baby toys in a bassinet

By Meghan Rossi

This blog is a summary of our published article: Rossi, M. A., Maxwell, J. A., & Rosen, N. O. (2020). Biased partner perceptions of women’s pain self-efficacy for postpartum pain during intercourse: A longitudinal dyadic examination. The Journal of Pain, 21(9-10), 1047-1059. https://doi.org/10.1016/j.jpain.2020.01.006

Childbirth increases a woman’s risk of developing pain during sex [1-3]. This pain is really common, with 37% of women reporting this pain at three months postpartum, and 31% at six months postpartum [4]. We know that pain during sex substantially interferes with couples’ sexual well-being and their quality of life [4-6]. Yet, there is really limited information about the factors that promote couples’ adjustment to this pain in the postpartum.

We know from past research outside of the postpartum period that when partners perceive women to have greater pain self-efficacy (AKA how confident a woman is that she can manage the pain), women report lower pain intensity [7]. However, the postpartum period is full of new challenges that may impact the accuracy of partners’ perceptions of women’s ability to manage the pain. In the postpartum, women may feel pressure to resume sexual activity, leading partners to overestimate how well she can cope with the pain. Partners with inaccurate perceptions of women’s pain self-efficacy may respond to the pain in unhelpful ways. For example, if a woman’s partner thinks that she is unable to manage the pain, the partner may avoid sex. Unfortunately, avoidance of sex is linked to greater pain and more sexual challenges [8, 9].

What did we want to know?

Are partners accurate in their perceptions of women’s pain self-efficacy?

If partners were under – or over-estimating women’s pain self-efficacy, is this connected to women’s pain intensity and couples’ sexual well-being across the postpartum?

 

What did we do?

We recruited 89 couples across North America at three months postpartum. One member of the couple had to report pain during sex and their partner had to be aware of this pain. Couples completed an online survey at three and six months postpartum. Women reported on their pain intensity, sexual well-being, and how well they felt they could manage their pain (e.g., “how certain are you that you can decrease your pain?”). Partners responded to similar questions about their sexual well-being and also reported their perceptions of the woman’s pain self-efficacy (e.g., “how certain is your partner that she can decrease her pain?”).

 

cartoon man hitting a bullseye above a woman

What did we find?

Overall, we found that partners were accurate in their perceptions of women’s pain self-efficacy.

Interestingly, we found that when women and their partner agreed that she was not able to manage her pain (i.e., low levels of pain self-efficacy), women reported greater pain and couples indicated poorer sexual well-being.

When both members agreed that the woman was able to manage her pain (i.e., high levels of pain self-efficacy), women reported lower pain and both members experienced greater sexual well-being.

 

What does it mean and Why is it important?

Having both members of a couple perceive high levels of women’s pain self-efficacy may be beneficial for women’s pain and the sexual well-being of each individual. When women and their partners agree that she is able to manage her pain, they may work together to adapt their sexual activities to accommodate the pain. Partners may also be offering women support that reduces the intensity of pain and its interference with their sex lives (e.g., not avoiding sex, focusing on other sexual activities that do not cause pain).

Given that partners’ perceptions of women’s pain self-efficacy were generally accurate, couples may work together to identify thoughts and behaviors that contribute to women feeling more confident in their ability to manage the pain. They may also benefit from engaging in treatments shown to improve couples’ perceptions of pain self-efficacy, such as cognitive behavioural couples therapy [10, 11].

References

[1] Cappell, J., & Pukall, C. F. (2017). Clinical profile of persistent genito-pelvic postpartum pain. Midwifery, 50, 125-132. doi:10.1016/j.midw.2017.04.002

[2] Connolly, A., Thorp, J., & Pahel, L. (2005). Effects of pregnancy and childbirth on postpartum sexual function: A longitudinal prospective study. Int Urogynecol J Pelvic Floor Dysfunct, 16(4), 263-267. doi:10.1007/s00192-005-1293-6

[3] Glowacka, M., Rosen, N. O., Chorney, J., Snelgrove Clarke, E., & George, R. B. (2014). Prevalence and predictors of genito-pelvic pain in pregnancy and postpartum: The prospective impact of fear avoidance. Journal of Sexual Medicine, 11(12), 3021-3034. doi:10.1111/jsm.12675

[4] Rosen, N. O., & Pukall, C. (2016). Comparing the prevalence, risk factors, and repercussions of postpartum genito-pelvic pain and dyspareunia. Sex Med Rev, 4(2), 126-135. doi:10.1016/j.sxmr.2015.12.003

[5] Pazmany, E., Bergeron, S., Verhaeghe, J., Van Oudenhove, L., & Enzlin, P. (2014). Sexual communication, dyadic adjustment, and psychosexual well-being in premenopausal women with self-reported dyspareunia and their partners: A controlled study. J Sex Med, 11(7), 1786-1797. doi:10.1111/jsm.12518

[6] 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. J Sex Med, 11(5), 1283-1293. doi:10.1111/jsm.12484

[7] Lemieux, J. B., S; Steben, M; Lambert, B. (2013). Do romantic partners’ responses to entry dyspareunia affect women’s experience of pain? The roles of catastrophizing and self-efficacy. J Sex Med, 10(9). doi:10.1111/jsm.12252.

[8] Benoit-Piau, J., Bergeron, S., Brassard, A., Dumoulin, C., Khalife, S., Waddell, G., & Morin, M. (2018). Fear-avoidance and pelvic floor muscle function are associated with pain intensity in women with vulvodynia. Clin J Pain, 34(9), 804-810. doi:10.1097/ajp.0000000000000604

[9] Thomtén, J., Lundahl, R., Stigenberg, K., & Linton, S. (2014). Fear avoidance and pain catastrophizing among women with sexual pain. Women’s Health, 10(6), 571-581. doi:10.2217/WHE.14.51

[10] Bergeron, S., Khalife, S., Dupuis, M. J., & McDuff, P. (2016). A randomized clinical trial comparing group cognitive-behavioral therapy and a topical steroid for women with dyspareunia. J Consult Clin Psychol, 84(3), 259-268. doi:10.1037/ccp0000072

[11] Corsini-Munt, S., Bergeron, S., Rosen, N. O., Mayrand, M. H., & Delisle, I. (2014). Feasibility and preliminary effectiveness of a novel cognitive-behavioral couple therapy for provoked vestibulodynia: a pilot study. J Sex Med, 11(10), 2515-2527. doi:10.1111/jsm.12646

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