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

Ida Katrina Flink; Linnéa Engman; Moniek M Ter Kuile; Johanna Thomtén; Steven J Linton

doi:10.1016/j.sjpain.2017.08.007

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

Scand J Pain. 2017 Oct:17:302-308. doi: 10.1016/j.sjpain.2017.08.007. Epub 2017 Sep 18.

Authors

Ida Katrina Flink¹, Linnéa Engman², Moniek M Ter Kuile³, Johanna Thomtén⁴, Steven J Linton²

Affiliations

¹ Center for Health and Medical Psychology (CHAMP), School of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden. Electronic address: ida.flink@oru.se.
² Center for Health and Medical Psychology (CHAMP), School of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden.
³ Department of Psychosomatic Gynaecology and Sexology, Leiden University Medical Center, Leiden, The Netherlands.
⁴ Department of Psychology, Mid Sweden University, Östersund, Sweden.

PMID: 28927649
DOI: 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 catastrophizing 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 strategies 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: Avoidance-endurance; Coping; Sexual pain; Vulvovaginal pain; Women.

MeSH terms

Adaptation, Psychological / physiology*
Adolescent
Adult
Catastrophization / physiopathology*
Female
Humans
Longitudinal Studies
Pelvic Pain / physiopathology*
Sexual Dysfunction, Physiological / physiopathology*
Vaginal Diseases / physiopathology*
Vulvar Diseases / physiopathology*
Young Adult