The Importance of Interpersonal Context When Conceptualizing Sexual Pain After Female Genital Cutting

  • Natalie O. RosenEmail author

In their Target Article, Connor, Brady, Chaisson, Mohamed, and Robinson (2019) make a compelling case for the timeliness and relevance of a conceptual model to guide research and clinical management of sexual pain1 in women who have experienced female genital cutting (FGC). They draw parallels between the experiences of women with FGC and women with other types of sexual pain (e.g., vulvodynia or chronic vulvar pain) to support their model, while also underscoring the unique features of the FGC context. For example, feelings of being stigmatized and other communication difficulties with healthcare providers are common barriers for women reporting other types of genital and pelvic pain (Nguyen, Turner, Rydell, Maclehose, & Harlow, 2013), but these experiences may be heightened among women who have undergone FGC given the widely held negative judgement toward this practice in Western cultures. In their model, Connor et al. have smoothly integrated four well-known (to the pain community)...



Natalie O. Rosen is supported by a New Investigator Award from the Canadian Institutes of Health Research. She is grateful to Samantha Dawson and Serena Corsini-Munt for their helpful comments on an earlier draft of this commentary.

Compliance with Ethical Standards

Conflict of interest

Dr. Rosen has no conflicts of interest.


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.CrossRefGoogle Scholar
  2. Bergeron, S., Rosen, N. O., & Morin, M. (2011). Genital pain in women: Beyond interference with intercourse. Pain, 152, 1223–1225.CrossRefPubMedGoogle Scholar
  3. Binik, Y. M. (2010). The DSM diagnostic criteria for dyspareunia. Archives of Sexual Behavior, 39, 292–303.CrossRefPubMedGoogle Scholar
  4. Binik, Y. M., Reissing, E. D., Pukall, C. F., Flory, N., Payne, K. A., & Khalifé, S. (2002). The female sexual pain disorders: Genital pain or sexual dysfunction? Archives of Sexual Behavior, 31, 425–429.CrossRefPubMedGoogle Scholar
  5. Boerner, K., & Rosen, N. O. (2015). Acceptance of vulvovaginal pain in women with provoked vestibulodynia and their partners: Associations with pain, psychological, and sexual adjustment. Journal of Sexual Medicine, 12, 1450–1462. Scholar
  6. Brauer, M., Lakeman, M., van Lunsen, R., & Laan, E. (2014). Predictors of task-persistent and fear-avoiding behaviors in women with sexual pain disorders. Journal of Sexual Medicine, 11, 3051–3063. Scholar
  7. Cano, A., & Williams, A. C. (2010). Social interaction in pain: Reinforcing pain behaviors or building intimacy? Pain, 149, 9–11.CrossRefPubMedGoogle Scholar
  8. Connor, J. J., Brady, S. S., Chaisson, N., Mohamed, F. S., & Robinson, B. E. (2019). Understanding women’s responses to sexual pain after female genital cutting: An integrative psychological pain response model. Archives of Sexual Behavior. Scholar
  9. Davis, S. N. P., Bergeron, S., Bois, K., Sadikaj, G., Binik, Y. M., & Steben, M. (2015). A prospective 2-year examination of cognitive and behavioral correlates of provoked vestibulodynia outcomes. Clinical Journal of Pain, 31, 333–341. Scholar
  10. Edmond, S. N., & Keefe, F. J. (2015). Validating pain communication: Current state of the science. Pain, 156, 215–219.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Elmerstig, E., Wijma, B., & Bertero, R. N. T. (2008). Why do young women continue to have sexual intercourse despite pain? Journal of Adolescent Health, 43, 357–363.CrossRefPubMedGoogle Scholar
  12. Gatchel, R. J., Peng, Y. B., Perters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133, 581–624. Scholar
  13. Hadjistavropoulos, T., Craig, K. D., Duck, S., Cano, A., Goubert, L., Jackson, P. L., … Fitzgerald, T. D. (2011). A biopsychosocial formulation of pain communication. Psychological Bulletin, 137, 910–939. Scholar
  14. Krahé, C., Springer, A., Weinman, J. A., & Fotopoulou, A. (2013). The social modulation of pain: Others as predictive signals of salience—a systematic review. Frontiers in Human Neuroscience, 7, 1021. Scholar
  15. Lemieux, A., Bergeron, S., Steben, M., & Lambert, B. (2013). Do romantic partners’ responses to entry dyspareunia affect women’s experiences of pain? The roles of catastrophizing and self-efficacy. Journal of Sexual Medicine, 10, 2274–2284. Scholar
  16. Muise, A., Bergeron, S., Impett, E. A., Delisle, I., & Rosen, N. O. (2018). Communal motivation in couples coping with vulvodynia: Sexual distress mediates associations with pain, depression, and anxiety. Journal of Psychosomatic Research, 106, 34–40.CrossRefPubMedGoogle Scholar
  17. Muise, A., Bergeron, S., Impett, E. A., & Rosen, N. O. (2017). Costs and benefits of sexual communal motivation for couples coping with vulvodynia. Health Psychology, 36, 819–827. Scholar
  18. Nguyen, R. H. N., Reese, R. L., & Harlow, B. L. (2015). Differences in pain subtypes between Hispanic and non-Hispanic white women with chronic vulvar pain. Journal of Women’s Health, 24, 144–150.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Nguyen, R. H. N., Turner, R. M., Rydell, S. A., Maclehose, R. F., & Harlow, B. L. (2013). Perceived stereotyping and seeking care for chronic vulvar pain. Pain Medicine, 14, 1461–1467.CrossRefPubMedGoogle Scholar
  20. 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. Journal of Sexual Medicine, 11, 1786–1797. Scholar
  21. Pukall, C. F., Goldstein, A., Bergeron, S., Foster, D., Stein, A., Kellogg-Spadt, S., & Bachmann, G. A. (2016). Vulvodynia: Definition, prevalence, impact, and pathophysiological factors. Journal of Sexual Medicine, 13, 291–304.CrossRefPubMedGoogle Scholar
  22. Racine, M., Tousignant-Laflamme, Y., Kloda, L. A., Dion, D., Dupuis, G., & Choinière, M. (2012). A systematic literature review of 10 years of research on sex/gender and pain perception (part 2): Do biopsychosocial factors alter pain sensitivity differently in women and men? Pain, 153, 619–635.CrossRefPubMedGoogle Scholar
  23. Rosen, N. O., & Bergeron, S. (2019). Genito-pelvic pain through a dyadic lens: Moving toward an interpersonal emotion regulation model of women’s sexual dysfunction. Journal of Sex Research, 56, 440–461. Scholar
  24. Rosen, N. O., Bergeron, S., Sadikaj, G., & Delisle, I. (2015). Daily associations among male partner responses, pain during intercourse, and anxiety in women with vulvodynia and their partners. Journal of Pain, 16, 1312–1320. Scholar
  25. Rosen, N. O., Bergeron, S., Sadikaj, G., Glowacka, M., Delisle, I., & Baxter, M. (2013). Impact of partner responses on sexual function in women with vulvodynia and their partners: A dyadic daily experience study. Health Psychology, 33, 823–831. Scholar
  26. Rosen, N. O., Muise, A., Impett, E. A., Delisle, I., Baxter, M., & Bergeron, S. (2018). Sexual cues mediate the daily relations between interpersonal goals, pain, and wellbeing in couples coping with vulvodynia. Annals of Behavioral Medicine, 52, 216–227.CrossRefPubMedGoogle Scholar
  27. Rosen, N. O., Rancourt, K., Corsini-Munt, S., & Bergeron, S. (2014). Beyond a “woman’s problem”: The role of relationship processes in genital pain. Current Sexual Health Reports, 6, 1–10. Scholar
  28. Rosen, N. O., Santos-Iglesias, P., & Byers, E. S. (2017). Understanding the sexual satisfaction of women with provoked vestibulodynia and their partners: Comparison with matched controls. Journal of Sex and Marital Therapy, 43, 747–759.CrossRefGoogle Scholar
  29. Sadownik, L., Smith, K. B., Hui, A., & Brotto, L. A. (2017). The impact of a woman’s dyspareunia and its treatment on her intimate partner: A qualitative analysis. Journal of Sex and Marital Therapy, 43, 529–542.CrossRefPubMedGoogle Scholar
  30. 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. Journal of Sexual Medicine, 11, 1283–1293. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Psychology and NeuroscienceDalhousie UniversityHalifaxCanada
  2. 2.Department of Obstetrics and GynecologyIWK Health CentreHalifaxCanada

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