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Coping with painful sex – A neglected female problem

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Scandinavian Journal of Pain
From the journal Scandinavian Journal of Pain Volume 9 Issue 1

In this issue of the Scandinavian Journal of Pain, Flink and coworkers [1] present a newly developed instrument for assessing sexual coping strategies in women with vulvar pain. The vulva refers to the external genitals located in the outside of the female genital area. Vulvar pain is a highly prevalent, and possibly underestimated, problem [2,3]. From previous studies, we know that recurrent and persistent vulva pain can have detrimental consequences for a woman’s sex life, but strangely, little is known about how these women actually cope with sexual activities. The study by Flink and coworkers, where such coping strategies are targeted, is thus both important and timely. Previous qualitative studies have indicated that women use different coping strategies to deal with painful sex, and this is further supported by Flink and coworkers. They find that there are essentially three different ways of coping with vulva pain when it comes to sex: (1) by avoiding sex completely, (2) by enduring sex despite the pain, and (3) by engaging in alternative sexual activities that do not involve vaginal penetration.

One of the main findings is particularly interesting and worth a closer look. As hypothesized by the authors, the first two coping strategies seem to imply maladaptive ways of coping. Both endurance and avoidance were associated with more pain and less sexual functioning. The third strategy, however, seemed to be more complex. Theoretically, one would think that engaging in alternative sexual strategies would imply coping, since it allows the person to be sexually active while avoiding the associated pain, but the study findings revealed a more complex association. While being positively associated with sexual functioning, it was not correlated with psychological flexibility, anxiety or depression. In other words, engaging in alternative sexual activities does not seem to make you less anxious or depressed, at least not for the group overall. A possible explanation is put forward by the authors: Perhaps the large group of women who report that they engage in alternative sexual activities, comprise contrasting subgroups-some who are well functioning and satisfied and others who are not. Given the complex nature of intimate relationships, this may not come as a surprise. A strategy of coping does not equal an experience of coping, which may explain the lack of correlation with anxiety and depression. Some might engage in alternative activities merely because the partner wants it, while others might be happy about the alternative activities themselves, but experience that the partner is not. Others again may experience a mutual satisfaction with the alternative activities. The very same strategy could thus result in different experiences of coping. Clearly, in-depth studies are warranted to further disentangle these complex relationships, and understand the nature and effects of engaging in alternative sexual activities. This is not only important in the further development of the scale, it is also important as it holds the potential of identifying adaptive coping strategies. In other words, identifying ways of coping, not only the lack of coping.

As for all pilot studies, this study too has methodological limitations that call for follow-up studies. The uncertainty regarding the representativeness of the study sample implies that replication studies should be conducted to further validate the distribution of scores and subscales. Furthermore, the sensitivity for change is largely unknown and thus makes it difficult to consider the scale’s suitability as an outcome measure. Nevertheless, the study represents an important first step in the development of an effective tool to identify women at risk of persistent pain and sexual problems. The main strength of the study is its novelty and direct response to the urgent need for a sexual pain coping scale. Another strength involves the potential to be used as an outcome measures in clinical trials. More knowledge about adaptive and maladaptive ways of coping with this problem could inform and inspire the development of effective interventions for women suffering from vulva pain and associated sexual problems. The availability, and mere existence, of such interventions are scarce. This should warrant serious concern, given the many women who are affected by this and the consequences they bear as a result of it.

In conclusion, recurrent vulva pain is a common, yet grossly neglected problem for a vast number of women [2]. Not only does it cause severe pain and discomfort for the women affected, it can also destroy their sex life completely. Many suffer in silence. Studies show that more than half of the women reporting vulva pain choose not to seek treatment [4]. Whether the reason for this is embarrassment and shame, or whether it has to do with availability of treatments, is not known. What is known, however, is the complete lack of effective clinical and research tools to identify treatment needs. The current study offers a direct response to this by presenting a new scale for sexual pain coping, that has the potential to be used epidemiologically, clinically and in research.

DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2015.05.002.

  1. Conflict of interest: The author declares no conflict of interest.

References

[1] Flink IK, Thomtén J, Engman L, Hedström S, Linton SJ. Coping with painful sex: development and initial validation of the CHAMP Sexual Pain Coping Scale. Scand J Pain 2015;9:74–80.Search in Google Scholar

[2] Harlow BL, Kunitz CG, Nguyen RH, Rydell SA, Turner RM, MacLehose RF. Prevalence of symptoms consistent with a diagnosis of vulvodynia: population-based estimates from 2 geographic regions. Am J Obstet Gynecol 2014;210, 40 e1-8.Search in Google Scholar

[3] Harlow BL, Stewart EG. A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? J Am Med Womens Assoc 2003;58:82-8.Search in Google Scholar

[4] Reed BD, Harlow SD, Sen A, Legocki LJ, Edwards RM, Arato N, Haefner HK. Prevalence and demographic characteristics of vulvodynia in a population-based sample. AmJ Obstet Gynecol 2012;206, 170 e1-9.Search in Google Scholar
Published Online: 2015-10-01
Published in Print: 2015-10-01

© 2015 Scandinavian Association for the Study of Pain

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  31. Editorial comment
  32. Coping with painful sex – A neglected female problem
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  35. Original experimental
  36. Spatial summation of thermal stimuli assessed by a standardized, randomized, single-blinded technique
https://doi.org/10.1016/j.sjpain.2015.08.003

Articles in the same Issue

  1. Editorial comment
  2. Editorial comment on Helen Richardson’s and Stephen Morley’s study on “Action identification and meaning in life in chronic pain”
  3. Original experimental
  4. Action identification and meaning in life in chronic pain
  5. Editorial comment
  6. Editorial comment on Karlsson et al. “Cognitive behavior therapy in women with fibromyalgia. A randomized clinical trial”
  7. Clinical pain research
  8. Cognitive behaviour therapy in women with fibromyalgia: A randomized clinical trial
  9. Editorial comment
  10. Assessing insomnia in pain – Can short be good?
  11. Observational study
  12. The Swedish version of the Insomnia Severity Index: Factor structure analysis and psychometric properties in chronic pain patients
  13. Editorial comment
  14. Reliability of pressure pain threshold testing (PPT) in healthy pain free young adults
  15. Observational study
  16. Reliability of pressure pain threshold testing in healthy pain free young adults
  17. Editorial comment
  18. Qualitative research in complex regional pain syndrome (CRPS)
  19. Topical review
  20. Building the evidence for CRPS research from a lived experience perspective
  21. Editorial comment
  22. Complex role of peroxisome proliferator activator receptors (PPARs) in nociception
  23. Original experimental
  24. Systemic administration of WY-14643, a selective synthetic agonist of peroxisome proliferator activator receptor-alpha, alters spinal neuronal firing in a rodent model of neuropathic pain
  25. Editorial comment
  26. Evaluation of pain in children with communication difficulties: r-FLACC translated and validated in Nordic languages
  27. Clinical pain research
  28. Assessment of pain in children with cerebral palsy focused on translation and clinical feasibility of the revised FLACC score
  29. Clinical pain research
  30. The revised FLACC score: Reliability and validation for pain assessment in children with cerebral palsy
  31. Editorial comment
  32. Coping with painful sex – A neglected female problem
  33. Clinical pain research
  34. Coping with painful sex: Development and initial validation of the CHAMP Sexual Pain Coping Scale
  35. Original experimental
  36. Spatial summation of thermal stimuli assessed by a standardized, randomized, single-blinded technique
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