Painful Sex in Context : Understanding Vulvodynia from a Relational Perspective

Abstract

Vulvodynia is a multifactorial persistent pain condition, characterized by pain in the vulva upon touch or pressure. It negatively impacts sexual function, satisfaction, and relational wellbeing. Relational factors have been indicated as integral to the understanding and outcomes of vulvodynia. The overall aim of this dissertation was to further the understanding of women’s pain-related behaviors in relation to the dyadic and normative contexts of vulvodynia. Using a person-oriented approach, study I explored links between coping behaviors, i.e., avoidance and endurance on the one hand, and on the other, relational and pain catastrophizing, perceived partner responses, and motivational goals, in a sample of 128 women with vulvodynia. Study II explored the significance of normative context for the experience of vulvodynia by qualitatively investigating subjective experiences of five women living with dyspareunia in a queer relationship. Using behavioral observation and self-report, study III investigated patterns of sexual communication quality in heterosexual vulvodynia couples (n = 25) as compared to couples without pain (n = 37), and assessed potential associations with pain, self-disclosure, and sexual assertiveness. The findings from the three studies together highlight the significance of the normative context and relational factors such as the emotional quality of sexual communication and women’s relational cognitions, for women’s pain-related experiences and coping behaviors. A new theoretical model, the Interpersonal Pain Coping Model of Vulvodynia, is proposed as a way of integrating contextual factors such as partner behaviors and sexual scripts into the understanding of women’s behavioral response to vulvodynia