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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

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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


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.


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.


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.


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.


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


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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.

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