By Kat Merwin

This blog summarizes our recently published paper: Rosen, N.O., Dewitte, M., Merwin, K. E., & Bergeron, S. (2017). Interpersonal Goals and Well-Being in Couples Coping with Genito-Pelvic Pain. Archives of Sexual Behavior, 46, 2007-2019. doi: 10.1007/s10508-016-0877-1

Provoked Vestibulodynia (PVD) is the most frequent cause of unexplained genito-pelvic pain in premenopausal women [1]. It is characterized by an acute pain at the vulvar vestibule (i.e., the entrance to the vagina) –for more information on this please see some of our other blog posts [here, here, here, and here].

As you can imagine, experiencing this type of pain can impact the sexual relationship, overall relationship, and psychological well-being of both the women with PVD and their partners. Women and their male partners* report:

  • lower sexual satisfaction compared to pain-free couples [2]
  • feelings of shame and inadequacy [3]
  • fears of relationship dissolution because of the pain [3]
  • increased rates of psychological distress, such as depression [4]

Research with other chronic pain conditions has found that goals (i.e., the reasons we have for engaging in any number of behaviours) can impact the experience of pain. What do I mean by ‘goals’? We tend to have two general types of goals:

Approach Goals: seeking positive outcomes 

Avoidance Goals: avoiding negative/aversive outcomes

Approach goals in relationships focus on the pursuit of positive experiences (e.g., fun, growth, development, intimacy), whereas Avoidance goals focus on avoiding negative experiences (e.g., disagreements and conflict). It is important to note that approach and avoidance goals are not mutually exclusive –you can be pursuing both types of goals in your relationship at any time!

In general, engaging in a behavior (e.g., having sex with your partner) while strongly motivated by approach goals tends to be associated with greater relationship satisfaction and sexual desire, whereas holding stronger avoidance goals has been associated with lower relationship satisfaction [5,6]. Past research by Rosen and colleagues (2015) found that when women with PVD had sex with their partners for approach reasons (e.g., to pursue intimacy) they reported greater sexual and relationship satisfaction, whereas those with stronger avoidance reasons (e.g., to avoid conflict) reported lower sexual and relationship well-being [7].

However, approach and avoidance relationship goals have not been examined in women with PVD (and their partners).

 Do relationship goals impact the experience of pain and/or psychological distress in women with PVD? What about the well-being of their partners?

 That is what we wanted to know. Specifically, we wanted to:

  • see how both women’s and partner’s approach and avoidance relationship goals were related to women’s experience of pain during intercourse
  • see how women’s and partner’s approach and avoidance relationship goals were related to the sexual, relationship, and psychological well-being of both members of the couple
  • examine the moderating role of sexual approach and avoidance goals in these associations (i.e., does the effect of approach/avoidance relationship goals on sexual, relationship, and psychological well-being of both member of the couple, and women’s pain depend on the amount of approach/avoidance sexual goals?)

What did we do?

We had 134 women diagnosed with PVD and their partners complete online measures assessing relationship and sexual goals, sexual satisfaction, relationship well-being, and depressive symptoms. We also had the women complete a measure to assess the intensity of pain experienced during intercourse. Note: one couple was in a same-sex relationship, but all remaining couples were in mixed-sex relationships.

What did we find?

  • Women with stronger relationship approach goals reported more sexual satisfaction
  • When partners held stronger relationship approach goals both women and partners reported more sexual and relationship satisfaction, and partners reported less depression
  • When partners held stronger relationship avoidance goals, women with PVD reported less sexual satisfaction
  • A combination of stronger relationship & sexual approach goals was associated with greater relationship and sexual satisfaction, and fewer depressive symptoms
  • A combination of stronger relationship & sexual avoidance goals was associated with lower relationship and sexual satisfaction, and greater pain during intercourse for women

What do these findings mean?

Broadly, this research tells us that the sexual and relationship goals that women with PVD and their partners hold have an impact on the sexual and relationship wellbeing of both members of a couple –and on women’s experience of pain during intercourse.

Conclusion

Our findings suggest that the relationship goals of women with PVD –and those of their partners –may contribute to their adaptation to genito-pelvic pain. Approach goals may facilitate positive adjustment whereas avoidance goals appear to be detrimental. When couples focus on approach goals, this may help them build greater intimacy, serve as a buffer to negative psychological consequences reported by women with PVD and their partners, and allow the couple to adapt sexual activities to accommodate the women’s pain —which then results in greater sexual satisfaction, fewer depressive symptoms, and less pain for women during intercourse. These associations also seem to be stronger when pursuing approach (or avoidance) goals in the sexual relationship as well.

Interventions for women and couples coping with PVD should consider encouraging couples to focus more on sexual and relationship approach goals (and help decrease their avoidance goals) to help increase the benefits to sexual and relationship well-being, as well as the pain experienced by women during intercourse.

While these findings are novel and promising, there are some limitations that need to be considered. This study included mainly mixed-sex couples and did not formally assess women’s menopausal status, which means these findings may not be generalizable to all couples with PVD.

Most importantly, this study was cross-sectional, so the associations between goals and sexual and relationship satisfaction, and pain, may go in the other direction: It is possible that couples struggling with greater pain, or poorer sexual and relationship well-being may be more likely to strongly endorse avoidance goals, and those with less pain and greater sexual and relationship well-being may endorse higher approach goals.

*Note: most of the current research on PVD in couples has studied women in mixed-sex relationships. For information on PVD in same-sex couples, please see the following articles:

Blair, K. L., Pukall, C. F., Smith, K. B., & Cappell, J. (2014). 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 & Marital Therapy, 41. doi: 10.1080/0092623X.2014.931315

Armstrong, H.L., & Reissing, E.D. (2012). Chronic vulvo-vaginal pain in lesbian, bisexual and other sexual minority women. Journal of Sexual Medicine, 9, 166–167. doi: 10.1111/j.1743-6109.2012.02758.x

Robinson, K,  Galloway, K.Y., Bewley, S., Meads, C. (2017) Lesbian and bisexual women’s gynaecological conditions: A systematic review and exploratory meta-analysis. BJOG: An International Journal of Obstetrics & Gynaecology 124:3, pages 381-392. doi: 10.1111/1471-0528.14414

Sources:

[1] Harlow, B. L., Kunitz, C. G., Nguyen, R. H., Rydell, S. A., Turner, R. M., & Maclehose, R. F. (2014). Prevalence of symptoms consistent with a diagnosis of vulvodynia: Population based estimates from 2 geographical regions. American Journal of Obstetrics and Gynecology, 210, 40.e1–40.e8. doi:10.1016/j.ajog.2013.09.033.

[2] 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. doi:10.1111/jsm.12484.

[3] Ayling, K., & Ussher, J.M. (2008).‘‘If sex hurts, am I still a woman?’’ The subjective experience of vulvodynia in hetero-sexual women. Archives of Sexual Behavior, 37, 294–304. doi:10.1007/s10508- 007-9204-1.

[4] Nylanderlundqvist, E., & Bergdahl, J. (2003). Vulvar vestibulitis: Evidence of depression and state anxiety in patients and partners. Acta dermato-venereologica, 83, 369–373. doi:10.1080/000155503100 03764.

[5] Impett, E. A., Gordon, A. M., Kogan, A., Oveis, C., Gable, S. L., & Keltner, D. (2010). Moving toward more perfect unions: Daily and long-term consequences of approach and avoidance goals in romantic relation- ships. Journal of Personality and Social Psychology, 99, 948–963. doi:10.1037/a0020271.

[6] Muise, A., Impett, E. A., & Desmarais, S. (2013). Getting it on vs giving it up: Sexual motivation, desire and satisfaction in intimate bonds. Personality and Social Psychology Bulletin, 39, 1320–1332. doi:10. 1177/0146167213490963.

[7] Rosen, N. O., Muise, A., Bergeron, S., Impett, E. A., & Boudreau, G. K. (2015). Approach and avoidance sexual goals in couples with provoked vestibulodynia: Associations with sexual, relational, and psychological well-being. Journal of Sexual Medicine, 12(8), 1781-1790. doi: 10.1111/jsm.12948

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