By Paige Robillard

This blog is a summary of: Pâquet, M., Rosen, N. O., Steben, M., Mayrand, M. H., Santerre-Baillargeon, M., & Bergeron, S. (2018). Daily anxiety and depressive symptoms in couples coping with vulvodynia: Associations with women’s pain, women’s sexual functioning, and both partners’ sexual distress. The Journal of Pain, 19, 552-561. doi: 10.1016/j.jpain.2017.12.264

Vulvodynia is a chronic, unexplained vulvar pain condition [1-3]. Provoked vestibulodynia (PVD) is the most common subtype. PVD is characterized by a burning pain that is triggered by pressure to the vulvar vestibule (the external opening of the vagina). PVD can be triggered in non-sexual situations such as when inserting a tampon, or during sexual activity [4-6].

Women with PVD report poorer sexual functioning and more sexual distress compared to women without this pain condition, as well as feelings of inadequacy as a sexual partner [7-9]. Partners of women with PVD are also affected; reporting impaired erectile function and lower sexual satisfaction [10].

According to the biopsychosocial model of pain, affective states like anxiety and depression can influence pain and disability [11]. Importantly, anxiety and depression have been found to be both an antecedent and consequence of PVD, with these symptoms commonly endorsed by women with this pain condition [9, 12, 13-14]. Depressive symptoms and anxiety have wide ranging impacts on women’s sexual desire, pain, and sexual impairment [15-17]. Although partners of women with PVD experience distress associated with the condition [10], the role of partner’s affective factors in women’s pain and couple’s well-being has not been examined.

To date, very few studies have looked at symptomology in chronic pain disorders across time [18-19], and no studies have looked at the role of the daily fluctuation of affective symptoms in PVD. Moreover, there is currently no research that examines how daily affective symptoms affect women with PVD and their partners.

What was the goal of the study?

The present study investigated how affective states can influence the patterns between mood, pain, and sexual impairment in couples with PVD by examining the daily fluctuations of depressive and anxiety symptoms in couples.

What did they do?

127 women and their partners complete online daily diaries for 8 consecutive weeks. The daily diaries measured participants’ mood (depressive and anxiety symptoms) and asked if sexual activity had occurred in the previous 24 hours. If sexual activity had occurred, women reported their level of pain and both members of the couple completed measures of sexual distress and sexual function.

What did they find?

  • Women’s and partners’ lower levels of depressive and anxiety symptoms was linked to lower levels of pain during sexual activity and better sexual functioning in women
  • Partners’ depressive and anxiety symptoms were not associated with womens’ pain, with their own sexual functioning, or with the womens’ sexual functioning
  • Lower depressive symptoms was linked with both women and their partners reporting less sexual distress
  • Womens’ anxiety levels had no significant effect on their reported level of sexual distress or their partners’
  • Lower anxiety symptoms in the partner was linked with lower levels of their own and the women’s sexual distress

What do these findings mean?

Broadly, this research suggests that women’s depression and anxiety symptoms are associated withthe level of pain women report feeling during sexual activity, and that the women’s depressive symptoms, but not anxiety symptoms, are linked with the women’s and their partners’ sexual functioning, and sexual distress.  The partners’ depressive and anxiety symptoms also affect their own and the women’s level of sexual distress, but not the women’s reported level of pain, and sexual functioning, or the partners’ own sexual functioning.

One possible explanation is that the women’s anxiety and depression may cause changes in the central nervous system that leads to higher sensitivity, and therefore more pain [20].

Secondly, the association between depressive symptoms and both partners’ reported sexual distress may be due to the couples negatively interpreting the cause of their distress. For example, both partners’ sexual distress could be a result of their frustration at failing to meet their shared expectation of what sex should be like. In addition, partners who attributed the pain caused by PVD as their responsibility reported higher levels of psychological distress, which could then impact their own distress, but not women’s. [21].

Thirdly, women with PVD may associate intercourse with pain and try to brace for it. This in turn can make it hard to engage in and be mindful in sexual activity, and therefore cause lower sexual functioning. Couples might also avoid sex altogether for fear of pain, and this avoidance might in turn cause the couple more distress and pain [22-23].

These findings are an important, novel addition to current literature surrounding affective symptoms and sexual pain disorders. It also provides a possible target for psychological treatments. Interventions designed to target affective symptoms in women with PVD and their partners may help reduce overall distress in couples with PVD.

References

[1] Harlow, B. L., Kunitz, C. G., Nguyen, R. H., Rydell, S. A., Turner, R. M., & MacLehose, R. F. (2014). Prevalence of symptoms consistent with a diagnosis of vulvodynia: Population-based estimates from 2 geographic regions. American Journal of Obstetrics & Gynecology, 210, e41-e48. doi: 10.1016/j.ajog.2013.09.033

[2] Harlow, B. L., Wise, L. A., & Stewart, E. G. (2001). Prevalence and predictors of chronic lower genital tract discomfort. American Journal of Obstetrics & Gynecology, 185, 545-550. doi: 10.1067/mob.2001.116748

[3] Pukall, C. F., Goldstein, A. T., Bergeron, S., Foster, D., Stein, A., Kellogg-Spadt, S., & Bachmann, G. (2016). Vulvodynia: Definition, prevalence, impact, and pathophysiological factors. The Journal of Sexual Medicine, 12, 391-304. doi: 10.1016/j.jsxm.2015.12.021

[4] Bergeron, S., Binik, Y. M., Khalife, S., Pagidas, K., & Glazer, H.I. (2001). Vulvar vesibulitis syndrome: Reliability of diagnosis and evaluation of current diagnostic criteria. Obstetrics & Gynecology,98, 45-51. doi: 10.1016/S0029-7844(01)01389-8

 [5] Bornstein, J., Goldstein, A. T., Stockdale, C. K., Bergeron, S., Pukall, C., Zolnoun, D., & Coady, D. (2016). 2015 ISSVD, ISSWSH, and IPPS consensus terminology and classification of persistent vulvar pain and vulvodynia. The Journal of Sexual Medicine, 13, 607-612. doi: 10.1016/j.jsxm.2016.02.167

[6] Goldstein, A. T., Pukall, C. F., Brown, C., Bergeron, S., Stein, A., & Kellogg-Spadt, S. (2016). Vulvodynia: Assessment and Treatment. The Journal of Sexual Medicine, 13, 572-590. doi: 10.1016/j.jsxm.2016.01.020

[7] Ayling, K., & Ussher, J. M. (2007). “If sex hurts, am I still a woman?” The subjective experience of vulvodynia in hetero-sexual women. Archives of Sexual Behavior, 37, 294-304. doi: 10.1007/s10508-007-9204-1

[8] Bergeron, S., Corsini-Munt, S., Aerts, L., Rancourt, K., & Rosen, N. O. (2015). Female sexual pain disorders: A review of the literature on etiology and treatment. Current Sexual Health Reports, 7, 159-169. doi: 10.1007/s11930-015-0053-y

[9] Gates, E. A., & Galask, R. P. (2001). Psychological and sexual functioning in women with vulvar vestibulitis. Journal of Psychosomatic Obstetrics and Gynecology, 22, 221-228. doi: 10.3109/01674820109049977

[10] Smith, K. B., & Pukall, C. F. (2014). Sexual function, relationship adjustment, and the relational impact of pain in male partners of women with provoked vulvar pain. Journal of Sexual Medicine, 11, 1283-1293. doi:10.1111/jsm.12484

[11] Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133, 581 – 624. doi: 10.1037/0033-2909.133.4.581

[12] Khandker, M., Brady, S. S., Vitonis, A. F., Maclehose, R. F., Stewart, E. G., & Harlow, B. L. (2011). The influence of depression and anxiety on risk of adult onset vulvodynia. Journal of Women’s Health, 20, 1445-1451. doi: 10.1089/jwh.2010.2661

[13] Nylanderlundqvist, E., & Bergdahl, J. (2003). Vulvar vestibulitis: Evidence of depression and state anxiety in patients and partners. Advances in Dermatology and Venereology, 83, 369-373. doi: 10.1080/00015550310003764

[14] Sackett, S., Gates, E., Heckman-Stone, C., Kobus, A. M., & Galask, R. (2001). Psychosexual aspects of vulvar vestibulitus. Journal of Reproductive Medicine for the Obstetrician and Gynecologist, 46, 593-598. doi: 10.1136/sti.73.6.541

[15] Kalmbach, D. A., Kingsberg, S. A., & Ciesla, J. A. (2014). How changes in depression and anxiety symptoms correspond to variations in female sexual response in a nonclinical sample of young women: A daily diary study. Journal of Sexual Medicine, 11, 2915-2927. doi: 10.1111/jsm.12692

[16] Laurent, S. M., & Simons, A. D. (2009). Sexual dysfunction in depression and anxiety: Conceptualizing sexual dysfunction as part of an internalizing dimension. Clinical Psychology Review, 29, 573-585. doi: 10.1016/j.cpr.2009.06.007

[17] Cyranowski, J. M., Hofkens, T. L., Frank, E., Seltman, H., Cai, H. M., & Amico, J A. (2008). Evidence of dysregulated peripheral oxytocin release among depressed women Psychosomatic Medicine, 70, 967. doi: 10.1097/PSY.0b013e318188ade4

[18] Lerman, S. F., Rudich, Z., Brill, S., Shalev, H., & Shahar, G. (2015). Longitudinal associations between depression, anxiety, pain, and pain-related disability in chronic pain patients. Psychosomatic Medicine, 77, 333-341. doi: 10.1097/PSY.0000000000000158

[19] Connelly, M., Bromberg, M. H., Anthony, K. K., Gil, K. M., Franks, L., & Schanberg, L., E. (2012). Emotion regulation predicts pain and functioning in children with juvenile idiopathic arthritis: An electronic diary study. Journal of Pediatric Psychology, 37, 43-52. doi: 10.1093/jpepsy/jsr088

[20] Weijmar Schultz, W., Basson, R., Binik, Y., Eschenbach, D., Wesselmann, U., & Van Lankveld, J. (2005). Women’s sexual pain and its management. Journal of Sexual Medicine, 2, 301-316. doi: 10.1111/j.1743-6109.2005.20347.x

[21] Jodoin, M., Bergeron, S., Khalife, S., Dupuis, M. J., Desrochers, G., Leclerc, B. (2008). Male partners of women with provoked vestibulodynia: Attributions for pain and their implications for dyadic adjustment, sexual satisfaction, and psychological distress. Journal of Sexual Medicine, 5, 2862-2870. doi: 10.1111/j.1743-6109.2008.00950.x

[22] Thomten J, & Linton, S. J. (2013). A psychological view of sexual pain among women: Applying the fear-avoidance model. Women’s Health, 9, 251-263. doi: 10.2217/WHE.13.19

[23] Waddell, G., Newton, M., Henderson, I., Somerville, D., & Main, C., J. (1993). A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain, 52, 157-168. doi: 10.1016/0304-3959(93)90127-B

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