Dewitte Marieke, Werner Marlene, Ter Kuile Moniek, Engman Linnea, Flink Ida
Department of Clinical Psychological Science, Maastricht University.
Department of Sexology and Psychosomatic Gynecology, Amsterdam UMC, The Netherlands.
J Sex Res. 2025 May-Jun;62(5):818-831. doi: 10.1080/00224499.2024.2352540. Epub 2024 Jun 4.
Using a novel data-driven network approach, this study aimed to examine the interconnection between the key elements of the Fear-Avoidance Model of female genital pain - sexual arousal, fear-avoidant cognitions, and motivational coping - and its associated factors to predict the intensity and frequency of genital pain across women over time. Network modeling allowed for a comprehensive evaluation of the Fear-Avoidance model while capturing the dynamic features of genital pain. We estimated a cross-sectional and a temporal, contemporaneous, and between-persons network model on convenience-based data of 543 female students (mean age = 23.7 years, = 3.6) collected at three time points. Results showed that lubrication, pain catastrophizing, pain avoidance, fear-avoidance beliefs, sexual satisfaction, anxiety, and frequency of coital and non-coital sex predicted pain, with lubrication being the most consistent predictor across estimations. The network of women with recurrent genital pain showed a similar pattern as the network of the total sample, except that pain avoidance and fear-avoidance beliefs rather than pain catastrophizing predicted pain directly, and frequency of coital and non-coital sexual activities played a more prominent role. These results suggest that the main problem of genital pain centers around women not being sufficiently aroused during intercourse and inadequate ways of pain coping, which are critical targets of cognitive-behavioral therapy treatment and should be developed further.
本研究采用一种全新的数据驱动网络方法，旨在探究女性生殖器疼痛恐惧 - 回避模型的关键要素（性唤起、恐惧 - 回避认知和动机性应对）之间的相互联系及其相关因素，以预测不同时间段内女性生殖器疼痛的强度和频率。网络建模能够在捕捉生殖器疼痛动态特征的同时，对恐惧 - 回避模型进行全面评估。我们基于在三个时间点收集的543名女学生（平均年龄 = 23.7岁，标准差 = 3.6）的便利样本数据，估计了一个横断面模型以及一个时间、同期和个体间网络模型。结果表明，润滑、疼痛灾难化、疼痛回避、恐惧 - 回避信念、性满意度、焦虑以及性交和非性交性行为的频率可预测疼痛，其中润滑是所有估计中最一致的预测因素。复发性生殖器疼痛女性的网络呈现出与总样本网络相似的模式，只是疼痛回避和恐惧 - 回避信念而非疼痛灾难化直接预测疼痛，并且性交和非性交性活动的频率发挥了更突出的作用。这些结果表明，生殖器疼痛的主要问题集中在女性在性交过程中未得到充分唤起以及疼痛应对方式不足，这是认知行为疗法治疗的关键靶点，应进一步深入研究。
