Vulvodynia, a common form of chronic vulvovaginal pain, is conceptualized as a multifactorial chronic pain condition. Research has examined the role of numerous physiological, psychological, and social factors in the development and maintenance of vulvodynia, however, health care experiences have not been closely examined in this clinical population. Three online studies were conducted to investigate the health care experiences of women with chronic vulvovaginal pain. Study 1 examined pelvic examination (PE) experiences in women with and without chronic pain during intercourse. During their last PE, women with pelvic and vulvovaginal pain reported significantly more pain and anxiety compared to women without pain during intercourse. Various predisposing (first PE experience), examination (quality of patient- physician interaction, physician gender), and psychological factors (vaginal penetration cognitions, body image) predicted PE ratings in women with and without pain during intercourse. Study 2 more broadly examined pain and adjustment in women with vulvovaginal pain. Pain-related beliefs (i.e., attributional style, perceived control) were related to health care variables and predicted adjustment. First, global attributions predicted depressive symptoms and pain-related cognitions/responses after controlling for pain severity and interference. Second, chance beliefs moderated the relationship between pain-related cognitions/responses and internal attributions. Third, women with higher chance and lower physician pain beliefs reported lower social support. Study 3 investigated the knowledge, attitudes, and comfort of Canadian medical residents in Family Medicine and Obstetrics and Gynecology (OBGYN) about vulvodynia. OBGYN residents later in their training reported greater knowledge and comfort with vulvodynia and its symptoms than their more junior counterparts; ratings did not significantly differ between specialties. Residents did report significantly more positive attitudes toward patients with ii vulvovaginal pain of identifiable pathology in comparison to patients with no physical findings. Comfort discussing sexuality in medical practice was a significant predictor of knowledge, attitudes, and comfort with vulvodynia after controlling for demographics/training variables. These findings offer a multidimensional perspective on the role of health care in biopsychosocial models of vulvovaginal pain, and have implications for the assessment and treatment of vulvodynia and Genito-Pelvic Pain/Penetration Disorder. / Thesis (Ph.D, Psychology) -- Queen's University, 2014-04-24 16:39:05.723

Introduction: Provoked vestibulodynia is a common life impacting disease. Research hasshown higher pain intensity and anxiety levels in primary (pain present since first penetrativeattempt) provoked vestibulodynia (PVD1) compared to secondary provoked vestibulodynia(PVD2) and mixed results regarding age and female sexual functioning when comparing thegroups.Aim: The aim of this study was to further investigate the differences between PVD1 andPVD2 regarding pain intensity, sexual functioning, age and anxiety levels. The secondary aimwas to analyze how PVD group, age, anxiety and pain intensity associates with sexualfunctioning.Method: A total of 57 women from the Netherlands and Sweden were recruited via socialmedia, advertisement and regional caregivers. This study was part of a larger study oncognitive behavioral group therapy for women with provoked vestibulodynia. Data wasextracted from a survey assessing intensity of pain, sexual functioning, age and anxiety levels.A t-test was used to compare the PVD1 and PVD2 groups and a multivariate regressionanalysis was used to analyze the variables association with sexual functioning.Results: No statistically significant differences were found regarding pain intensity, sexualfunctioning, age and anxiety levels between PVD1 and PVD2. Decreased sexual functioningwas significantly related to higher age and pain intensity.Conclusion: We found no significant differences between PVD1 and PVD2. Increased ageand higher pain intensity seems to associate with lower sexual functioning. Longitudinalstudies with a greater sample size are needed for further investigation.

Provoked vulvodynia (PVD) is a disorder characterized by intense vulvar pain, most often reported as raw, burning, or stinging tissue. Current treatment options for PVD are insufficient and narrow in focus, as they predominantly address the physical pain associated with the disorder. Current publications regarding cognitive behavioral therapy and mindfulness treatment indicate that both therapies are highly effective. Mindfulness and cognitive behavioral therapies are noninvasive, efficacious long term, and provide a comprehensive biopsychosocial approach. The aim of this study is to educate nurse practitioners regarding these treatment options, which manage the physical as well as psychosocial aspects of PVD.

Although Provoked Vestibulodynia has a great impact on women’s relationships, including their partners, research has predominantly focused on the women. This thesis aimed to expand the knowledge regarding psychosexual health of the partner. Depressive symptoms, anxiety, sexual distress, and domains of sexual function (erectile function, orgasmic function, sexual desire, intercourse satisfaction, overall sexual satisfaction) were investigated through descriptive comparisons, correlations, and regression analyses. The sample consisted of male partners (N=53) of women with PVD, aged 20-50 years. Baseline data from a larger RCT was compared with data from external studies. Results showed that PVD partners reported similar levels of depressive symptoms and anxiety as comparison groups. However, PVD partners expressed higher levels of sexual distress, and lower levels of sexual function than comparison groups. Several domains of sexual function predicted overall sexual satisfaction, whereas depressive symptoms did not explain levels of sexual distress. However, depressive symptoms co-occurring with poorer overall sexual satisfaction and orgasmic function, explained higher sexual distress. We conclude that partners have a perceived impaired sexual health. Their impairment is localised to sexuality and not generalised to the rest of their lives. Partner involvement is integral in the treatment of PVD and should be investigated in future research.

Enligt forskning har kvinnor en högre rädsla för brott än män. En förklaring är att kvinnors rädsla för sexuella brott ökar rädslan för alla typer av brott. Andra faktorer som har visat sig påverka rädsla för brott är fysisk och psykisk ohälsa. Dessa faktorer och teorin om att kvinnors rädsla för brott påverkas av rädsla för sexuella brott kan innebära att smärtsjukdomar som vulvodyni och vaginism som innebär svår smärta vid penetration och / eller beröring av slidan gör att kvinnor som lider av det kan uppleva en högre rädsla av brottslighet än andra kvinnor. Studiens syfte var att undersöka om vulvodyni har en inverkan på kvinnors rädsla för brott. Deltagarna bestod av 243 kvinnor (medelålder= 24,58, SD= 5,15) med (n=129) och utan (n=114) vulvodyni. Resultaten av studien indikerar att vulvodyni påverkar rädsla för brott och gör kvinnor som lider av den mer rädda för brott än de utan vulvodyni. Kvinnor med vulvodyni har också en högre rädsla för sexualbrott som våldtäkt och sexuella trakasserier. Vulvodyni visar på en unik association till rädsla för brott vid kontroll över andra variabler som tidigare forskning visat samband med rädsla för brott. Rädsla för sexualbrott visar också associationer med rädsla för andra brott hos kvinnor med och utan vulvodyni. Mer forskning om ämnet behövs för att se hur kvinnor med vulvodyni resonerar om sin rädsla för brott. / According to research, women have a higher fear of crime than men. one explanation is that women's fear of sexual offenses increases the fear of all types of crime. Other factors that have been shown to affect fear of crime are physical and mental health. The factors and the theory that women's fear of crime is affected by fear of sexual offenses could mean that pain diseases such as vulvodynia and vaginism that involve severe pain when penetrating and/or touching the vagina make women who suffer from it to have a higher fear of crime than other women. The purpose of the study was to investigate if vulvodynia has an impact on women's fear of crime. The study sample consisted of 243 women (mean age=24,58, SD= 5,15) with (n= 129) and without (n=114) vulvodynia. The results of the study indicate that vulvodynia affects fear of crime and makes women who suffer from it more afraid of crime than those without. Women with vulvodynia also have a higher fear of sexual offenses such as rape and sexual harassment. Vulvodynia also demonstrates having a unique compound to fear of crime proud control for other variables. Fear of sexual crime also shows associates of fear to other types of crimes for women with and without vulvodynia. More research on the subject is needed to see how women with vulvodynia reason about their fear of crime.

Vestibulodyni är ett medicinsk tillstånd som orsakar en brännande och svidande känsla runt slidöppningen och har setts drabba uppemot 15% av den kvinnliga befolkningen. För många kvinnor är smärtproblematiken så pass omfattande att det påverkar flera aspekter av livet och kan medföra psykosociala konsekvenser för de drabbade. Syftet med denna studie är att undersöka hur kvinnor med vestibulodyni beskriver sin livskvalitet samt hur de upplever bemötandet inom vården. Åtta kvalitativa djupintervjuer med vestibulodynidrabbade kvinnor ligger till grund för resultatet, som har analyserats utifrån genusteori, stigmateori och teorier om coping. Den empiriska datan har analyserats utifrån en tematisk narrativ analys, som har genererat ett flertal teman som utgör studiens resultat. Resultaten indikerar att vestibulodynidrabbade personer upplever smärta som en begränsning, en brist på adekvat vård, tycker att behandlingsprocessen är frustrerande samt erfar en stor psykisk påfrestning och självstigmatisering. / Vestibulodynia is a medical condition that causes a burning and stinging sensation around the vaginal opening and has been seen to affect up to 15% of the female population. For many women, the pain problem is so extensive that it affects several aspects of life and can have psychosocial consequences for those affected. The purpose of this study is to investigate how the women with vestibulodynia describes their quality of life and their experiences with the healthcare system. Eight qualitative in-depth interviews with women affected by vestibulodynia form the basis of the results, which have been analyzed through gender theory, stigma theory and theories of coping. The empirical data have been analyzed using a thematic narrative analysis, generating a number of themes that constitute the results of the study. The results indicate that people with vestibulodynia experience pain as a form of limitation and a lack of adequate health care. They also find the treatment process frustrating and experience a great deal of mental strain and self-stigma.

L’étude de l’intimité a été négligée chez les couples dont la femme présente une vulvodynie, un problème de santé sexuelle qui affecte négativement les femmes et leurs partenaires. Or, l’intimité a été associée à des indicateurs d’adaptation psychologique et conjugale auprès d’autres populations cliniques. L’objectif de la thèse était d’examiner les liens entre l’intimité et le bien-être sexuel chez les femmes présentant de la vulvodynie et leurs partenaires. Le but du premier article était d’examiner l’intimité conjugale et l’intimité sexuelle en lien avec la satisfaction sexuelle, la fonction sexuelle, le sentiment d’auto-efficacité face à la douleur et l’intensité de la douleur vulvo-vaginale de la femme. Quatre-vingt-onze femmes présentant de la vulvodynie et leurs partenaires ont complété des mesures auto-rapportées. Chez les femmes, une plus grande intimité sexuelle a été associée à une satisfaction sexuelle et à un sentiment d’auto-efficacité plus élevés. Des degrés plus élevés d’intimité conjugale et sexuelle ont été associés à une fonction sexuelle plus élevée. L’intimité sexuelle et conjugale n’ont pas été associées à l’intensité de la douleur. Le deuxième article visait, par une méthodologie observationnelle et des mesures auto-rapportées, à examiner les associations entre deux composantes centrales de l’intimité – le dévoilement et la réponse empathique – et la satisfaction et la détresse sexuelle chez cinquante femmes et leurs partenaires. Le dévoilement et la réponse empathique ont été évalués selon la perspective d’une observatrice formée et auto-rapportés par les couples après une tâche de discussion. Les femmes et les partenaires ayant une plus grande réponse empathique rapportaient eux-mêmes une satisfaction sexuelle plus élevée. Pendant la discussion, une plus grande réponse empathique chez les femmes a été associée à une plus grande satisfaction sexuelle chez leurs partenaires. Un plus grand dévoilement chez le couple, tel que perçu par les femmes et leurs partenaires, a été associé à une plus grande satisfaction sexuelle chez les partenaires. Une plus grande réponse empathique chez les femmes a été associée à une plus faible détresse sexuelle chez les partenaires. Un plus grand dévoilement chez le couple, tel que perçu par les partenaires, a été associé à une plus faible détresse sexuelle chez ces derniers. Les implications cliniques, théoriques et méthodologiques de la thèse sont discutées. / Intimacy has been a neglected area of research among couples coping with vulvodynia, a sexual health problem which has a negative impact on the sexual well-being of both the woman and her partner. Yet, intimacy has been associated with indicators of psychological and marital adjustment in other clinical populations. The main goal of this thesis was to investigate associations between intimacy and sexual well-being in women with vulvodynia and their partners. The first article aimed to examine relationship intimacy and sexual intimacy in relation to sexual satisfaction, sexual function, pain self-efficacy and pain during intercourse in women. Ninety-one women with vulvodynia and their partners completed self-report questionnaires. Women’s higher sexual intimacy was associated with their higher sexual satisfaction and pain self-efficacy. Women’s higher relationship intimacy and sexual intimacy were also associated with their higher sexual function. Relationship intimacy and sexual intimacy were not associated with pain intensity. Using a combination of observational and self-report methodologies, the second article aimed to investigate the associations between two central components of intimacy – empathic response and disclosure – and sexual satisfaction and distress among fifty women and their partners. Disclosure and empathic response were measured from the perspective of a trained observer and self-reported by women and their partners immediately following a discussion task. During the discussion, greater empathic response in women and partners were associated with their own higher sexual satisfaction. Greater women’s empathic response was associated with their partners’ higher sexual satisfaction. Greater disclosure in couples, as perceived by women and partners, was associated with higher partners’ sexual satisfaction. Greater empathic response in women was associated with partners’ lower sexual distress. Greater disclosure in couples, as perceived by partners, was associated with partners’ lower sexual distress. Clinical, theoretical, methodological implications of the thesis are discussed.

La vestibulodynie provoquée (VP) est la forme la plus répandue de douleur génito-pelvienne/trouble de la pénétration et la cause la plus fréquente de douleur vaginale chez les femmes pré-ménopausées. Les femmes qui en souffrent rapportent plus de détresse psychologique ainsi qu’un fonctionnement sexuel appauvri, une diminution de la fréquence des activités sexuelles et du plaisir, et plus d’attitudes négatives à l’égard de la sexualité. Les recherches portant sur les couples souffrant de VP ont montré le rôle prépondérant des variables relationnelles dans la modulation des conséquences sexuelles et psychologiques pour les femmes et leurs partenaires. Cependant, aucune analyse dyadique n’a été appliquée au facteur de risque étiologique le plus robuste, soit la maltraitance durant l’enfance. Par ailleurs, malgré des recommandations répétées pour inclure le partenaire dans le traitement psychologique pour la VP, aucune étude à ce jour n’a examiné l’efficacité d’une psychothérapie qui inclut systématiquement le partenaire et dont la cible est le couple. L’objectif général de cette thèse a été d’utiliser une perspective dyadique afin d’examiner les antécédents de maltraitance et l’efficacité d’une intervention conçue pour améliorer les issues des couples souffrant de VP. Le premier article vise à examiner les liens entre la maltraitance durant l’enfance des femmes souffrant de VP et leurs partenaires, et leur fonctionnement sexuel, leur ajustement psychologique, leur satisfaction conjugale et enfin avec la douleur rapportée par les femmes durant les relations sexuelles. Quarante-neuf couples souffrant de VP ont complété des questionnaires auto-rapportés. La maltraitance durant l’enfance chez les femmes était associée à un fonctionnement sexuel plus faible chez les femmes et les hommes, une augmentation de l’anxiété chez les femmes seulement, et une douleur affective accrue durant les relations sexuelles. La maltraitance durant l’enfance chez les hommes était associée à un fonctionnement sexuel plus faible, moins de satisfaction conjugale, plus d’anxiété chez les femmes et les hommes, et une douleur affective accrue durant les relations sexuelles rapportée par les femmes. En se basant sur les recommandations issues des études empiriques, une thérapie cognitive et comportementale pour les couples (TCCC) souffrant de VP a été développée. Le deuxième article présente les résultats d’une étude pilote testant son efficacité, fidélité et faisabilité potentielles. Neuf couples ont complété des questionnaires auto-rapportés pré- et post-traitement. La TCCC de 12 rencontres était manualisée. Les femmes ont rapporté une amélioration significative de la douleur, du fonctionnement et de la satisfaction sexuels, et les partenaires ont rapporté une amélioration significative de leur satisfaction sexuelle. Les couples ont rapporté des niveaux élevés de satisfaction quant à la psychothérapie, et les psychothérapeutes ont rapporté suivre le manuel de traitement de manière fidèle. Le troisième article, s’appuyant sur les résultats prometteurs de l’étude pilote, décrit le protocole de recherche pour un essai clinique randomisé mesurant l’efficacité de la TCCC comparée à une intervention médicale de première ligne, la lidocaïne topique, pour le traitement de la VP. Enfin, les implications cliniques et théoriques de la thèse sont discutées. / Provoked vestibulodynia (PVD), a chronic, recurrent pain elicited via pressure to the vulvar vestibule or attempted vaginal penetration, is the most common form of pain during intercourse (genito-pelvic pain/penetration disorder), and the most frequent cause of vulvar pain in pre-menopausal women. Because of its deleterious impact on sexuality, it carries a heavy psychosexual burden for afflicted women, who report impoverished sexual function, decreased sexual frequency and pleasure, and more negative attitudes about sex. Research among couples with PVD has demonstrated the prominent role of partner variables in the modulation of PVD-associated consequences for women, and the negative sexual and psychological consequences experienced by partners. Yet, a dyadic analysis has not been applied to the most robust etiological risk factor for adult-onset PVD, childhood trauma or maltreatment. Furthermore, despite repeated recommendations to include the partner in psychological treatment of PVD, no study to date has examined the effectiveness of a treatment that systematically includes the partner and targets the couple. The overarching goal of this thesis was to use a dyadic perspective in examining trauma antecedents of PVD and treatment effectiveness of an intervention designed to improve outcomes for couples with PVD. The first article aimed to examine associations between childhood maltreatment of both women with PVD and their partners and their sexual functioning, psychological adjustment and couple satisfaction, as well as women’s reported pain during sexual intercourse. Forty-nine couples with PVD completed self-report questionnaires. Women’s childhood maltreatment was associated with lower sexual functioning for women and men, increased anxiety for women only, and increased affective pain during sexual intercourse. Male partners’ childhood maltreatment was associated with lower sexual functioning, decreased couple satisfaction and increased anxiety for women and men, and higher affective pain reported by women during sexual intercourse. Drawing from the recommendations in the empirical literature, a Cognitive-Behavioural Couple Therapy (CBCT) for PVD was developed. The second article presents the results from its pilot testing for potential effectiveness, reliability and feasibility. Nine couples completed pre- and post-treatment self-report measures following the 12-session, manualized intervention. Women reported significant improvements in pain, sexual function and satisfaction, and partners reported significant improvements in sexual satisfaction. Exploratory analyses revealed improvements in anxiety, depression and pain-related cognitions, such as pain catastrophizing, for both women and partners. Couples reported high rates of treatment satisfaction and therapists reported good treatment reliability. The third article, building on the promising pilot study results, describes the research protocol for a randomized clinical trial to assess the efficacy of CBCT compared to a first-line medical intervention, topical lidocaine, for the treatment of PVD. In this ongoing trial, couples with PVD are randomized to one of the two treatment options. The clinical and theoretical implications of the thesis are discussed.