When touch leads to ouch: How attachment predicts couples’ adjustment to PVD, through partner responses to pain

By Lucretia Groff

This blog is a summary of our published article: Charbonneau-Lefebvre, V., Rosen, N. O., Bosisio, M., Vaillancourt-Morel, M.-P., & Bergeron, S. (2020). An attachment perspective on partner responses to Genito-pelvic pain and their associations with relationship and sexual outcomes. The Journal of Sex Research, 58(2), 235–247. https://doi.org/10.1080/00224499.2020.1761936

Provoked vestibulodynia (PVD) is a condition that causes pressure-provoked pain at the entrance of the vagina. [1] This pain can interfere with sex, which can affect sexual, psychological and relationship wellbeing for couples. [2] Past research shows that a partner’s response to a woman’s pain during sex can influence how well the couple adapts to PVD. [2] When partners respond in facilitative ways, with encouragement and affection, women tend to be more sexually satisfied and happier with their relationships. [2] Other times, partners may respond negatively, by getting frustrated or expressing hostility. In these cases, both members of a couple report more anxiety and worse sexual function. [2] These findings have made addressing how partners respond to pain a key focus in couple treatments for PVD. [3]

We’re not sure why different partners respond to pain in different ways, which limits how well we’re able to address these issues in therapy. One promising explanation, however, is attachment. In romantic relationships, attachment affects how a person seeks out support from their partner and how they provide support in return. [4] Insecurely attached people can struggle to do these things effectively, due to relationship fears developed during childhood. [5,6] For instance, people with anxious attachment may worry about pushing their partners away, whereas people with avoidant attachment may worry about getting too close. [4] In the context of PVD-related pain during sex, these attachment trends could explain why partners respond differently to women’s pain, and why women perceive those responses differently.

What did we want to know?

The focus for this study was to examine associations between attachment, partner responses to pain, and couples’ adjustment to PVD. Our goal was to fill gaps in existing research on PVD and provide possible directions for future treatments.

Specifically, we looked at:

  • Whether attachment can predict how partners will respond to pain during sex and how women perceive their responses
  • How partner responses mediate the relationship between attachment and couples’ adjustment to PVD


What did we do?

Our study included 125 couples in which a woman was diagnosed with PVD. We asked both members of each couple to complete measures assessing their attachment, partner responses to the woman’s pain (both self-reported and as perceived by the woman), and their adjustment to PVD, including their levels of sexual distress, sexual satisfaction, and relationship satisfaction.

What did we find?

We found that partner responses (both self-reported and perceived) mediated the relationship between attachment and couple adjustment: 

These results suggest that attachment does play a role in how individuals and couples adjust to PVD, through their mutual association with partner responses to pain during sex, and that women’s perceptions of negative responses may play an especially important role.


 What does this mean?

Our findings suggests that couples may benefit from treatments that address how partners respond to women’s pain and how women perceive those responses, with a special focus on reducing negative responses. Understanding attachment may give couples insight into the fears that drive their responses and perceptions, making it easier to work on them. 


[1] Bornstein, J., Goldstein, A. T., Stockdale, C. K., Bergeron, S., Pukall, C., Zolnoun, D., Coady, D., Bornstein, J., Goldstein, A., Zolnoun, D., Bachmann, G. A., Bissonnette, I., Bergeron, S., Starke, N. B., Burrows, L., Coady, D., Dellon, A. L., Farmer, M., Foster, D., … Mate, P. (2016). 2015 ISSVD, ISSWSH, and IPPS consensus terminology and classification of persistent vulvar pain and vulvodynia. The Journal of Sexual Medicine, 13(4), 607–612. https://doi.org/10.1016/j.jsxm.2016.02.167

[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(3), 159–169. https://doi.org/10.1007/s11930-015-0053-y

[3] 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. The Journal of Sexual Medicine, 11(10), 2515–2527. https://doi.org/10.1111/jsm.12646

[4] Bowlby, J. (1969). Attachment and Loss: Volume I: Attachment. Basic Books.

[5] Wei, M., Vogel, D. L., Ku, T.-Y., & Zakalik, R. A. (2005). Adult attachment, affect regulation, negative mood, and interpersonal problems: The mediating roles of emotional reactivity and emotional cutoff. Journal of Counseling Psychology, 52(1), 14–24. https://doi.org/10.1037/0022-0167.52.1.14

[6] Péloquin, K., Brassard, A., Lafontaine, M.-F., & Shaver, P. R. (2013). Sexuality examined through the lens of attachment theory: Attachment, caregiving, and sexual satisfaction. The Journal of Sex Research, 51(5), 561–576. https://doi.org/10.1080/00224499.2012.757281