Jump to ContentJump to Main Navigation
Show Summary Details
More options …
New at De Gruyter

Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald

4 Issues per year


CiteScore 2017: 0.84

SCImago Journal Rank (SJR) 2017: 0.401
Source Normalized Impact per Paper (SNIP) 2017: 0.452

Online
ISSN
1877-8879
See all formats and pricing
More options …
Volume 17, Issue 1

Coping with pain in intimate situations: Applying the avoidance-endurance model to women with vulvovaginal pain

Ida Katrina Flink
  • Corresponding author
  • Center for Health and Medical Psychology (CHAMP), School of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Linnéa Engmana
  • Center for Health and Medical Psychology (CHAMP), School of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Moniek M. Ter Kuile
  • Department of Psychosomatic Gynaecology and Sexology, Leiden University Medical Center, Leiden, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Johanna Thomtén / Steven J. Linton
  • Center for Health and Medical Psychology (CHAMP), School of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2017-10-01 | DOI: https://doi.org/10.1016/j.sjpain.2017.08.007

Abstract

Background and aims

Chronic vulvovaginal pain is strikingly common and has a serious impact on women’s lives. Nevertheless, there are few longitudinal studies focusing on mechanisms involved in the pain development. One area of interest is how women cope with sexual activities and how this affects their pain. In this study, avoidance and endurance coping behaviors were explored as possible mediators of the relation between catastrophizing and pain, cross-sectionally and longitudinally.

Methods

251 women (18-35 years old) with vulvovaginal pain were recruited in university settings and filled out questionnaires about their pain, catastrophizing and coping behaviors at two occasions, with five months in between. Multiple mediation models were tested, exploring avoidance and endurance as mediators of the relation between catastrophizing and pain.

Results

The results showed that avoidance was an influential mediator of the link between catastro¬phizing and pain. Using multiple mediation models we found that although the indirect effects of both avoidance and endurance were significant cross-sectionally, only avoidance was a significant mediator in the combined model exploring associations over time.

Conclusions

This study indicates that the strategies women with vulvovaginal pain use for coping with sexual activities are important for the course of pain. Avoidance and, to a lesser degree, endurance strate¬gies were identified as important mediators of the effects of catastrophizing on pain. When exploring the links over time, only avoidance emerged as a significant mediator.

Implications

In this longitudinal study, catastrophizing was linked to vulvovaginal pain, via avoidance and endurance of sexual activities. Hence, targeting catastrophizing early on in treatment, as well as addressing coping, may be important in clinical interventions.

Keywords: Vulvovaginal pain; Sexual pain; Women; Coping; Avoidance-endurance

References

  • [1]

    Bachmann GA, Rosen R, Arnold LD, Burd I, Rhoads GG, Leiblum SR, Avis N. Chronic vulvovaginal and gynecologic pain: prevalence and characteristics in a self-reported survey. J Reprod Med 2006;51:3.Google Scholar

  • [2]

    Harlow BL, Kunitz CG, Nguyen RH, Rydell SA, Turner RM, MacLehose RF. Prevalence of symptoms consistent with a diagnosis of vulvodynia: population-based estimates from 2 geographic regions. Am J Obstet Gynecol 2014;210:40.PubMedWeb of ScienceGoogle Scholar

  • [3]

    Masheb RM, Brondolo E, Kerns RD. A multidimensional, case-control study of women with self-identified chronicvulvovaginal pain. Pain Med 2002;3:253–9.CrossrefPubMedGoogle Scholar

  • [4]

    Arnold LD, Bachmann GA, Kelly S, Rosen R, Rhoads GG. Vulvodynia: characteristics and associations with co-morbidities and quality oflife. Obstet Gynecol 2006;107:617.Google Scholar

  • [5]

    Smith KB, Pukall CF. A systematic review of relationship adjustment and sexual satisfaction among women with provoked vestibulodynia. J Sex Med 2011;48:166–91.Google Scholar

  • [6]

    Vlaeyen JW, Linton SJ. Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain 2012;153:1144–7.Web of ScienceCrossrefPubMedGoogle Scholar

  • [7]

    Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: astate of the art. Pain 2000;85:317–32.CrossrefGoogle Scholar

  • [8]

    Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fearavoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med 2007;30:77–94.CrossrefGoogle Scholar

  • [9]

    Thomten J, Linton SJ. A psychological view ofsexual pain amongwomen: applying the fear-avoidance model. Women’s Health 2013;9:251–63.Google Scholar

  • [10]

    Davis SNP, Bergeron S, Bois K, Sadikaj G, Binik YM, Steben M. A prospective 2-yearexamination ofcognitive and behavioral correlates ofprovoked vestibulodynia outcomes. Clin J Pain 2015;31:333–41.CrossrefGoogle Scholar

  • [11]

    Elmerstig E, Wijma B, Swahnberg K. Prioritizing the partner’s enjoyment: a population-based study on young Swedish women with experience of pain during vaginal intercourse. J Psychosom Obstet Gynaecol 2013;34:82–9.CrossrefGoogle Scholar

  • [12]

    Brauer M, Lakeman M, Lunsen R, Laan E. Predictors of task-persistent and fear-avoiding behaviors in women with sexual pain disorders. J Sex Med 2014;11:3051–63.Web of ScienceCrossrefPubMedGoogle Scholar

  • [13]

    Elmerstig E, Wijma B, Bertero C. Why do young women continue to have sexual intercourse despite pain? J Adolesc Health 2008;43:357–63.Web of ScienceCrossrefGoogle Scholar

  • [14]

    Van Lankveld JJ, Granot M, Weijmar Schultz W, Binik YM, Wesselmann U, Pukall CF, Bohm-Starke N, Achtrari C. Women’s sexual pain disorders. J Sex Med 2010;7 (pt2):615–31.CrossrefWeb of SciencePubMedGoogle Scholar

  • [15]

    Thomten J, Karlsson A. Psychological factors in genital pain: the role of fearavoidance, pain catastrophizing and anxiety sensitivity among women living in Sweden. Scand J Pain 2014;5:193–9.Google Scholar

  • [16]

    Flink IK, Thomten J, Engman L, Hedstrom S, Linton SJ. Coping with painful sex: development and initial validation of the CHAMP Sexual Pain Coping Scale. Scand J Pain 2015;9:74–80.Web of ScienceGoogle Scholar

  • [17]

    Rosen C, Brown J, Heiman S, Leiblum C, Meston R, Shabsigh D, Ferguson R, D’Agostino R. The Female Sexual Function Index (FSFI): a multidimensional selfreport instrument for the assessment of female sexual function. J Sex Marital Ther 2000;26:191–208.CrossrefGoogle Scholar

  • [18]

    Ryding EL, Blom C. Validation of the Swedish version of the Female Sexual Function Index (FSFI) in women with hypoactive sexual desire disorder. J Sex Med 2015;12:341–9.CrossrefWeb of SciencePubMedGoogle Scholar

  • [19]

    Sullivan MJ, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. PsycholAssess 1995;7:524.Google Scholar

  • [20]

    Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 2008;40:879–91.CrossrefWeb of SciencePubMedGoogle Scholar

  • [21]

    Hayes AF. Introduction to mediation, moderation, and conditional process analysis. A regression-based approach. New York: Guilford; 2013.Google Scholar

  • [22]

    Hayes AF, Rockwood NJ. Regression-based statistical mediation and moderation analysis in clinical research: observations, recommendations, and implementation. Behav Res Ther 2016.PubMedWeb of ScienceGoogle Scholar

  • [23]

    Hayes AF. Beyond Baron and Kenny: statistical mediation analysis in the new millennium. Commun Monogr 2009;76:408–20.Web of ScienceCrossrefGoogle Scholar

  • [24]

    Preacher KJ, Kelley K. Effect sizes measures for mediation models: quantitative strategies for communicating indirect effects. Psychol Methods 2011;16:93–115.CrossrefPubMedGoogle Scholar

  • [25]

    Cohen J. Statistical power analysis for the behavioural sciences. New York: Academic Press; 1988.Google Scholar

  • [26]

    Flink IL, Boersma K, Linton SJ. Pain catastrophizing as repetitive negative thinking: a development of the conceptualization. Cogn Behav Ther 2013;42:215–23.CrossrefPubMedWeb of ScienceGoogle Scholar

  • [27]

    Wertli MM, Eugster R, Held U, Steurer J, Kofmehl R, Weiser S. Catastrophizing-a prognostic factor for outcome in patients with low back pain: a systematic review. SpineJ 2014;14:2639–57.Google Scholar

  • [28]

    Borg C, Peters ML, Schultz WW, deJong PJ. Vaginismus: heightened harmavoidance and pain catastrophizing cognitions. J Sex Med 2012;9:558–67.CrossrefGoogle Scholar

  • [29]

    Desrochers G, Bergeron S, Khalife S, Dupuis MJ, Jodoin M. Fear avoidance and self-efficacy in relation to pain and sexual impairment in women with provoked vestibulodynia. Clin J Pain 2009;25:520–7.Web of ScienceCrossrefPubMedGoogle Scholar

  • [30]

    Rosen NO, Bergeron S, Lambert B, Steben M. Provoked vestibulodynia: mediators of the associations between partner responses, pain, and sexual satisfaction. Arch Sex Behav 2013;42:129–41.Web of SciencePubMedCrossrefGoogle Scholar

  • [31]

    Andrews NE, Strong J, Meredith PJ. Activity pacing, avoidance, endurance, and associations with patient functioning in chronic pain: a systematic review and meta-analysis. Arch Phys Med Rehabil 2012;93:2109–21.Web of ScienceCrossrefPubMedGoogle Scholar

  • [32]

    Gable SL, Impett EA. Approach and avoidance motives and close relationships. Soc Pers Psychol Compass 2012;6:95–108.CrossrefGoogle Scholar

  • [33]

    Hasenbring MI, Hallner D, Rusu AC. Endurance-related pain responses in the development of chronic back pain. In: Hasenbring M, Rusu A, Turk D, editors. From acute to chronic pain: risk factors, mechanisms, and clinical implications. Oxford: Oxford University Press; 2012. p. 295-314.Google Scholar

  • [34]

    Rosen NO, Muise A, Bergeron S, Impett EA, Boudreau GK. Approach and avoidance sexual goals in couples with provoked vestibulodynia: associations with sexual, relational, and psychological well-being. J Sex Med 2015;12: 1781-90.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [35]

    Dewitte M, Van Lankveld J, Crombez G. Understandin sexual pain: a cognitive motivational account. Pain 2011;152:251–3.CrossrefGoogle Scholar

  • [36]

    Gustavson K, von Soest T, Karevold E, R0ysamb E. Attrition and generalizability in longitudinal studies: findings from a 15-year population-based study and a Monte Carlo simulation study. BMC Public Health 2012;12:1.Web of ScienceGoogle Scholar

  • [37]

    terKuile MM, Bulte I, Weijenborg P, Beekman A, Melles R, Onghena P. Therapistaided exposure for women with lifelong vaginismus: a replicated single-case design. J Consult Clin Psychol 2009;77:149.PubMedGoogle Scholar

  • [38]

    ter Kuile MM, Melles R, de Groot HE, Tuijnman-Raasveld CC, van Lankveld JJ. Therapist-aided exposure for women with lifelong vaginismus: a randomized waiting-list controltrial ofefficacy. J Consult Clin Psychol 2013;81:1127.Google Scholar

  • [39]

    Westman A, Linton SJ, Ohrvik J, Wahlen P, Leppert J. Do psychosocial factors predict disability and health at a 3-year follow-up for patients with non-acute musculoskeletal pain? Avalidation of the Orebro Musculoskeletal Pain Screening Questionnaire. EurJ Pain 2008;12:641–9.CrossrefGoogle Scholar

About the article

School of Law, Psychology, and Social Work, 70182 Örebro, Sweden


Received: 2017-03-06

Revised: 2017-08-17

Accepted: 2017-08-23

Published Online: 2017-10-01

Published in Print: 2017-10-01


Funding sources: This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Ethical issues:The participants filled out informed consents and the study was approved by the Regional Ethical Review Board in Uppsala, Sweden (D Number 2014-407). The study protocol was not registered.

Conflict of interest: The authors have no conflicts of interest in relation to this study.


Citation Information: Scandinavian Journal of Pain, Volume 17, Issue 1, Pages 302–308, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2017.08.007.

Export Citation

© 2017 Scandinavian Association for the Study of Pain.Get Permission

Comments (0)

Please log in or register to comment.
Log in