Skip to main content
SpringerLink
Log in

Provoked Vestibulodynia: Mediators of the Associations Between Partner Responses, Pain, and Sexual Satisfaction

  • Original Paper
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

Provoked vestibulodynia (PVD) is a chronic, recurrent vulvo-vaginal pain condition affecting 12% of the general population, and is associated with sexual dysfunction, psychological distress, and reduced quality of life. There is growing interest in the role of interpersonal variables in PVD, which have been widely neglected. In a sample of 175 couples, the present study examined the mediating roles of partner and participant catastrophizing and self-efficacy in the association between solicitous partner responses and pain intensity, and that of dyadic adjustment in the association between solicitous and negative partner responses and sexual satisfaction. Couples completed measures of partner responses, catastrophizing, self-efficacy, dyadic adjustment, and depression. Women also completed measures of pain, sexual satisfaction, and sexual function. Controlling for depression and solicitousness perceived by the other member of the couple, catastrophizing and self-efficacy partially mediated the association between higher solicitous responses and higher pain during intercourse, accounting for 26 and 25% of the variance in this association for participant and partner-perceived responses, respectively. For both participant and partners, only pain catastrophizing was a unique mediator. Controlling for depression, sexual function and partner-perceived responses, dyadic adjustment partially mediated the association between higher participant-perceived solicitous responses and higher sexual satisfaction, and between higher participant-perceived negative responses and lower sexual satisfaction, accounting for 26% of the variance in each association. The current findings suggest that catastrophizing and dyadic adjustment may constitute a route by which partner responses exacerbate pain and increase or decrease sexual satisfaction in PVD couples.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Ayre, M., & Tyson, G. A. (2001). The role of self-efficacy and fear-avoidance beliefs in the prediction of disability. Australian Psychologist, 36, 250–253.

    Article  Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). BDI-II, Beck Depression Inventory: Manual (2nd ed.). Boston: Harcourt, Brace, and Company.

    Google Scholar 

  • Bergeron, S., Binik, Y. M., Khalifé, S., Pagidas, K., & Glazer, H. I. (2001). Vulvar vestibulitis syndrome: Reliability of diagnosis and evaluation of current diagnostic criteria. Obstetrics and Gynecology, 98, 45–51.

    Article  PubMed  Google Scholar 

  • Bergeron, S., Khalifé, S., Glazer, H. I., & Binik, Y. M. (2008). Surgical and behavioral treatments for vestibulodynia: Two-and-one-half-year follow-up and predictors of outcome. Obstetrics and Gynecology, 111, 159–166.

    Article  PubMed  Google Scholar 

  • Boothby, J. L., Thorn, B. E., Overduin, L. Y., & Ward, L. C. (2004). Catastrophizing and perceived partner responses to pain. Pain, 109, 500–506.

    Article  PubMed  Google Scholar 

  • Buenaver, L. F., Edwards, R. R., & Haythornthwaite, J. A. (2007). Pain-related catastrophizing and perceived social responses: Inter-relationships in the context of chronic pain. Pain, 127, 234–242.

    Article  PubMed  Google Scholar 

  • Busby, D. M., Christensen, C., Crane, D. R., & Larson, J. H. (1995). A revision of the Dyadic Adjustment Scale for use with distressed and nondistressed couples: Construct hierarchy and multidimensional scales. Journal of Marital and Family Therapy, 21, 289–308.

    Article  Google Scholar 

  • Cano, A. (2004). Pain catastrophizing and social support in married individuals with chronic pain: The moderating role of pain duration. Pain, 110, 656–664.

    Article  PubMed  Google Scholar 

  • Cano, A., Gillis, M., Heinz, W., Geisser, M., & Foran, H. (2004). Marital functioning, chronic pain, and psychological distress. Pain, 107, 99–106.

    Article  PubMed  Google Scholar 

  • Cano, A., Johansen, A. B., Leonard, M. T., & Hanawalt, J. D. (2005). What are the marital problems of patients with chronic pain? Current Pain Headache Reports, 9, 96–100.

    Article  Google Scholar 

  • Cano, A., Leonard, M. T., & Franz, A. (2005). The significant other version of the Pain Catastrophizing Scale (PCS-S): Preliminary validation. Pain, 119, 26–37.

    Article  PubMed  Google Scholar 

  • Cano, A., Leong, L., Heller, J. B., & Lutz, J. R. (2009). Perceived entitlement to pain-related support and pain catastrophizing: Associations with perceived and observed support. Pain, 147, 249–254.

    Article  PubMed  Google Scholar 

  • Cano, A., Weisberg, J. N., & Gallagher, R. M. (2000). Marital satisfaction and pain severity mediate the association between negative spouse responses to pain and depressive symptoms in chronic pain patient sample. Pain Medicine, 1, 35–43.

    Article  PubMed  Google Scholar 

  • Collins, L. M., Graham, J. W., & Flaherty, B. P. (1998). An alternative framework for defining mediation. Multivariate Behavioral Research, 33, 295–312.

    Article  Google Scholar 

  • Craig, K. D., & Prkachin, K. M. (1978). Social modeling influences on sensory decision theory and psychophysiological indices of pain. Journal of Personality and Social Psychology, 36, 805–813.

    Article  PubMed  Google Scholar 

  • Cutrona, C. E., & Russell, D. (1990). Type of social specific support stress: Toward a theory of optimal matching. In I. G. Sarason, B. R. Sarason, & G. R. Pierce (Eds.), Social support: An interactional view (pp. 319–366). New York: Wiley.

    Google Scholar 

  • Daker-White, G. (2002). Reliable and valid self-report outcome measures in sexual (dys)function: A systematic review. Archives of Sexual Behavior, 31, 197–209.

    Article  PubMed  Google Scholar 

  • Danielsson, I., Sloberg, I., & Wilman, M. (2000). Vulvar vestibulitis: Medical, psychosexual and psychosocial aspects, a case–control study. Acta Obstetrics Gynecology Scandinavia, 79, 872–878.

    Google Scholar 

  • Desrochers, G., Bergeron, S., Khalifé, S., Dupuis, M.-J., & Jodoin, M. (2009). Fear avoidance and self-efficacy in relation to pain and sexual impairment in women with provoked vestibulodynia. Clinical Journal of Pain, 25, 520–527.

    Article  PubMed  Google Scholar 

  • Desrochers, G., Bergeron, S., Khalifé, S., Dupuis, M.-J., & Jodoin, M. (2010). Provoked vestibulodynia: Psychological predictors of topical and cognitive-behavioral treatment outcome. Behavior Research and Therapy, 48, 106–115.

    Article  Google Scholar 

  • Desrosiers, M., Bergeron, S., Meana, M., Leclerc, B., Binik, Y. M., & Khalifé, S. (2008). Psychosexual characteristics of vestibulodynia couples: Partner solicitousness and hostility are associated with pain. Journal of Sexual Medicine, 5, 418–427.

    Article  PubMed  Google Scholar 

  • Farmer, M. A., & Meston, C. M. (2007). Predictors of genital pain in young women. Archives of Sexual Behavior, 36, 831–843.

    Article  PubMed  Google Scholar 

  • Flor, H., Elbert, T., Knecht, S., Wienbruch, C., Pantev, C., Birbaumer, N., et al. (1995). Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature, 375, 482–484.

    Article  PubMed  Google Scholar 

  • Gatchel, R. J., & Turk, D. C. (1999). Psychosocial factors in pain: Critical perspectives. New York: Guilford Press.

    Google Scholar 

  • Gates, E. A., & Galask, R. P. (2001). Psychological and sexual functioning in women with vulvar vestibulitis. Journal of Psychosomatic Obstetrics and Gynaecology, 22, 221–228.

    Article  PubMed  Google Scholar 

  • Geisser, M. E., Robinson, M. E., & Riley, J. L. (1999). Pain beliefs, coping, and adjustment to chronic pain. Pain Forum, 8, 161–168.

    Article  Google Scholar 

  • Giardino, N. D., Jensen, M. P., Turner, J. A., Ehde, D. M., & Cardenas, D. D. (2003). Social environment moderates the association between catastrophizing and pain among persons with a spinal cord injury. Pain, 106, 19–25.

    Article  PubMed  Google Scholar 

  • Hallam-Jones, R., Wylie, K. R., Osborne-Cribb, J., Harrington, C., & Walters, S. (2001). Sexual difficulties within a group of patients with vulvodynia. Sexual and Relationship Therapy, 16, 113–126.

    Article  Google Scholar 

  • Harlow, B. L., Wise, L. A., & Stewart, E. G. (2001). Prevalence and predictors of chronic lower genital tract discomfort. American Journal of Obstetrics and Gynecology, 185, 545–550.

    Article  PubMed  Google Scholar 

  • Holtzman, S., & DeLongis, A. (2007). One day at a time: The impact of daily satisfaction with spouse responses on pain, negative affect, and catastrophizing among individuals with rheumatoid arthritis. Pain, 131, 202–213.

    Article  PubMed  Google Scholar 

  • Jodoin, M., Bergeron, S., Khalifé, S., Dupuis, M. J., Desrochers, G., & Leclerc, B. (2008). Male partners of women with provoked vestibulodynia: Attributions for pain and their implications for dyadic adjustment, sexual satisfaction, and psychological distress. Journal of Sexual Medicine, 5, 2862–2870.

    Article  PubMed  Google Scholar 

  • Keefe, F. J., Lefebvre, J. C., Egert, J. R., Affleck, G., Sullivan, M. J. L., & Caldwell, D. S. (2000). The relationship of gender to pain, pain behavior, and disability in osteoarthritis patients: The role of catastrophizng. Pain, 87, 325–334.

    Article  PubMed  Google Scholar 

  • Keefe, F. J., Lefebvre, J. C., & Smith, S. J. (1999). Catastrophizing research: Avoiding conceptual errors and maintaining a balanced perspective. Pain Forum, 8, 176–180.

    Article  Google Scholar 

  • Kenny, D. A., Kashy, D. A., & Bolger, N. (1998). Data analysis in social psychology. New York: McGraw-Hill.

    Google Scholar 

  • Kerns, R. D., Haythornthwaite, J. A., Southwick, S., & Giller, E. L. (1990). The role of marital interaction in chronic pain and depressive symptom severity. Journal of Psychosomatic Research, 34, 40–408.

    Article  Google Scholar 

  • Kerns, R. D., & Jacob, M. C. (1992). Assessment of the psychosocial context of the experience of chronic pain. New York: Guilford Press.

    Google Scholar 

  • Kerns, R. D., Turk, D. C., & Rudy, T. E. (1985). The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain, 23, 345–356.

    Article  PubMed  Google Scholar 

  • Lawrance, K., & Byers, E. S. (1995). Sexual satisfaction in long-term heterosexual relationships: The interpersonal exchange model of sexual satisfaction. Personal Relationships, 2, 267–285.

    Article  Google Scholar 

  • Lefebvre, J. C., Keefe, F. J., Affleck, G., Raezer, L. B., Starr, K., Caldwell, D. S., et al. (1999). The relationship of arthritis self-efficacy to daily pain, daily mood, and daily pain coping in rheumatoid arthritis patients. Pain, 80, 425–435.

    Article  PubMed  Google Scholar 

  • Leonard, M. T., Cano, A., & Johansen, A. B. (2006). Chronic pain in a couples context: A review and integration of theoretical models and empirical evidence. Journal of Pain, 7, 377–390.

    Article  PubMed  Google Scholar 

  • Lorig, K., Chastain, R. L., Ung, E., Shoor, S., & Holman, H. R. (1989). Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis and Rheumatism, 32, 37–44.

    Article  PubMed  Google Scholar 

  • Lundvist, E. N., & Bergdahl, J. (2003). Vulvar vestibulitis: Evidence of depression and state anxiety in patients and partners. Acta Dermato Venereologica, 83, 369–373.

    Article  Google Scholar 

  • MacKinnon, D. P., & Dwyer, J. H. (1993). Estimating mediated effects in preventio n studies. Evaluation Review, 17, 144–158.

    Article  Google Scholar 

  • MacKinnon, D. P., Krull, J. L., & Lockwood, C. M. (2000). Equivalence of the mediation, confounding, and suppression effect. Psychological Science, 1, 1–13.

    Google Scholar 

  • MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7, 83–104.

    Article  PubMed  Google Scholar 

  • Masheb, R. M., Kerns, R. D., Lozano, C., Minkin, M. J., & Richman, S. (2009). A randomized clinical trial for women with vulvodynia: Cognitive-behavioral therapy vs. supportive psychotherapy. Pain, 141, 31–40.

    Article  PubMed  Google Scholar 

  • McCabe, M., Althof, S. E., Assalian, P., Chevret-Measson, M., Leiblum, S. L., Simonelli, C., et al. (2010). Psychological and interpersonal dimensions of sexual function and dysfunction. Journal of Sexual Medicine, 7, 327–336.

    Article  PubMed  Google Scholar 

  • Meana, M., Binik, Y. M., Khalifé, S., & Cohen, D. R. (1997). Biopsychosocial profile of women with dyspareunia. Obstetrics and Gynecology, 90, 583–589.

    Article  PubMed  Google Scholar 

  • Meana, M., Binik, Y. M., Khalifé, S., & Cohen, D. (1998). Affect and marital adjustment in women’s rating of dyspareunic pain. Canadian Journal of Psychiatry, 43, 381–385.

    Google Scholar 

  • Moyal-Barracco, M., & Lynch, P. (2004). 2003 ISSVD terminology and classification of vulvodynia: A historical perspective. Journal of Reproductive Medicine, 49, 772–779.

    PubMed  Google Scholar 

  • Osman, A., Barrios, F. X., Gutierrez, P. M., Kopper, B. A., Merrifield, T., & Grittman, L. (2000). The Pain Catastrophizing Scale: Further psychometric evaluation with adult samples. Journal of Behavioral Medicine, 23, 351–365.

    Article  PubMed  Google Scholar 

  • Payne, K. A., Binik, Y. M., Amsel, R., & Khalifé, S. (2005). When sex hurts, anxiety and fear orient attention towards pain. European Journal of Pain, 9, 427–436.

    Article  PubMed  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 health controls. Archives of Sexual Behavior, 36, 289–300.

    Article  PubMed  Google Scholar 

  • Pence, L. B., Cano, A., Thorn, B., & Ward, L. C. (2006). Perceived spouse responses to pain: The level of agreement in couple dyads and the role of catastrophizing, marital satisfaction, and depression. Journal of Behavioral Medicine, 29, 511–522.

    Article  PubMed  Google Scholar 

  • Pence, L. B., Thorn, B. E., Jensen, M. P., & Romano, J. M. (2008). Examination of perceived spouse responses to patient well and pain behavior in patients with headache. Clinical Journal of Pain, 24, 654–661.

    Article  PubMed  Google Scholar 

  • Porter, L. S., Keefe, F. J., Garst, J., McBride, C. M., & Baucom, D. (2008). Self-efficacy for managing pain, symptoms, and function in patients with lung cancer and their informal caregivers: Associations with symptoms and distress. Pain, 137, 306–315.

    Article  PubMed  Google Scholar 

  • Porter, L. S., Keefe, F. J., McBride, C. M., Pollak, K., Fish, L., & Garst, J. (2002). Perceptions of patients’ self-efficacy for managing pain and lung cancer symptoms: Correspondence between patients and family caregivers. Pain, 98, 169–178.

    Article  PubMed  Google Scholar 

  • Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, & Computers, 36, 717–731.

    Article  Google Scholar 

  • Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.

    Article  PubMed  Google Scholar 

  • Reed, B. D., Haefner, H. K., Hope, K., Harlow, D. S., Gorenflo, D. W., & Sen, A. (2006). Reliability and validity of self-reported symptoms for predicting vulvodynia. Obstetrics and Gynecology, 108, 906–913.

    Article  PubMed  Google Scholar 

  • Reissing, E. D., Binik, Y. M., Khalifé, S., Cohen, D., & Amsel, R. (2003). Etiological correlates of vaginismus: Sexual and physical abuse, sexual knowledge, sexual self-schema, and relationship adjustment. Journal of Sex and Marital Therapy, 29, 47–59.

    Article  PubMed  Google Scholar 

  • Romano, J. M., Turner, J. A., Jensen, M. P., Friedman, L. S., Bulcroft, R. A., Hops, H., et al. (1995). Chronic pain patient–spouse behavioral interactions predict patient disability. Pain, 63, 353–360.

    Article  PubMed  Google Scholar 

  • Rosen, N. O., Bergeron, S., Leclerc, B., Lambert, B., & Steben, M. (2010). Woman and partner-perceived partner responses predict pain and sexual satisfaction in provoked vestibulodynia (PVD) couples. Journal of Sexual Medicine, 7, 3715–3724.

    Article  PubMed  Google Scholar 

  • Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsigh, R., et al. (2000). The female sexual function index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex and Marital Therapy, 26, 191–208.

    Article  PubMed  Google Scholar 

  • Schwartz, L., Jensen, M. P., & Romano, J. M. (2005). The development and psychometric evaluation of an instrument to assess spouse responses to pain and well behavior in patients with chronic pain: The Spouse Response Inventory. Journal of Pain, 6, 243–252.

    Article  PubMed  Google Scholar 

  • Sharp, T. J., & Nicholas, M. K. (2000). Assessing the significant others of chronic pain patients: The psychometric properties of significant other questionnaires. Pain, 88, 135–144.

    Article  PubMed  Google Scholar 

  • Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7, 422–445.

    Article  PubMed  Google Scholar 

  • Stone, A., Turkkan, J., Bachrach, C., Jobe, J., Kurtzman, H., & Cain, V. (2000). The science of self-report: Implications for research and practice. Hillsdale, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Sullivan, M. J. L., Bishop, S., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation. Psychological Assessment, 7, 524–532.

    Article  Google Scholar 

  • Sullivan, M. J. L., Thorn, B., Haythornthwaite, J. A., Keefe, F., Martin, M., Bradley, L. A., et al. (2001). Theoretical perspectives on the relation between catastrophizing and pain. Clinical Journal of Pain, 17, 52–64.

    Article  PubMed  Google Scholar 

  • Turner, J. A., & Romano, J. M. (1984). Self-reported screening measures for depression in chronic pain patients. Journal of Clinical Psychology, 40, 909–913.

    Article  PubMed  Google Scholar 

  • van Lankveld, J. J. D. M., Granot, M., Weijmar Schultz, W. C. M., Binik, Y. M., Wesselmann, U., Pukall, C. F., et al. (2010). Women’s sexual pain disorders. Journal of Sexual Medicine, 7, 615–631.

    Article  PubMed  Google Scholar 

  • Waltz, M., Kriegel, W., & van’t Pad Bosh, P. (1998). The social environment and health in rheumatoid arthritis: Marital quality predicts individual variability in pain severity. Arthritis Care Research, 11, 356–374.

    Article  Google Scholar 

  • Woby, S. R., Urmston, M., & Watson, P. J. (2007). Self-efficacy mediates the relation between pain-related fear and outcome in chronic low back pain patients. European Journal of Pain, 11, 711–718.

    Article  PubMed  Google Scholar 

  • Wouda, J. C., Hartman, P. M., Bakker, R. M., Bakker, J. O., van de Wiel, H., & Weijmar Schultz, W. C. M. (1998). Vaginal plethysmography in women with dyspareunia. Journal of Sex Research, 35, 141–147.

    Article  Google Scholar 

Download references

Acknowledgments

This research was supported by a Canadian Institutes of Health Research postdoctoral fellowship to Natalie O. Rosen and a Canadian Institutes of Health Research grant to Sophie Bergeron. We thank Mylène Desrosiers and Gaëlle Piché for their assistance with this study.

Author information

Authors and Affiliations

  1. Department of Psychology, Université de Montréal, Montreal, QC, Canada

    Natalie O. Rosen & Sophie Bergeron

  2. Department of Obstetrics and Gynaecology, IWK Health Centre, PO Box 9700, G2141, 5850/5980 University Avenue, Halifax, NS, B3K 6R8, Canada

    Natalie O. Rosen

  3. VUVA Clinic, Centre Hospitalier de l’Université de Montréal, Hôpital Notre-Dame, Montreal, QC, Canada

    Bernard Lambert & Marc Steben

Authors
  1. Natalie O. Rosen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sophie Bergeron
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bernard Lambert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marc Steben
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Natalie O. Rosen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rosen, N.O., Bergeron, S., Lambert, B. et al. Provoked Vestibulodynia: Mediators of the Associations Between Partner Responses, Pain, and Sexual Satisfaction. Arch Sex Behav 42, 129–141 (2013). https://doi.org/10.1007/s10508-012-9905-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-012-9905-y

Keywords

Search

Navigation