Do perfectionism, body image concerns, and intimacy predict genitopelvic pain in the postpartum? A prospective study of new mothers.

BACKGROUND: Genitopelvic pain following childbirth is common and likely to challenge the psychological, relational, and sexual well-being of new mothers. While genitopelvic pain generally decreases during the postpartum period, personal and interpersonal characteristics may explain why genitopelvic pain persists beyond the period of physical recovery in some mothers. Body image concerns, increased stress, and relationship challenges would be particularly salient during pregnancy and the postpartum period, which could put new mothers at greater risk of sexual difficulties. Also, mothers may display a negative appraisal regarding genitopelvic pain and doubt their ability to cope with it, which may contribute to the pain. AIM: The current study aimed to examine the role of perfectionism, body image concerns, and perceived intimacy in the occurrence and change in genitopelvic pain in new mothers in postpartum. METHODS: A total of 211 new mothers and their partners were recruited for a larger prospective dyadic study on the transition to parenthood. OUTCOMES: Mothers completed a single item assessing genitopelvic pain, in addition to brief validated questionnaires measuring perfectionism, body image concerns, and perceived couple intimacy during pregnancy and at 4, 8, and 12 months postpartum. RESULTS: Five multilevel modeling analyses revealed that adaptive perfectionism, maladaptive perfectionism, and body image concerns were associated with a higher occurrence of genitopelvic pain from 4 to 12 months postpartum. Mothers' and partners' perceived intimacy was not significantly related to new mothers' genitopelvic pain. None of the predictors modified the trajectory of genitopelvic pain over time. CLINICAL IMPLICATIONS: Raising awareness among health care professionals regarding the role of perfectionism and body image concerns in genitopelvic pain may help them identify new mothers at risk of chronic genitopelvic pain, while offering a new avenue of intervention. STRENGTHS AND LIMITATIONS: There has been little research examining the role of perfectionism, body image concerns, and intimacy in postpartum genitopelvic pain. Based on a longitudinal prospective approach, this study identified perfectionism and body image concerns as significant predictors of postpartum genitopelvic pain. However, prepregnancy genitopelvic pain, genitopelvic pain intensity, and sexual distress were not measured. CONCLUSION: Adaptive and maladaptive perfectionism and body image concerns are associated with new mothers' genitopelvic pain up to 12 months postpartum.

A Dyadic Study of Attachment, Coping, and Quality of Life in Couples Seeking Fertility Treatment.

This study examined attachment insecurities, infertility-specific coping strategies, and quality of life (QoL) in 87 couples seeking fertility treatment. Partners completed self-report measures. Path analyses showed that women's and men's attachment anxiety were associated with their own lower QoL, whereas attachment avoidance was associated with their own and their partner's lower QoL. Adaptive coping in men and women were associated with women's higher QoL. Non-adaptive coping was associated with men and women's lower QoL. Coping strategies explained the associations between attachment and QoL. This highlights the importance of individual and dyadic factors for understanding QoL in couples seeking fertility treatment.

Attachment and Sexual Functioning in Couples Seeking Fertility Treatment: The Role of Infertility-Specific Coping Strategies.

Couples facing infertility often experience sexual difficulties. Yet, little is known about the factors associated with these difficulties. We examined whether infertility-related coping strategies explain the associations between attachment insecurities (anxiety, avoidance) and sexual function and satisfaction in 97 couples seeking fertility treatment. Anxiety was associated with one's lower sexual satisfaction and function via self-neglect coping strategies. Anxiety was also associated with the partner's lower sexual satisfaction via self-blame coping. Avoidance was associated with lower partner support-seeking and sexual satisfaction. These findings support the roles of attachment and coping in the experience of sexual difficulties among couples seeking fertility treatment.

Dissociation and Sexual Concerns in Male Survivors of Childhood Sexual Abuse: The Role of Identity Cohesion.

Research on male survivors of childhood sexual abuse is notably deficient when it comes to addressing their sexual concerns, such as experiences of sexual distress, negative thoughts, and feelings related to their sexuality. Dissociation, a known consequence of childhood sexual abuse, could be associated with higher sexual concerns through identity cohesion. Precisely, dissociation can potentially be related to lower identity cohesion (e.g., not knowing what you want or need). In return, lower identity cohesion may be related to higher sexual concerns by impeding the capacity to know and accept oneself, which tends to promote a positive and healthy sexuality. This study aimed to examine the role of identity cohesion in the link between dissociation and sexual concerns in 105 men consulting for their history of childhood sexual abuse. Men completed questionnaires assessing dissociation, sexual concerns, and identity cohesion at admission in a community setting. Results of a path analysis revealed an indirect association between dissociation and higher sexual concerns through lower identity cohesion. The model explained 27.6% of the variance in sexual concerns. This study highlights the relevance of interventions targeting dissociative symptoms to improve identity cohesion and sexual health in male survivors of childhood sexual abuse.

Sexual growth and destiny beliefs: Longitudinal associations with dyadic coping among couples seeking medically assisted reproduction.

BACKGROUND: Medically assisted reproduction is a vulnerable time for couples' sexual health. Believing that sexual challenges can be worked through (i.e., sexual growth beliefs) or that these challenges indicate incompatibility (i.e., sexual destiny beliefs) may be related to dyadic coping-the strategies couples use to cope-with the physical and psychological stressors of medically assisted reproduction. AIM: In the current study we aimed to examine the longitudinal associations between typical (i.e., average) levels of sexual growth and destiny beliefs and positive and negative facets of dyadic coping and how greater than typical levels of these constructs predicted each other across time. METHODS: Couples (n = 219) seeking medically assisted reproduction were recruited for an online longitudinal, dyadic study. OUTCOMES: Couples completed online measures of sexual growth and destiny beliefs and positive and negative dyadic coping at baseline, 6-and 12-months. RESULTS: Random intercept cross-lagged panel models demonstrated that at the within-person level, reporting higher sexual growth beliefs at baseline, relative to their average across time points, was associated with lower negative dyadic coping at 6 months. Higher negative dyadic coping at 6 months, relative to their average, was linked to lower sexual growth beliefs at 12-months. When individuals reported higher sexual destiny beliefs at 6-months, relative to their average, they and their partners reported higher negative dyadic coping at 12 -months. At the between-person level, higher overall levels of sexual destiny beliefs were related to higher overall levels of negative dyadic coping. No associations with positive dyadic coping were identified. CLINICAL IMPLICATIONS: Couples may benefit from identifying and reducing unhelpful beliefs about sex and negative dyadic coping. STRENGTHS AND LIMITATIONS: Strengths of this study include our large, inclusive sample, engagement of community partners, and novel analytical approach to assess change over time. However, following couples in 6-month increments and not using questionnaires specific to medically assisted reproduction may have limited our ability to detect nuanced changes that couples experience during this time. CONCLUSION: Lower sexual growth and higher sexual destiny beliefs may promote couples' engagement in less adaptive coping behaviors as they seek medically assisted reproduction.

Attachment, Sexual Motives, and Sexual Satisfaction among Couples Expecting their First Child.

This study examined direct and indirect links among attachment insecurities (anxiety, avoidance) and sexual satisfaction through sexual motives in couples expecting their first child. A sample of 204 first-time pregnant couples completed online questionnaires. Dyadic path analyses revealed that attachment and sexual satisfaction were not directly associated, but rather indirectly associated through three sexual motives: partner approval, self-affirmation, and intimacy. For non-pregnant partners, attachment anxiety was related to higher sexual satisfaction through higher intimacy, whereas attachment avoidance was related to lower sexual satisfaction through lower intimacy. Results are discussed in light of clinical implications for expecting couples.

How Do Partner Support, Psychological Aggression, and Attachment Anxiety Contribute to Distressed Couples' Relationship Outcomes?

Few studies have simultaneously looked at the relative contribution of positive and negative behaviors to understand relationship outcomes. This study examined the relative roles of perceived partner support and psychological aggression in two relationship outcomes-relationship satisfaction and the willingness to invest in the relationship-as well as the contribution of attachment anxiety as a moderator in 307 couples seeking relationship therapy. Path analyses revealed that perceived partner support was associated with individuals' own higher relationship satisfaction and willingness to invest in the relationship. Attachment anxiety moderated these associations. Perceived partner psychological aggression was not associated with relationship outcomes.

Relational Instability in Couples Seeking Therapy: The Contribution of Attachment, Caregiving and Sex.

Attachment theory postulates that three behavioral systems-attachment, caregiving, and sex-are essential for optimal relationship functioning in couples. We examined the contribution of attachment insecurities, perceived partner support, and sexual satisfaction to relational instability in 274 couples seeking relationship therapy. The results underscore the importance of all three systems for relationship stability, showing that for both men and women, avoidance of intimacy, low perceived partner support, and low sexual satisfaction were significant and concurrent predictors of relational instability. As such, intervening on factors associated with all three behavioral systems might help reduce relationship instability in couples experiencing relationship distress.

Why do you have sex and does it make you feel better? Integrating attachment theory, sexual motives, and sexual well-being in long-term couples.

Attachment theory postulates that three behavioral systems are central to optimal couple functioning: attachment, caregiving, and sex. However, few studies have examined the concurrent contribution of these systems to understand sexual well-being. This daily diary study examined the intermediary role of attachment- and caregiving-related sexual motives in the associations linking attachment insecurities and positive and negative emotions during sexual activity in 149 long-term mixed-gender/sex couples. Multilevel analyses revealed that individuals higher in attachment avoidance endorsed less caregiving sexual motives, which was associated with their own more negative emotional experience during sexual activity. Individuals higher in attachment anxiety endorsed more attachment sexual motives, which was associated with their own and their partner's more negative emotional experience during sex. However, individuals higher in attachment anxiety also concurrently endorsed more caregiving sexual motives, which predicted their own and their partner's more positive emotional experience during sex. Overall, the findings support the associations between the attachment, caregiving, and sexual behavioral systems and suggest that engaging in sex as a way to care for one's partner might foster sexual well-being in long-term couples.

Changes in Attachment and Commitment in Couples Transitioning to Parenthood.

This study examined whether attachment predicts changes in commitment and whether commitment predicts changes in attachment in both partners during the transition to parenthood. Both partners of 93 couples completed online questionnaires individually at the second trimester of pregnancy and at 4 months postpartum. Autoregressive cross-lagged path analyses based on the Actor-Partner Interdependence Model tested the bidirectional associations between attachment dimensions (anxiety and avoidance) and three modes of commitment (optimal, over-commitment, and under-commitment). Results revealed that for both partners, prenatal attachment avoidance was associated with a decrease in optimal commitment and an increase in under-commitment from pre- to postpartum. Fathers' attachment anxiety was associated with a decrease in mothers' under-commitment. Furthermore, prenatal optimal commitment was associated with a decrease in attachment avoidance, whereas under-commitment was associated with an increase in attachment avoidance. Fathers' prenatal over-commitment was associated with an increase in their own attachment anxiety and avoidance. These results highlight how attachment insecurities and relationship commitment interrelate during this major transition.

Sexual Function and Satisfaction in Couples with Infertility: A Closer Look at the Role of Personal and Relational Characteristics.

BACKGROUND: Research to date suggests that couples undergoing assisted reproductive technology (ART) are at a high risk of experiencing sexual difficulties. AIM: This dyadic cross-sectional study aimed to provide a better understanding of the infertility-specific personal (ie, emotional, mind-body) and relational stressors associated with the sexual desire, orgasm, arousal, and sexual satisfaction of infertile couples seeking ART. METHODS: The sample included 185 mixed-sex infertile couples seeking ART. Participants completed online the Fertility Quality of Life tool and either the Female Sexual Function Index or the International Index of Erectile Function. Data were analyzed using path analyses based on the Actor-Partner Interdependence Model. OUTCOMES: Individuals' own and their partners' sexual function (desire, orgasm, arousal domains) and sexual satisfaction. RESULTS: For men and women, infertility-related emotional stressors were associated with their own and their partner's lower sexual desire. For women, experiencing greater infertility-related emotional stressors was also associated with their partner's lower sexual satisfaction. While experiencing greater infertility-related mind-body stressors was not associated with men and women's own sexual desire, arousal, orgasm, and satisfaction, for women, it was associated with their partner's lower sexual arousal. Lastly, for men and women, infertility-related relational stressors were associated with their own lower sexual arousal, as well as with their own and their partner's lower sexual satisfaction. For women, experiencing greater relational stressors was also associated with their own lower sexual desire and orgasm. CLINICAL IMPLICATIONS: Interventions addressing the emotional, mind-body, and relational spheres of infertile couples seeking ART may help facilitate improvements in sexual function and satisfaction and better serve their needs. STRENGTHS & LIMITATIONS: This study included a large sample of couples. Our sample was heterogeneous with regards to couples' cause of infertility and treatment stage. The use of an infertility-related measure allowed us to better capture personal and relational stressors specific to couples seeking ART. Given the cross-sectional design of our study, causality between infertility-related stressors and sexual function and satisfaction cannot be inferred. Our sample included predominantly White, mixed-sex individuals with a high level of education, which may reduce the generalizability of our findings. CONCLUSION: Couples' subjective experience of infertility and treatment (personal and relational stressors) seems to be strongly associated with their sexual health, allowing us to identify potential targets of intervention with couples seeking ART. S.E. Amiri, A Brassard, N.O. Rosen, et al. Sexual Function and Satisfaction in Couples with Infertility: A Closer Look at the Role of Personal and Relational Characteristics. J Sex Med 2021;18:1984-1997.

Attachment Insecurities and Sexual Coercion in Same- and Cross-Gender Couples: The Mediational Role of Couple Communication Patterns.

The use of subtle strategies to have sex with an unwilling partner is harmful to a couple's sexual well-being but these strategies remain understudied. This research examined the mediating role of communication patterns in the associations between attachment insecurities and sustained sexual coercion in 145 same- and cross-gender couples, and the moderating role of partners' gender. In addition to actor and partner effects, results revealed significant indirect effects from attachment insecurities to sexual coercion via communication patterns, with moderating effects of gender. Results may help practitioners and researchers understand the ways attachment insecurities and dysfunctional communication patterns can manifest in the experience of subtle forms of sexual coercion within couples.

Under, Over, or Optimal Commitment? Attachment Insecurities and Commitment Issues in Relationally Distressed Couples.

Using a new multidimensional model of relationship commitment, this study examined the association among attachment insecurities (avoidance and anxiety) and commitment (optimal, over, and under) in 159 relationally distressed, monogamous and mainly heterosexual couples. Dyadic analyses revealed that avoidant individuals reported less optimal and less over-commitment, as well as more under-commitment. Their partners also reported less over-commitment. Moreover, whereas anxious individuals reported more over-commitment, their partners reported less optimal commitment and more under-commitment. Moderation analyses showed that anxious individuals reported more optimal commitment when their partners reported very high levels of avoidance. The findings suggest nuanced implications for couple therapy.

Self-Efficacy Mediates the Attachment-Pain Association in Couples with Provoked Vestibulodynia: A Prospective Study.

INTRODUCTION: Attachment influences the way individuals anticipate, react, and seek support when faced with chronic pain. Although cross-sectional research indicates that attachment insecurity and pain self-efficacy are associated with pain intensity in chronic pain populations, little is known about their long-term effects on pain, and about the directionality of associations between these constructs. Furthermore, whereas attachment is a relational concept, few studies on genito-pelvic pain have espoused a couples' perspective. AIM: Using a prospective dyadic design, the present study aimed to examine the directionality of the associations among attachment dimensions, pain self-efficacy, and pain intensity in couples coping with provoked vestibulodynia (PVD). A second aim was to test whether pain self-efficacy mediated the attachment-pain association. METHODS: 213 couples coping with PVD completed self-report questionnaires at baseline (T1) and at a 2-year follow-up (T2). MAIN OUTCOME MEASURE: (1) Experiences in Close Relationships - Revised; (2) Painful Intercourse Self-Efficacy Scale; and (3) 10-point Numerical Rating Scale for pain intensity. RESULTS: Autoregressive cross-lagged models revealed that women's greater attachment anxiety and avoidance at T1 predicted their greater pain intensity at T2. Women's greater attachment anxiety at T1 predicted their poorer pain self-efficacy at T2, and poorer pain self-efficacy in women at T1 predicted their higher pain intensity at T2. A mediation model showed that women's lower pain self-efficacy at T2 fully mediated the association between women's higher attachment anxiety at T1 and their higher pain intensity at T2. Partners' attachment dimensions did not predict their own or women's pain self-efficacy nor pain intensity. CLINICAL IMPLICATIONS: Results suggest that greater attachment anxiety may contribute to women with PVD's lower confidence that they can manage their pain, which leads to long-term persistent pain. This study highlights the importance of assessing attachment and pain self-efficacy in women with genito-pelvic pain and to consider interventions targeting these variables, as they have far-reaching consequences. STRENGTH & LIMITATIONS: The use of longitudinal and dyadic data inform interpersonal processes and the long-term implications of attachment and pain self-efficacy in PVD. The use of self-report measures may introduce a social desirability and recall bias. CONCLUSION: This prospective dyadic study adds to a body of literature on PVD and chronic pain by empirically supporting theoretical models on attachment, pain self-efficacy, and persistent pain, and supports the role of psychosocial factors in the adjustment to PVD. Charbonneau-Lefebvre V, Vaillancourt-Morel M-P, Brassard A, et al. Self-Efficacy Mediates the Attachment-Pain Association in Couples with Provoked Vestibulodynia: A Prospective Study. J Sex Med 2019;16:1803-1813.

Testing a New Group Intervention for Couples Seeking Fertility Treatment: Acceptability and Proof of Concept.

This study tested the acceptability and preliminary efficacy of a novel group intervention for couples seeking fertility treatment. Twenty-nine couples completed psychological, relational, and sexual outcome measures pre- and post-intervention. Repeated-measures ANOVAs revealed significant reductions in terms of depressive symptoms, rejection of childfree lifestyle, and stress related to the need for parenthood. The results also revealed improvements in marital benefits and fertility-related emotional and relational quality of life. Couples' high participation rates and reported treatment satisfaction indicate adequate acceptability. These results support the preliminary success of the intervention in reducing the psychological and relational burden for couples undergoing fertility treatment.

Trauma périnéal à l'accouchement, intimité, ajustement dyadique et fonction sexuelle de nouveaux couples parentaux.

OBJECTIVE: This study focuses on perineal trauma during childbirth and its relationship to postnatal marital and sexual issues as expressed by the sexual function and perceived intimacy of new parent couples in Ontario. METHODS: As part of a retrospective study on perinatal intimate and sexual experiences, 67 Canadian French-speaking couples from Ontario (heterosexual couples with their first child between 6 and 12 months of age) were recruited. They filled out online questionnaires that included questions about the severity of the perineal trauma and validated questionnaires that evaluated perceived sexual intimacy, dyadic adjustment, and sexual function. RESULTS: Mediation analyses based on the actor-partner interdependence model were conducted and revealed that the severity of perineal trauma is linked to the perception of decreased intimacy and to weaker sexual function for the woman. Furthermore, the perception of decreased intimacy and the weak sexual function of the man and the woman are related to a weaker dyadic adjustment for the partners. CONCLUSION: The study emphasizes the importance of supporting women who have experienced perineal trauma due to childbirth, as well as their partners.

Attachment, Sexual Assertiveness, and Sexual Outcomes in Women with Provoked Vestibulodynia and Their Partners: A Mediation Model.

Provoked vestibulodynia (PVD) is a prevalent women's sexual pain disorder, which is associated with sexual function difficulties. Attachment theory has been used to understand adult sexual outcomes, providing a useful framework for examining sexual adaptation in couples confronted with PVD. Research to date indicates that anxious and avoidant attachment dimensions correlate with worse sexual outcomes in community and clinical samples. The present study examined the association between attachment, pain, sexual function, and sexual satisfaction in a sample of 101 couples in which the women presented with PVD. The actor-partner interdependence model was used in order to investigate both actor and partner effects. This study also examined the role of sexual assertiveness as a mediator of these associations via structural equation modeling. Women completed measures of pain intensity and both members of the couple completed measures of romantic attachment, sexual assertiveness, sexual function, and satisfaction. Results indicated that attachment dimensions did not predict pain intensity. Both anxious and avoidant attachment were associated with lower sexual satisfaction. Only attachment avoidance predicted lower sexual function in women. Partner effects indicated that higher sexual assertiveness in women predicted higher sexual satisfaction in men. Finally, women's sexual assertiveness was found to be a significant mediator of the relationship between their attachment dimensions, sexual function, and satisfaction. Findings highlight the importance of examining how anxious and avoidant attachment may lead to difficulties in sexual assertiveness and to less satisfying sexual interactions in couples where women suffer from PVD.

Sexual well-being among partnered adults and couples over 60: a scoping review.

INTRODUCTION: Although society still holds age-related stereotypes dismissing the sexuality of aging individuals, older adults remain sexually active and find sexuality to be an important part of their quality of life. Primarily oriented toward a biomedical and dysfunctional lens, prior research neglected the subjective well-being of elderly individuals, especially partnered adults and couples aged 60 years or more. Shedding a more positive light on this area of life could promote older individuals' and couples' sexual well-being. OBJECTIVES: This scoping review aimed to synthetize the studies including community samples of partnered adults or couples over 60 who reported on various indicators of subjective sexual well-being including sexual satisfaction, distress, and function using validated measures. METHODS: Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMAScR), the electronic literature search was conducted using PubMed, PsycINFO, Medline, and CINAHL for peer-reviewed journal articles published before July 2023. RESULTS: Results showed how relational variables such as relationship satisfaction and intimacy emerge as important correlates of older adults' sexual well-being. CONCLUSION: Avenues for future research arising from gaps in the studies identified thorough this scoping review, including the underrepresentation of sexual/gender diverse individuals and the use of single and/or non-validated items to assess sexual well-being, are discussed.

Attachment and Breakup Distress: The Mediating Role of Coping Strategies.

Breakups are common among emerging adults and are associated with elevated depressive and anxiety symptoms, especially in the presence of attachment insecurities. Previous authors have suggested that inadequate coping strategies might explain this association, yet this has not been examined longitudinally. This study examined the mediating role of five coping strategies (self-help, approach, accommodation, avoidance, self-punishment) in the longitudinal associations between attachment insecurities (anxiety, avoidance) and depressive and anxious symptoms in 196 emerging adults experiencing a romantic breakup. Measures of pre-breakup attachment, post-breakup coping strategies (one-month post-breakup), and depressive and anxiety symptoms (one- and three-month post-breakup) were administered. Results from a longitudinal autoregressive cross-lagged model showed that pre-breakup attachment insecurities were related to higher depressive and anxiety post-breakup symptoms through higher use of self-punishment and lower use of accommodation coping strategies. Findings highlight coping strategies as potential intervention targets to promote the recovery of emerging adults experiencing breakup distress.

Associations Between Contents of Pornography and Sexual Satisfaction and Function Among Young Adults.

Pornography offers a wide variety of sexual contents and has documented potential positive (e.g., higher sexual satisfaction) and negative associations (e.g., lower sexual function) with sexuality. The aims of this study were to describe the proportion of use of five different contents of pornography (i.e. group sex, passion and romance, gender-bending, taboo transgression and forbidden sex, power, control, and rough sex pornography), to examine gender-based differences in the frequency of use of these contents, and to examine the associations between the frequency of use of these contents and sexual satisfaction and function, considering potential differences among genders and individuals with and without a romantic or sexual partner, and controlling for frequency of masturbation. A sample of 827 young adults (503 women; Mage = 23.44) completed online self-report questionnaires. Results of path analysis indicated that, controlling for frequency of masturbation, the use of passion and romance pornography was associated with higher sexual satisfaction, whereas the use of power, control, and rough sex pornography was associated with lower sexual satisfaction. Cisgender men's use of power, control, and rough sex pornography was also associated with lower sexual function. These findings suggest different associations between pornography use and sexual satisfaction and function depending on the pornographic contents used.