By Serena Corsini-Munt
This post is a summary of Dr. Rosen’s published article: Rosen, N. O., Muise, A., Impett, E. A., Delisle, I., Baxter, M.L., & Bergeron, S. (2018). Sexual cues mediate the daily relations between interpersonal goals, pain, and wellbeing in couples coping with vulvodynia. Annals of Behavioral Medicine. https://doi.org/10.1093/abm/kax046
Provoked vestibulodynia (PVD) is not only the most common type of vulvodynia and most frequent cause of pain during sex for premenopausal women, it also carries with it many negative consequences for the psychological, sexual and relational wellbeing of women AND their partners (1). Despite the pain and the associated difficulties and distress, many women continue to attempt penetrative sexual activity with their partners. In fact, over 85% (2). This sexual motivation seems to be fueled by wanting to achieve something such as intimacy or feeling closer to a partner (approach sexual goals) or to prevent something unpleasant such as avoiding a fight with a partner (avoidance sexual goal). Previous research has shown that approach goals are associated with more sexual and relational satisfaction, whereas avoidance goals are associated with poorer outcomes (3). Knowing the significance of sexual goals has helped researchers and clinicians like those on our team help couples harness the power of their goals through sharing information with them about the importance of approach goals (i.e., psychoeducation), or helping them reprioritize approach sexual goals during therapy.
But Dr. Rosen and her colleagues were still curious to understand the mechanism by which sexual approach and avoidance goals exert their influence on better and worse sexual and relational functioning. Drawing from approach-avoidance theory and the dual-control model of sexual response (4), they wanted to test whether approach and avoidance sexual goals make a person more attentive to positive versus negative sexual cues (e.g., feelings, thoughts and emotions during sex). Specifically, in the current study they set out to examine the daily associations between interpersonal sexual goals (approach and avoidance sexual goals) and women’s pain during sexual intercourse and sexual functioning and relationship satisfaction for both women with PVD and their partners, while considering the mediating role of sexual cues. They predicted that when women and partners pursued sex for approach goals (higher compared to their average levels) they would report attending to positive sexual cues more, and in turn, they would report higher sexual function and relationship satisfaction. Conversely, they hypothesized that when women and partners pursued sex for avoidance goals, they would report attending to more negative sexual cues and in turn, would report lower sexual function and relationship satisfaction.
To answer their research questions, they asked 101 women with PVD and their partners to complete daily questionnaires about their sexual goals, attention to sexual cues, sexual function, relationship satisfaction and women’s pain during intercourse over the course of 8 weeks. Participants rated the importance of approach and avoidance sexual goals on a scale of 1-7, and similarly rated how true positive and negative sexual cue statements were for them (e.g., During sexual activity, I feel passionately attracted to my partner, or During sexual activity, bothersome thoughts disturbed my concentration).
Dr. Rosen and her fellow researchers found that their hypotheses were confirmed. When women and partners reported higher avoidance goals, they focused more on sexual cues and reported higher relationship satisfaction. Versus days when they reported more avoidance goals, partners focused more on negative cues and were less relationally satisfied. On days when women reported higher approach goals, they reported less pain, they and their partners attended more to positive sexual cues, and they both experienced higher sexual function. Conversely, on days when women reported more avoidance sexual goals, they and their partners attended more to negative sexual cues, women reported more pain and both reported lower sexual functioning.
So, what does it mean? Interpersonal sexual goals are clearly important to couples coping with PVD not just for the type of goal (approach vs. avoidance) but also because of their association with one’s focus or attention to feelings and thoughts during the experience associated with that goal (sex in this case). And not only that. The results of this study highlight that each member of the couple’s goals and attention to sexual cues can play a part in the other’s sexual functioning. These findings help deepen our understanding of how sexual goals can help couples adapt to PVD. And by knowing more about the mechanism by which sexual goals are associated with sexual and relational functioning for couples with PVD, clinicians will be better situated to provide targeted interventions to couples coping with PVD.
- Rosen NO, Rancourt K, Bergeron S, Corsini-Munt S. Beyond a “woman’s problem”: the role of relationship processes in genital pain. Cur Sex Health Rep. 2014;6(1):1–10.
- Reed BD, Harlow SD, Sen A, et al. Prevalence and demo- graphic characteristics of vulvodynia in a population-based sample. Am J Obstet Gynecol. 2012;206(2):170.e1–170.e9.
- Rosen NO, Muise A, Bergeron S, Impett EA, Boudreau GK. Approach and avoidance sexual goals in couples with provoked vestibulodynia: associations with sexual, relational, and psychological well-Being. J Sex Med. 2015;12(8):1781–1790.
- Bancroft J, Graham CA, Janssen E, Sanders SA. The dual control model: current status and future directions. J Sex Res. 2009;46(2–3):121–142.