Anxiety Mediates the Relation Between Childhood Sexual Abuse and Genito-Pelvic Pain in Adolescent Girls.

Previous research has demonstrated associations between child sexual abuse, anxiety, and genito-pelvic pain, but no study to date has examined whether sexual abuse may be associated with genito-pelvic pain through victims' elevated anxiety. The present study aimed to determine whether anxiety mediates the relationship between child sexual abuse and genito-pelvic pain. Using self-report questionnaires, data were gathered from 218 sexually active adolescent girls recruited from seven metropolitan high schools. As expected, results revealed a significant indirect effect of sexual abuse on the development of genito-pelvic pain through trait anxiety. This study thus suggests that anxiety may be one of the mechanisms by which child sexual abuse leads to an increased risk of developing genito-pelvic pain in this population.

Mediators of change in cognitive-behavioral couple therapy for genito-pelvic pain: Results of a randomized clinical trial.

OBJECTIVE: A novel cognitive-behavioral couple therapy (CBCT) has shown efficacy for treating provoked vestibulodynia (PVD), the most common type of genito-pelvic pain, in comparison to topical lidocaine. However, mechanisms of therapeutic change have not been determined. We examined women's and partners' pain self-efficacy and pain catastrophizing as mediators of change in CBCT, using topical lidocaine as a control group. METHOD: 108 couples coping with PVD were randomized to 12-week CBCT or topical lidocaine and assessed at pre-treatment, post-treatment, and six-month follow-up. Dyadic mediation analyses were conducted. RESULTS: CBCT was not more effective in increasing pain self-efficacy than topical lidocaine, so this mediator was discarded. In women, decreases in pain catastrophizing at post-treatment mediated improvement in pain intensity, sexual distress, and sexual function. In partners, decreases in pain catastrophizing at post-treatment mediated improvement in sexual function. Partners' decreases in pain catastrophizing also mediated reductions in women's sexual distress. CONCLUSIONS: Pain catastrophizing may be a mediator specific to CBCT for PVD, explaining improvements in pain and sexuality. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Daily Anxiety and Depressive Symptoms in Couples Coping With Vulvodynia: Associations With Women's Pain, Women's Sexual Function, and Both Partners' Sexual Distress.

Vulvodynia is a idiopathic vulvovaginal pain condition that interferes with the sexual and mental health of affected couples. Research has underscored that psychological factors, such as anxiety and depression, are associated with its development and maintenance and related sexual impairment. However, the daily role of anxiety and depressive symptoms in the pain and sexuality outcomes of couples coping with vulvodynia is not well understood. Using a dyadic daily experience method, 127 women (mean age = 26.21, SD = 6.24 years) diagnosed with vulvodynia and their partners (mean age = 27.44, SD = 7.29 years) reported on anxiety and depressive symptoms, pain, sexual function, and sexual distress over a period of 8 weeks. Multilevel modeling was used to examine how daily deviations in anxiety and depressive symptoms from a participant's own mean were associated with pain, sexual function, and sexual distress. On days of sexual activity, when women reported higher anxiety and depressive symptoms (compared with their average), they reported greater pain and lower sexual function. On days of sexual activity, when women reported higher depressive symptoms, they reported greater levels of sexual distress, and when partners reported higher anxiety and depressive symptoms, women as well as partners reported greater levels of sexual distress. Results suggest that daily anxiety and depressive symptoms play a role in women's experience of vulvodynia-related pain, women's sexual function, and the couple's sexual distress. Targeting daily anxiety and depressive symptoms could enhance the efficacy of psychological interventions for vulvodynia. PERSPECTIVE: This article examines the daily associations between anxiety and depressive symptoms, women's pain, sexual function, and sexual distress among couples coping with vulvodynia. Findings contribute to refine the biopsychosocial model of pain, showing that daily affective factors are associated with pain and sexual well-being.

Does Self-compassion Benefit Couples Coping With Vulvodynia? Associations With Psychological, Sexual, and Relationship Adjustment.

OBJECTIVES: Vulvodynia, a chronic vulvovaginal pain condition, has deleterious consequences for the psychological, relational, and sexual well-being of affected women and their partners. Protective factors, which can reduce these negative effects, are increasingly studied in the field of chronic pain. One of these, self-compassion, entails qualities such as kindness toward oneself, and has been associated with better adjustment in individuals with chronic pain. Because many women with vulvodynia have a negative image of themselves in the context of sexuality, self-compassion may be especially relevant for this population. This study aimed to investigate self-compassion among couples coping with vulvodynia and its associations with psychological, sexual, and relationship adjustment, as well as pain during sexual intercourse. MATERIALS AND METHODS: Data were gathered from 48 women diagnosed with provoked vestibulodynia-a subtype of vulvodynia-and their partners, using self-report questionnaires pertaining to anxiety, depression, sexual distress, relationship satisfaction, and pain intensity during sexual intercourse. RESULTS: For both women and their partners, higher levels of self-compassion were associated with their own lower anxiety and depression. When partners reported higher levels of self-compassion, they were more satisfied with their relationship, and both partners and women reported lower sexual distress. No significant association was found for pain during intercourse. DISCUSSION: Findings suggest that self-compassion is a promising protective factor in the experience of vulvodynia and associated distress. Interventions aimed at increasing self-compassion could enhance the efficacy of psychological treatments for these women and their partners. Further studies are needed to better understand the correlates of self-compassion among this population.

A comparison of cognitive-behavioral couple therapy and lidocaine in the treatment of provoked vestibulodynia: study protocol for a randomized clinical trial.

BACKGROUND: Provoked vestibulodynia (PVD), a frequent form of chronic genital pain, is associated with decreased sexual function for afflicted women, as well as impoverished sexual satisfaction for women and their partners. Pain and sexuality outcomes for couples with PVD are influenced by interpersonal factors, such as pain catastrophizing, partner responses to pain, ambivalence over emotional expression, attachment style and perceived relationship and sexual intimacy. Despite recommendations in the literature to include the partner in cognitive-behavioral therapy targeted at improving pain and sexuality outcomes, no randomized clinical trial has tested the efficacy of this type of intervention and compared it to a first-line medical intervention. METHODS: This bi-center, randomized clinical trial is designed to examine the efficacy of cognitive-behavioral couple therapy compared to topical lidocaine. It is conducted across two Canadian university-hospital centers. Eligible women diagnosed with PVD and their partners are randomized to one of the two interventions. Evaluations are conducted using structured interviews and validated self-report measures at three time points: Pre-treatment (T1: prior to randomization), post-treatment (T2), and 6-month follow-up (T3). The primary outcome is the change in reported pain during intercourse between T1 and T2. Secondary outcomes focus on whether there are significant differences between the two treatments at T2 and T3 on (a) the multidimensional aspects of women's pain and (b) women and partners' sexuality (sexual function and satisfaction), psychological adjustment (anxiety, depression, catastrophizing, self-efficacy, and quality of life), relationship factors (partner responses and dyadic adjustment) and self-reported improvement and treatment satisfaction. In order to detect an effect size as small as 0.32 for secondary outcomes, a sample of 170 couples is being recruited (27% dropout expected). A clinically significant decrease in pain is defined as a 30% reduction. DISCUSSION: The randomized clinical trial design is the most appropriate to examine the efficacy of cognitive-behavioral couple therapy, a recently developed and pilot-tested psychosocial intervention for couples coping with PVD, in comparison to a frequent first-line treatment option, topical lidocaine. Findings from this study will provide important information about empirically supported treatment options for PVD, and inform future treatment development and research for this patient population. TRIAL REGISTRATION: Clinicaltrials.gov NCT01935063; registration date: 27 August 27 2013.