By Meghan Rossi

This blog summarizes our recently published paper: 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

Vulvodynia is a chronic vulvar pain condition that has significant impacts on women’s psychological and sexual well-being. Provoked vestibulodynia (PVD) is the most common form of vulvodynia and affects approximately 8% of women [1]. It is often characterized by pain upon touch to the vulvar vestibule (i.e. the area around vaginal opening). This debilitating pain condition extends beyond women; past research suggests that partners of women with PVD report reduced sexual satisfaction, greater sexual distress, and depressive symptoms[2].

Women with PVD engage in intercourse despite the pain [3]. Motives for persisting with intercourse include approach and avoidance sexual goals. Approach sexual goalscan be thought of as having sex to obtain a desirable outcome like increasing intimacy within the relationship. Avoidance sexual goals are often conceptualized as having sex to avoid negative consequences, and include not wanting to disappoint or lose their partner [4]. However, we aren’t certain on what factors might be contributing to the experience of pain and well-being of couples who hold these approach or avoidance sexual goals.

How women and their partners perceive sexual experiences may be the contributing factor. Couples who hold approach sexual goals may process more positive sexual cues, such as positive sensations and thoughts. Comparatively, couples who hold avoidance sexual goals may focus on more negative sexual cues, which can include any signs of partner discomfort during sexual activity. So what does this suggest? Well, women and their partners who utilize approach sexual goals and attend to positive sexual cues, may focus on the pleasurable aspects of the sexual experience, which can create a more enjoyable interaction.

In our study, we wanted to examine the daily associations between sexual goals and women’s pain, as well as both partners’ sexual and relationship functioning. Extending past research, we also wanted to determine whether attendance to positive or negative sexual cues play a role in the relationship between sexual goals and these outcomes. We hypothesized that when couples pursued sex for approach sexual goals, both partners would report greater attention to positive sexual cues and subsequently report higher sexual functioning, relationship satisfaction, and lower pain in women.

What did we do?
We had 101 couples complete daily online surveys over 8 weeks on days that they were sexually active. Each survey included validated measures of  sexual goals, sexual cues, relationship satisfaction, sexual function, and pain intensity.

What did we find?

  • When women with PVD and their partners reported higher approach goals, both members of the couple attended to more positive sexual cues, and subsequently endorsed more relationship satisfaction.
  • On days when women reported higher approach goals, they reported less pain, and both they and their partners focused more on positive sexual cues, which was associated with higher sexual function.
  • On days when women reported greater avoidance goals, both members of the couple reported more attendance to negative sexual cues, and in turn, both partners reported poorer sexual function and women reported more pain.

What do these findings mean?
Essentially what we found is that couples who engage in sex for approach goals and attend to more positive sexual cues during sexual activity experience more positive outcomes than couples who engage in sex for avoidance goals and focus on negative sexual cues. Holding these positive goals and attending to pleasurable aspects of sexual activity can be beneficial for women with PVD and their partners. The couple can continue to engage in a valued activity and reduce avoidance of and negative cognitions around sex which may promote more pain and relational challenges [5].

As most of the research in our lab shows, the thoughts and feeling of both members of the couple matter when it comes to sex and may be especially important when one member experiences a sexual pain disorder.

References

[1]Harlow BL, Kunitz CG, Nguyen RH, et  al. Prevalence of symptoms consistent with a diagnosis of vulvodynia: population based estimates from 2 geographical regions. Am J Obstet Gynecol. 2014;210(1):e1–e8.

[2] 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

[3] Elmerstig E, Wijma B, Berterö C. Why do young women continue to have sexual intercourse despite pain? J Adolesc Health. 2008;43(4):357–363.

[4] 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.

[5] Boerner KE, Rosen NO. Acceptance of vulvovaginal pain in women with provoked vestibulodynia and their partners: associations with pain, psychological, and sexual adjustment. J Sex Med. 2015;12(6):1450–1462.

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