Maintaining affection despite pain: Daily associations between physical affection and sexual and relationship well-being in women with genito-pelvic pain

Posted on Sep 14, 2016

flickr-user_you-meBy Sarah Vannier

*Note: This is a summary of our recently published paper Vannier, S.A., Rosen, N.O., Mackinnon, S.P., & Bergeron, S. (2016). Maintaining affection despite pain: Daily associations between physical affection and sexual and relationship well-being in women with genito-pelvic pain. Archives of Sexual Behavior. Online First. doi: 10.1007/s10508-016-0820-5 Access the paper: Full-Text View Only (Open-Access), Full-Text Download (Paywall)

Provoked vestibulodynia (PVD) is the most common cause of genito-pelvic pain in premenopausal women and affects 8 to 12 % of women. Many women with PVD report that the condition has a negative effect on their sexual and relationship well-being [1]. The goal of this study was to look at the link between day-to-day physical affection with a romantic partner (i.e., hugging/kissing and cuddling) and sexual, relational, and pain outcomes in women with PVD.

Physical affection is an important part of our intimate and romantic relationships. Actions like kissing, hugging, caressing, and cuddling have been linked to greater sexual and relationship satisfaction [2-5], and touch from romantic partners can help to reduce stress [6, 7].

No research has looked at the link between physical affection, pain, and sexual and relationship well-being in women with PVD. On the one hand, some women with genito-pelvic pain report that affectionate contact (e.g., hugging and kissing) with their partner helps them to maintain intimacy in their relationship when they have difficulty engaging in sexual activity [8-11]. On the other hand, many women with genito-pelvic pain, report avoiding or limiting physical affection because they worry it might lead to painful sexual activity [11-14]. For example, in a recent study of Canadian women receiving treatment for PVD, 38% said that they avoided all forms of physical intimacy with their romantic partner [9]. This avoidance may be partially driven by a desire to prevent a painful encounter, but may also be driven by concern about “leading a partner on” and not wanting to reject a partner who is trying to initiate sexual activity.

What did we do?

Seventy women diagnosed with PVD completed the study. All women were in mixed-sex relationships and living with their partner. We used a daily diary method where women completed a short survey every day for 8-weeks. This daily diary method is useful because it helps us collect more accurate reports of women’s experiences (i.e., it is easier to remember what you did in the past 24 hours than to remember your typical behaviour over the past four weeks). The diary method also lets us look at the day-to-day changes in women’s lives. Each day women reported whether they had engaged in physical affection and sexual activity and rated their relationship satisfaction. On days when sexual activity occurred women also rated their sexual functioning, sexual satisfaction, and intensity of pain.

What did we find?

Many of the women in our sample were physically affectionate with their partner. On days with sexual activity, women hugged/kissed their partner eight times, and cuddled their partner twice, on average. On days with no sexual activity, women were slightly less affectionate; they report hugging/kissing five times and cuddling once, on average.

Affection was linked with sexual and relationship well-being. On days that women reported more affection they also reported increased satisfaction, relationship satisfaction, and sexual functioning. This was true for hugging and kissing that happened on the same day as sexual activity, and for hugging and kissing that happened on the day before sexual activity. Cuddling was not related to any of the sexual and relationship outcomes, and physical affection was not linked with women’s experiences of pain.

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What does this mean?

Our findings suggest that physical affection, such as hugging and kissing, is associated with higher sexual satisfaction, relationship satisfaction, and better sexual functioning in the daily lives of women with PVD. Affection also appears to be helpful when it happens both within and outside of a sexual context. This means that hugging and kissing regularly, and on days when you do not have sex, may be helpful for women with PVD and their partners.

It is very common for women with PVD to report that physical affection with their partner produces negative emotions and avoidance, mostly driven by a fear that affection can lead to painful sexual activity [15-18]. However, our data suggest that maintaining affectionate contact with a partner may offer benefits for women with PVD and their romantic relationships. That said, we must keep in mind that this study was correlational. This means that we do not know if hugging and kissing more causes improvements in sexual and relationship well-being, or if women who are in better sexual and romantic relationships are also more likely to hug and kiss their partner. Longitudinal research, where we follow couples over time, will help us to tease apart this association. Overall, we hope that this data will inform future interventions aimed at enhancing the sexual and relationship well-being of women with PVD.

REFERENCES

  1. Ponte, M., et al., Effects of vulvodynia on quality of life. Journal of the American Academy of Dermatology, 2009. 60(1): p. 70-76.
  2. Dainton, M., L. Stafford, and D.J. Canary, Maintenance strategies and physical affection as predictors of love, liking, and satisfaction in marriage. Communication Reports, 1994. 7(2): p. 88-98.
  3. Fisher, W.A., et al., Individual and partner correlates of sexual satisfaction and relationship happiness in midlife couples: Dyadic analysis of the international survey of relationships. Archives of Sexual Behavior, 2015. 44(6): p. 1609-1620.
  4. Gulledge, A.K., M.H. Gulledge, and R.F. Stahmann, Romantic physical affection types and relationship satisfaction. American Journal of Family Therapy, 2003. 31(4): p. 233-242.
  5. Muise, A., E. Giang, and E.A. Impett, Post sex affectionate exchanges promote sexual and relationship satisfaction. Archives of Sexual Behavior, 2014. 43(7): p. 1391-1402.
  6. Ditzen, B., et al., Effects of different kinds of couple interaction on cortisol and heart rate responses to stress in women. Psychoneuroendocrinology, 2007. 32(5): p. 565-574.
  7. Grewen, K.M., et al., Warm partner contact is related to lower cardiovascular reactivity. Behavioral Medicine, 2004. 29(3): p. 123-130.
  8. Blair, K.L., et al., Differential associations of communication and love in heterosexual, lesbian, and bisexual women’s perceptions and experiences of chronic vulvar and pelvic pain. Journal of Sex and Marital Therapy, 2015. 41(5): p. 498-524.
  9. Brotto, L.A., et al., Impact of a multidisciplinary vulvodynia program on sexual functioning and dyspareunia. Journal of Sexual Medicine, 2015. 12(1): p. 238-247.
  10. Smith, K.B. and C.F. Pukall, A systematic review of relationship adjustment and sexual satisfaction among women with provoked vestibulodynia. Journal of Sex Research, 2011. 48(2-3): p. 166-191.
  11. Svedhem, C., G. Eckert, and B. Wijma, Living with genito-pelvic pain/penetration disorder in a heterosexual relationship: An interpretative phenomenological analysis of interviews with eight women. Sexual and Relationship Therapy, 2013. 28(4): p. 336-349.
  12. Hinchliff, S., M. Gott, and K. Wylie, A qualitative study of heterosexual women’s attempts to renegotiate sexual relationships in the context of severe sexual problems. Archives of Sexual Behavior, 2012. 41(5): p. 1253-1261.
  13. Marriott, C. and A.R. Thompson, Managing threats to femininity: Personal and interpersonal experience of living with vulval pain. Psychology and Health, 2008. 23(2): p. 243-258.
  14. Sutherland, O., Qualitative analysis of heterosexual women’s experience of sexual pain and discomfort. Journal of Sex & Marital Therapy, 2012. 38(3): p. 223-244.
  15. Gates, E.A. and R.P. Galask, Psychological and sexual functioning in women with vulvar vestibulitis. Journal of Psychosomatic Obstetrics and Gynecology, 2001. 22(4): p. 221-228.
  16. Nylanderlundqvist, E. and J. Bergdahl, Vulvar vestibulitis: Evidence of depression and state anxiety in patients and partners. Acta Dermato-Venereologica, 2003. 83(5): p. 369-373.
  17. Payne, K.A., et al., When sex hurts, anxiety and fear orient attention towards pain. European Journal of Pain, 2005. 9(4): p. 427-436.
  18. Payne, K.A., et al., Effects of sexual arousal on genital and non-genital sensation: A comparison of women with vulvar vestibulitis syndrome and healthy controls. Archives of Sexual Behavior, 2007. 36(2): p. 289-300.