequently. Our findings demonstrate that being motivated to meet a partner's sexual needs is associated with greater sexual well-being for couples coping with FSIAD, but when this motivation involves neglecting one's own needs, people do not report greater sexual well-being and instead, partners report higher sexual distress.

Sexual Distress Mediates the Associations Between Sexual Contingent Self-Worth and Well-Being in Women With Genitopelvic Pain: A Dyadic Daily Experience Study

Provoked vestibulodynia (PVD), a common cause of women's genitopelvic pain, is associated with poorer psychological and sexual well-being in affected couples. Greater sexual contingent self-worth (CSW)-defined as self-esteem that is dependent on the perceived success or failure of a sexual relationship-has been linked to poorer well-being in a cross-sectional study of couples coping with PVD. This study aimed to examine whether daily sexual distress mediated the associations between greater sexual CSW and lower sexual satisfaction and greater anxiety, depressed mood, and women's pain in affected couples. Women (N = 125) diagnosed with PVD and their partners completed the Sexual CSW Scale and then online daily surveys for eight weeks measuring sexual distress, sexual satisfaction, anxiety, depressed mood, and women's pain during intercourse. Multilevel analyses were based on the actor-partner interdependence model (APIM). For women who had higher sexual CSW (compared to lower sexual CSW), on sexual activity days when their sexual distress was higher, they reported lower sexual satisfaction and greater anxiety, depressed mood, and pain (compared to their average level across all sexual activity days). Findings suggest that daily sexual distress may be one pathway between greater sexual CSW and poorer day-to-day well-being in women with PVD.

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.

Fear-based reasons for not engaging in sexual activity during pregnancy: associations with sexual and relationship well-being

OBJECTIVE

Pregnant women consistently report fears that sexual activity could harm their pregnancy. Little is known, however, about the degree to which women report these fears as reasons for not having sex during pregnancy and whether these fears relate to women's well-being. The aims of this study were to assess the importance of women's fears of sexual activity harming the pregnancy in their decision not to engage in sex during pregnancy, and the associations between these fears and sexual and relationship well-being.

METHODS

Pregnant women (N = 261) were recruited online to complete a survey that included a novel scale of fear-based reasons for not engaging in sexual activity during pregnancy and validated measures of sexual functioning, sexual satisfaction, sexual distress and relationship satisfaction.

RESULTS

Over half of the women (58.6%) reported at least one fear as a reason for not engaging in sexual activity while pregnant, though total fear scores were low. Greater fear-based reasons for not having sex were associated with greater sexual distress but were unrelated to sexual functioning, sexual satisfaction and relationship satisfaction.

CONCLUSIONS

Women who reported higher rates of refraining from sex due to fear that it could harm their pregnancy reported greater sexual distress, but not lower sexual functioning or sexual and relationship satisfaction. Results suggest that interventions focused on minimizing fears of sexual activity during pregnancy may not be essential for promoting women's broader sexual and relationship well-being in pregnancy, but may help to reduce women's global feelings of worry and anxiety about their sexual relationship.

What Theories and Methods From Relationship Research Can Contribute to Sex Research

Sexual and relationship satisfaction tend to be closely linked in the context of romantic relationships. Understanding how sexual processes influence relationships and how aspects of the relationship influence a couple's sex life can provide insight into the maintenance of sexual desire and satisfaction over time. In this article, we review how theories and methods that form the foundation for relationship research have made-and will continue to make-sexuality research a stronger, more theoretical, and methodologically sophisticated science. We discuss the key theories that have been used to advance our understanding of who is more likely to be sexually satisfied in relationships, when sex is most satisfying, and how couples can have more satisfying sex lives and relationships. We then provide an overview of dyadic and repeated-measures designs and demonstrate how the use of these types of research methods allows relationship and sexuality researchers to answer novel and nuanced questions about how romantic partners influence each other, as well as how sexual processes unfold in couples' daily lives and over time. Throughout the review, we highlight what we see as fruitful directions for future research at the intersection of sexuality and relationships.

Avoiding or enduring painful sex? A prospective study of coping and psychosexual function in vulvovaginal pain

BACKGROUND

Recurring vulvovaginal pain is common, with evident effects on affected women's lives. Little is known about how affected women cope with painful sexual activities and how coping relates to pain intensity and psychosexual functioning over time. This prospective study explored the impact of avoidance and endurance on sexual function over time. Additionally, patterns of coping were studied on an individual level to increase knowledge about coping and its relation to psychosexual functioning.

METHODS

One hundred and seventeen women, 18-35 years old, with recurring vulvovaginal pain answered questionnaires at two measurement points, five months apart, assessing avoidance and endurance coping, pain intensity and psychosexual functioning. A multiple regression model explored the predictive value of avoidance and endurance on sexual function over time. Cluster analyses investigated patterns of coping and stability within the clusters. These subgroups were compared on psychosexual outcomes.

RESULTS

Avoidance at baseline was the only significant predictor of sexual function five months later. Distinct and stable subgroups with different patterns of coping were identified, where avoidance and endurance coping were used both separately and combined. Women who both avoided and endured had the most unfavourable outcomes in terms of psychosexual functioning.

CONCLUSIONS

Avoidance of sexual activities was related to reduced sexual function over time, which calls for attention and clinical interventions targeting avoidance. Additionally, women who both avoid and endure sexual activities despite pain possibly need tailored interventions, as women with this coping pattern reported the lowest levels of psychosexual functioning.

SIGNIFICANCE

In this prospective study, avoidance of sexual activities predicted sexual function over time, when controlling for pain intensity. Subgroups of women using distinct patterns of coping were identified. Those who both avoided and endured had the lowest levels of psychosexual functioning.

Communal motivation in couples coping with vulvodynia: Sexual distress mediates associations with pain, depression, and anxiety

OBJECTIVE

To examine the role of a novel motivational perspective-sexual communal motivation-in women's pain during intercourse and both partners' distress in couples coping with vulvodynia, a prevalent gynecological pain condition. Our goal was to test whether sexual communal strength (i.e., motivation to meet a partner's sexual needs) and unmitigated sexual communion (i.e., prioritization of a partner's sexual needs in neglect of one's own needs) were indirectly associated with pain, depression, and anxiety via sexual distress.

METHODS

Couples (N=101) completed daily surveys about their sexual communal motivation, sexual distress, anxiety, depression, and women reported on their pain during intercourse. Using multilevel modeling, we examined how daily fluctuations in sexual communal motivation were directly and indirectly (via sexual distress) associated with pain and psychological distress.

RESULTS

On days when women with vulvodynia reported higher sexual communal strength, they reported less pain and anxiety, and on days when they reported higher unmitigated sexual communion, they reported more pain, more anxiety, and both partners reported more depressive symptoms. Daily associations between women's unmitigated sexual communion and greater pain, depression and anxiety were mediated by sexual distress.

CONCLUSIONS

Being motivated to meet a partner's sexual needs was associated with less pain and anxiety for women with vulvodynia, but when this motivation excluded a focus on one's own needs, there were detrimental consequences for women's pain and both partners' depressive symptoms. Interventions for improving women's pain and the psychological well-being of affected couples should target motivational factors and sexual distress.

Sexual Satisfaction Among Couples: The Role of Attachment Orientation and Sexual Motives

The mediating effect of sexual motives between attachment orientation and sexual satisfaction and functioning was investigated among 128 couples (N = 256) using the actor-partner interdependence model (Campbell & Kashy, 2002). Actor effects between attachment orientation and sexual satisfaction and functioning, mediated by sexual motives, were found regarding men's sexual satisfaction, sexual intimacy, and orgasmic responsivity. Partner effect revealed two significant paths in which the greater the women's attachment avoidance, the lower the partners' intimacy motivation, which in turn was linked with lower partners' sexual satisfaction and increased lack of sexual intimacy. The analyses did not reveal significant mediation paths affecting women's sexual satisfaction and functioning. These findings emphasize the importance of implementing a dyadic perspective on sexuality within practice. Recommendations for further research and additional clinical implications are discussed.

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.

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.