A Prospective 2-Year Examination of Cognitive and Behavioral Correlates of Provoked Vestibulodynia Outcomes

Abstract

Background: Provoked vestibulodynia (PVD) is a common genital pain disorder in women, which is associated with sexual dysfunction and lowered sexual satisfaction. A potentially applicable cognitive-behavioral model of chronic pain and disability is the fearavoidance model (FAM) of pain. The FAM posits that cognitive variables, such as pain catastrophizing, fear, and anxiety lead to avoidance of pain-provoking behaviors (intercourse), resulting in continued pain and disability. Although some of the FAM variables have been shown to be associated with PVD pain and sexuality outcomes, the model as a whole has never been tested in this population. An additional protective factor, pain self-efficacy, is also associated with PVD, but has not been tested within the FAM model.

Female Sexual Pain Disorders: a Review of the Literature on Etiology and Treatment

“…Higher levels of catastrophizing, fear of pain, and hypervigilance and lower levels of self-efficacy correlate with increased pain in women with PVD, while higher levels of anxiety and avoidance and lower levels of self-efficacy were associated with their increased sexual dysfunction [64]. Moreover, there is evidence of a prospective relationship between cognitive variables and PVD, where higher levels of pain catastrophizing and lower levels of self-efficacy were shown to predict worse treatment outcomes in a randomized trial evaluating cognitive-behavioral therapy (CBT) [65], and increases in pain self-efficacy over a 2-year period were associated with better pain, sexual function, and sexual satisfaction outcomes [66].…”

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

“…In other chronic pain populations, avoidance patterns have been strongly associated with higher pain intensity and lower overall function (Leeuw et al, 2007;Vlaeyen and Linton, 2012). Similarly, in women with vulvovaginal pain, avoidance behaviour, pain catastrophizing and cognitive aspects of avoidance are prevalent (Gordon et al, 2003;Desrochers et al, 2009;Davis et al, 2015) and associated with higher pain intensity, well in line with the fear-avoidance model of pain (Vlaeyen and Linton, 2000). To our knowledge, only one study (Desrochers et al, 2009) has investigated and confirmed a cross-sectional link between avoidance coping, in the form of cognitive fear-avoidance tendencies, and lower sexual function.…”

Are Primary and Secondary Provoked Vestibulodynia Two Different Entities? A Comparison of Pain, Psychosocial, and Sexual Characteristics

“…Participants were asked how many times in the past month they had attempted to have sexual intercourse with vaginal penetration. The actual number of attempts, successful or not, was taken as the behavioral measure of avoidance, with a lower number of attempts being indicative of more avoidance [43].…”