Maintaining Affection Despite Pain: Daily Associations Between Physical Affection and Sexual and Relationship Well-Being in Women with Genito-Pelvic Pain
Provoked vestibulodynia (PVD) is a recurrent, genito-pelvic pain condition that affects 8–12 % of women and has negative implications for sexual and relationship functioning. Many women with PVD report avoiding physical affection because they are concerned that affectionate behavior will lead to painful sexual activity. In community samples, physical affection is associated with improved sexual and relational well-being; however, no research has assessed the influence of physical affection on well-being in women with PVD. The current study examined day-to-day, within-person associations between affectionate behavior (hugging/kissing, cuddling) and sexual satisfaction, relationship satisfaction, sexual functioning, and pain intensity in women with PVD. Seventy women diagnosed with PVD completed an 8-week daily survey. Data were analyzed using multilevel modeling. All outcomes were assessed on days involving sexual activity (n = 401 days). Physical affection was assessed on days with and without sexual activity. Hugging/kissing was positively associated with sexual satisfaction, relationship satisfaction, and sexual functioning within any given day and when predicting the next day. Hugging/kissing was unrelated to pain intensity. Cuddling was not associated with any outcomes. Results persisted for affection that occurred on days with and without sexual activity. Findings suggest physical affection is beneficial for the sexual and relationship well-being of women with PVD. These results may inform interventions that encourage women coping with PVD to engage in more daily physical affection with their partners.
KeywordsAffection Provoked vestibulodynia Genito-pelvic pain Sexual satisfaction Relationship satisfaction Sexual functioning
This research was supported by a postdoctoral fellowship awarded to the second author from the Canadian Institutes of Health Research (CIHR) and by grants awarded to the second and fourth author from the CIHR and the Social Sciences and Humanities Research Council.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.Google Scholar
- Blair, K. L., Pukall, C. F., Smith, K. B., & Cappell, J. (2015). Differential associations of communication and love in heterosexual, lesbian, and bisexual women’s perceptions and experiences of chronic vulvar and pelvic pain. Journal of Sex and Marital Therapy, 41, 498–524. doi: 10.1080/0092623X.2014.931315.CrossRefPubMedGoogle Scholar
- Bois, K., Bergeron, S., Rosen, N. O., McDuff, P., & Grégoire, C. (2013). Sexual and relationship intimacy among women with provoked vestibulodynia and their partners: Associations with sexual satisfaction, sexual function, and pain self-efficacy. Journal of Sexual Medicine, 10, 2024–2035. doi: 10.1111/jsm.12210.CrossRefPubMedGoogle Scholar
- Burleson, M. H., Trevathan, W. R., & Todd, M. (2007). In the mood for love or vice versa? Exploring the relations among sexual activity, physical affection, affect, and stress in the daily lives of mid-aged women. Archives of Sexual Behavior, 36, 357–368. doi: 10.1007/s10508-006-9071-1.CrossRefPubMedGoogle Scholar
- Davison, S. L., Bell, R. J., La China, M., Holden, S. L., & Davis, S. R. (2008). Assessing sexual function in well women: Validity and reliability of the Monash women’s health program female sexual satisfaction questionnaire. Journal of Sexual Medicine, 5, 2575–2586. doi: 10.1111/j.1743-6109.2008.00967.x.CrossRefPubMedGoogle Scholar
- Debrot, A., Schoebi, D., Perrez, M., & Horn, A. B. (2013). Touch as an interpersonal emotion regulation process in couples’ daily lives: The mediating role of psychological intimacy. Personality and Social Psychology Bulletin, 39, 1373–1385. doi: 10.1177/0146167213497592.CrossRefPubMedGoogle Scholar
- Ditzen, B., Neumann, I. D., Bodenmann, G., von Dawans, B., Turner, R. A., Ehlert, U., & Heinrichs, M. (2007). Effects of different kinds of couple interaction on cortisol and heart rate responses to stress in women. Psychoneuroendocrinology, 32, 565–574. doi: 10.1016/j.psyneuen.2007.03.011.CrossRefPubMedGoogle Scholar
- Fisher, W. A., Donahue, K. L., Long, J. S., Heiman, J. R., Rosen, R. C., & Sand, M. S. (2015). Individual and partner correlates of sexual satisfaction and relationship happiness in midlife couples: Dyadic analysis of the international survey of relationships. Archives of Sexual Behavior, 44, 1609–1620. doi: 10.1007/s10508-014-0426-8.CrossRefPubMedGoogle Scholar
- Floyd, K. (2002a). Communicating affection: Interpersonal behavior and social context. Cambridge, England: Cambridge University Press.Google Scholar
- Harlow, B. L., Kunitz, C. G., Nguyen, R. H. N., 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 and Gynecology, 210, 40–42. doi: 10.1016/j.ajog.2013.09.033.CrossRefPubMedGoogle Scholar
- Kutner, J. S., Smith, M. C., Corbin, L., Hemphill, L., Benton, K., Mellis, B. K., & Fairclough, D. L. (2008). Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: A randomized trial. Annals of Internal Medicine, 149, 369–379.CrossRefPubMedPubMedCentralGoogle Scholar
- L’Abate, L. (2007). Hugging, holding, huddling, and cuddling (3HC): A task prescription in couple and family therapy. In L. L. Hecker, C. F. Sori, L. L. Hecker, & C. F. Sori (Eds.), The therapist’s notebook: More homework, handouts, and activities for use in psychotherapy (Vol. 2, pp. 47–55). New York: Haworth Press.Google Scholar
- Leclerc, B., Bergeron, S., Brassard, A., Bélanger, C., Steben, M., & Lambert, B. (2014). Attachment, sexual assertiveness, and sexual outcomes in women with provoked vestibulodynia and their partners: A mediation model. Archives of Sexual Behavior, 44, 1561–1572. doi: 10.1007/s10508-014-0295-1.CrossRefPubMedGoogle Scholar
- Masheb, R. M., Lozano-Blanco, C., Kohorn, E. I., Minkin, M. J., & Kerns, R. D. (2004). Assessing sexual function and dyspareunia with the Female Sexual Function Index (FSFI) in women with vulvodynia. Journal of Sex and Marital Therapy, 30, 315–324. doi: 10.1080/00926230490463264.CrossRefPubMedGoogle Scholar
- McAuliffe, T. L., DiFranceisco, W., & Reed, B. R. (2007). Effects of question format and collection mode on the accuracy of retrospective surveys of health risk behavior: A comparison with daily sexual activity diaries. Health Psychology, 26, 60–67. doi: 10.1037/0278-618.104.22.168.CrossRefPubMedGoogle Scholar
- Muthén, L. K. M., & Muthén, B. O. (2012). The comprehensive modelling program for applied researchers: User’s guide, 5. Los Angeles, CA: Author.Google Scholar
- Payne, K. A., Binik, Y. M., Pukall, C. F., Thaler, L., Amsel, R., & Khalifé, S. (2007). Effects of sexual arousal on genital and non-genital sensation: A comparison of women with vulvar vestibulitis syndrome and healthy controls. Archives of Sexual Behavior, 36, 289–300. doi: 10.1007/s10508-006-9089-4.CrossRefPubMedGoogle Scholar
- Rancourt, K. M., Rosen, N. O., Bergeron, S., & Nealis, L. J. (2016). Talking about sex when sex is painful: Dyadic sexual communication is associated with women’s pain, and couples’ sexual and psychological outcomes in provoked vestibulodynia. Archives of Sexual Behavior. doi: 10.1007/s10508-015-0670-6.PubMedGoogle Scholar
- Rosen, N. O., Bergeron, S., Glowacka, M., Delisle, I., & Baxter, M. L. (2012). Harmful or helpful: Perceived solicitous and facilitative partner responses are differentially associated with pain and sexual satisfaction in women with provoked vestibulodynia. Journal of Sexual Medicine, 9, 2351–2360. doi: 10.1111/j.1743-6109.2012.02851.x.CrossRefPubMedGoogle Scholar
- Rosen, N. O., Bergeron, S., Sadikaj, G., Glowacka, M., Baxter, M.-L., & Delisle, I. (2014a). Relationship satisfaction moderates the associations between male partner responses and depression in women with vulvodynia: A dyadic daily experience study. Pain, 155, 1374–1383. doi: 10.1016/j.pain.2014.04.017.CrossRefPubMedGoogle Scholar
- Rosen, N. O., Bergeron, S., Sadikaj, G., Glowacka, M., Delisle, I., & Baxter, M.-L. (2014b). Impact of male partner responses on sexual function in women with vulvodynia and their partners: A dyadic daily experience study. Health Psychology, 33, 823–831. doi: 10.1037/a0034550.CrossRefPubMedGoogle Scholar
- Rosen, N. O., Muise, A., Bergeron, S., Delisle, I., & Baxter, M. L. (2015b). Daily associations between partner responses and sexual and relationship satisfaction in couples coping with provoked vestibulodynia. Journal of Sexual Medicine, 12, 1028–1039. doi: 10.1111/jsm.12840.CrossRefPubMedGoogle Scholar
- Smith, A. M. A., Patrick, K., Heywood, W., Pitts, M. K., Richters, J., Shelley, J. M., & Ryall, R. (2012). Sexual practices and the duration of last heterosexual encounter: Findings from the Australian Longitudinal Study of Health and Relationships. Journal of Sex Research, 49, 487–494. doi: 10.1080/00224499.2011.598247.CrossRefPubMedGoogle Scholar
- Svedhem, C., Eckert, G., & Wijma, B. (2013). Living with genito-pelvic pain/penetration disorder in a heterosexual relationship: An interpretative phenomenological analysis of interviews with eight women. Sexual and Relationship Therapy, 28, 336–349. doi: 10.1080/14681994.2013.844785.CrossRefGoogle Scholar