Provoked Vestibulodynia: Mediators of the Associations Between Partner Responses, Pain, and Sexual Satisfaction

Abstract

Provoked vestibulodynia (PVD) is a chronic, recurrent vulvo-vaginal pain condition affecting 12% of the general population, and is associated with sexual dysfunction, psychological distress, and reduced quality of life. There is growing interest in the role of interpersonal variables in PVD, which have been widely neglected. In a sample of 175 couples, the present study examined the mediating roles of partner and participant catastrophizing and self-efficacy in the association between solicitous partner responses and pain intensity, and that of dyadic adjustment in the association between solicitous and negative partner responses and sexual satisfaction. Couples completed measures of partner responses, catastrophizing, self-efficacy, dyadic adjustment, and depression. Women also completed measures of pain, sexual satisfaction, and sexual function. Controlling for depression and solicitousness perceived by the other member of the couple, catastrophizing and self-efficacy partially mediated the association between higher solicitous responses and higher pain during intercourse, accounting for 26% and 25% of the variance in this association for woman and partner-perceived responses, respectively.For both women and partners, only pain catastrophizing was a unique mediator. Controlling for depression, sexual function and partner-perceived responses, dyadic adjustment partially mediated the association between higher participant-perceived solicitous responses and higher sexual satisfaction, and between higher participant-perceived negative responses and lower sexual satisfaction, accounting for 26% of the variance in each association. The current findings suggest that catastrophizing and dyadic adjustment may constitute a route by which partner responses exacerbate pain and increase or decrease sexual satisfaction in PVD couples.

Psychosexual aspects of vulvovaginal pain

“…Furthermore, the associations were mediated by greater patient and partner pain catastrophizing and self-efficacy [39,40]. In fact, partner pain catastrophizing and selfefficacy directly predicted patient pain, suggesting that the partner's view of the pain may modulate patient symptomatology [41].…”

“…demonstrations of anger, were significantly associated with higher levels of pain during intercourse, suggesting that partner responses, both positive and negative, may play a role in the experience of vulvovaginal pain [38]. Results from a larger cross-sectional study of 191 couples indicated that higher solicitous partner responses -assessed from the perspective of both the 8 woman and partner -were associated with higher levels of women's pain intensity.Furthermore, the associations were mediated by greater patient and partner pain catastrophizing and self-efficacy [39,40]. In fact, partner pain catastrophizing and selfefficacy directly predicted patient pain, suggesting that the partner's view of the pain may modulate patient symptomatology [41].…”

“…In fact, partner pain catastrophizing and selfefficacy directly predicted patient pain, suggesting that the partner's view of the pain may modulate patient symptomatology [41]. Lower negative partner responses were also associated with more sexual satisfaction in women, and this association was mediated by greater dyadic adjustment [39,40]. Another study with a sample of 121 couples showed that facilitative partner responses -defined as partner responses that encourage a patient's efforts at adaptive coping with the pain (e.g., decreased avoidance) -were associated with lower vulvovaginal pain and higher sexual satisfaction [42].…”

Partner Behavioral Responses to Pain Mediate the Relationship Between Partner Pain Cognitions and Pain Outcomes in Women With Provoked Vestibulodynia

“…In the context of PVD, an example of a solicitous response is when a partner suggests that the couple stop engaging in sexual activity; a negative response is when a partner expresses anger or disappointment. Both are associated with worse pain outcomes in cross-sectional and daily diary studies of musculoskeletal pain and PVD 4,5,28,30,32,33,37,39 . Negative partner responding, more so than solicitous responding, has been shown to be related to patient depressive symptoms, which may be due to the perceived supportiveness of solicitous responses 4,30,37 Less is known about why partners respond in specific ways, but based on a cognitive behavioral framework, partner cognition regarding pain may influence their subsequent behavior.…”

“…This could indicate changes in partners' ability or desire to respond in positive ways as time goes on, suggesting that positive behavioral responding may take more self-regulation. One study showed that partner catastrophizing and self-efficacy partially mediated the association between higher partner solicitous responses and higher pain during intercourse in women with PVD, although only pain catastrophizing was a unique mediator 3,32 .…”