School of Behavioral, Social, and Legal Sciences, Örebro University, Örebro, Sweden.
Karolinska Institute, Department of Neuroscience, Stockholm, Sweden.
Eur J Pain. 2024 Oct;28(9):1596-1606. doi: 10.1002/ejp.2297. Epub 2024 Jun 1.
Provoked vestibulodynia (PVD) is a common pain condition, negatively impacting the relationships and sexual lives of sufferers. Women's coping behaviour has been associated with psychosexual outcomes, yet coping patterns in clinical PVD samples are unexplored, and it is not known how women's coping relates to their relational context.
Women (N = 128) with PVD answered questionnaires about psychosexual function, pain coping (avoidance and endurance), relational- and pain catastrophizing, sexual goals and perceived partner responses. Cluster analysis was used to explore coping patterns; clusters were validated on measures of pain and psychosexual function and compared on catastrophizing, sexual goals and partner responses using multivariate analyses of variance.
The analysis yielded four clusters: endurance; combined high avoidance and endurance; avoidance; and combined low. The group with high levels of both avoidance and endurance coping displayed the worst psychosexual outcomes and high levels of pain- and relational catastrophizing, approach and avoidance goals and perceived negative partner responses.
There are distinct patterns of coping among women with PVD, and these coping patterns are associated with psychosexual outcomes and relational cognitions and goals, and perceived partner responses. Women who alternate between avoidance and endurance are more distressed and report worse psychosexual functioning. This pattern needs to be identified and addressed in the treatment of PVD.
This study extends previous findings on vulvar pain coping patterns to a clinical population of women with PVD. It is further the first study to address the relationship between relational variables, such as partner responses and relational catastrophizing and different coping patterns. Thus, the contribution of this study is the contextualizing of coping patterns among women with PVD. The results showed that a combined pattern of avoidance and endurance coping is associated with high distress, poor psychosexual outcomes, and indications of insufficient relational coping, highlighting the need for clinical assessment and intervention to target both women's individual coping patterns and their relational context.
诱发性外阴痛（PVD）是一种常见的疼痛病症，会对患者的人际关系和性生活产生负面影响。女性的应对行为与性心理结果相关，但在临床 PVD 样本中，应对模式尚未得到探索，也不知道女性的应对方式与她们的关系背景有何关联。
患有 PVD 的女性（N=128）回答了关于性心理功能、疼痛应对（回避和忍受）、关系和疼痛灾难化、性目标和感知伴侣反应的问卷。聚类分析用于探索应对模式；使用多元方差分析比较聚类在疼痛和性心理功能测量上的验证结果，以及在灾难化、性目标和伴侣反应上的结果。
分析产生了四个聚类：忍受；高回避和忍受相结合；回避；低回避和忍受相结合。回避和忍受水平都高的组表现出最差的性心理结果和高水平的疼痛和关系灾难化、接近和回避目标以及感知到的负面伴侣反应。
患有 PVD 的女性存在不同的应对模式，这些应对模式与性心理结果和关系认知、目标以及感知到的伴侣反应相关。在回避和忍受之间交替的女性更痛苦，报告的性心理功能更差。这种模式需要在 PVD 的治疗中加以识别和处理。
本研究将外阴疼痛的应对模式研究扩展到患有 PVD 的临床女性人群，并且是首次研究关系变量（如伴侣反应和关系灾难化）与不同应对模式之间的关系。因此，本研究的贡献在于将 PVD 女性的应对模式置于背景中。结果表明，回避和忍受相结合的应对模式与高度痛苦、较差的性心理结果和关系应对不足的迹象相关，突出了需要对女性的个体应对模式和她们的关系背景进行临床评估和干预的必要性。
