Psychological factors in genital pain: The role of fear-avoidance, pain catastrophizing and anxiety sensitivity among women living in Sweden

Scandinavian Journal of Pain - Tập 5 - Trang 193-199 - 2014
Johanna Thomtén1,2, Andreas Karlsson2
1Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Sweden
2Department of Psychology, Mid Sweden University, Östersund, Sweden

Tóm tắt

Abstract Objectives One in five women under the age of 30 report recurrent genital pain and pain during sexual intercourse. Female genital pain negatively affects sexual and general health, as well as dyadic function and quality of life. Although the current field of research and clinical expertise in general agree upon a biopsychosocial conceptualization, there is still a lack of theoretical models describing the psychosocial mechanisms involved in the development of genital pain. Originally developed to outline the transition from acute to chronic back pain, the fear avoidance (FA) model has lately been proposed as a possible tool in illustrating the mechanisms involved in genital pain. However, only few studies have empirically tested the components of the FA model empirically. The aim of the present study is to examine fear avoidance beliefs, pain catastrophizing, and symptoms of depression and anxiety among women reporting genital pain, and to relate these concepts to sexual satisfaction/function and the characteristics of pain. Methods The study was a population-based study using a postal questionnaire administered to 4052 women (age 18–35). Of these 944 (response rate: 23%) took part in the study. Results Genital pain of six months duration was reported by 16.1% of the women. Women with pain reported elevated levels of symptoms of anxiety, fear avoidance beliefs, pain catastrophizing and anxiety sensitivity. Symptoms of anxiety also predicted pain in the explanatory model together with vaginal tension and fungal infection. Vaginal tension has previously been described as a fear-response to painful intercourse and the results thereby seem to give further support to viewing genital pain from a fear avoidance perspective. Furthermore, fear avoidance beliefs seem to be of similar importance as lack of desire for the experience of sexual satisfaction and could also predict pain during specific activities among women with pain. The results also indicate that sexual satisfaction is related to a specific pain-related fear, rather than a heightened level of general anxiety. Conclusions The study had a low response rate, but still indicates that genital pain is common and is associated with several aspects of fear and avoidance. In sum, the results support the FA model by giving strong support for fear reactions (vaginal tension) and fear avoidance beliefs, and moderate support for negative affect. In the model negative affect drives pain catastrophizing. Implications It seems that the experience of genital pain among women in the general population is common and could be associated with increased levels of anxiety and fear-avoidance beliefs. However, the associations should not be understood in isolation from physiological mechanisms but seem to indicate interactions between, e.g. fungal infections, negative appraisals of pain and symptoms, lack of sexual function and satisfaction and increased pain experience. It is possible that psychological mechanisms work in the transition from acute physiological pain to chronic psychologically maintained pain in terms of secondary reactions to, e.g. repeated fungal infections by adding emotional distress, fear of pain and avoidance behaviours.

Tài liệu tham khảo

LoFrisco BM. Female sexual pain disorders cognitive behavioral therapy. J Sex Res 2011;48:573–9.2118433810.1080/00224499.2010.540682 Arnold LD, Bachmann GA, Rosen R, Kelly S, Rhoads GG. Vulvodynia: characteristics and associations with comorbidities and quality of life. Obstet Gynecol 2006;107:617–24.10.1097/01.AOG.0000199951.26822.2716507933 Danielsson I, Sjöberg I, Stenlund H, Wikman M. Prevalence and incidence of prolonged and severe dyspareunia in women: results from a population study. Scand J Public Health 2003;31:113–8.10.1080/1403494021013404012745761 Fisher W, Boroditsky R, Bridges M. The 1998 Canadian Contraception Study. Can J Hum Sex 1999;8:161–230. Harlow BL, Stewart EG. A population-based assessment of chronic unexplained vulvar pa have we underestimated the prevalence of vulvodynia? Am Med Women’s Assoc 2003;58:82–8. Berglund A, Nigaard L, Rylander E. Vulvar pain, sexual behavior and genital infections in a young population: a pilot study. Acta Obst Gyn Scand 2002;81:738–42.10.1034/j.1600-0412.2002.810809.x Mercer CH, Fenton KA, Johnson AM, Wellings K, Macdowall W, McManus S. Sexual function problems and help seeking behaviour in Britain: a national probability sample survey. Br Med J 2003;327:426–7.10.1136/bmj.327.7412.426 Lauman EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. J Am Med Assoc 1999;281:537–44.10.1001/jama.281.6.537 Moyal-Barracco M, Lynch PJ. 2003 ISSVD terminology and classification of vulvodynia: a historical perspective. J Reprod Med 2004;49:772–7.15568398 American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. – text revision Washington, DC: APA; 2000. Bushnell MC, Villemure C, Strigo I, Duncan GH. Imaging pain in the brain: the role of the cerebral cortex in pain perception and modulation. J Musculoskeletal Pain 2002;10:59–72.10.1300/J094v10n01_06 Giesecke J, Reed BD, Haefner HK, Giesecke T, Clauw DJ, Gracely RH. Quantitative sensory testing in vulvodynia patients and increased peripheral pressure pain sensitivity. Obstet Gynecol 2004;104:126–33.10.1097/01.AOG.0000129238.49397.4e15229011 Granot M, Yarnitsky D, Friedman M, Zimmer EZ. Enhancement of systemic pain perception in women with vulvar vestibulitis. Br J Obstet Gynecol 2002;109:863–6.10.1111/j.1471-0528.2002.01416.x Lowenstein L, Vardi Y, Deutch M, Friedman M, Gruenwald I. Vulvar vestibulitis severity-assessment by sensory and pain testing modalities. Pain 2004;107:47–53.1471538810.1016/j.pain.2003.09.012 Pukall CF, Binik YM, Khalife S, Amsel R, Abbott F. Vestibular tactile and pain thresholds in women with VVS. Pain 2002;96:163–75.1193207210.1016/S0304-3959(01)00442-0 Pukall CF, Payne KA, Binik YM, Khalife S. Pain measurement in vulvodynia. J Sex Marital Ther 2003;29:111–20.1273509510.1080/713847136 Pukall CF, Payne KA, Kao A, Khalife S, Binik YM. Dyspareunia. In: Balon R, Segraves RT, editors. Handbook of sexual dysfunctions. New York, USA: Taylor & Francis; 2005. p. 249–72. Weijmar Schultz W, Basson R, Binik Y, Eschenbach D, Wesselmann U, Van Lankveld J. Women’s sexual pain and its management. J Sex Med 2005;2:301–16.10.1111/j.1743-6109.2005.20347.x16422861 Leiblum S. Principles and practice of sex therapy. 4th ed. NY: The Guilford Press; 2007. Vlayen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 2000;85:317–32.10.1016/S0304-3959(99)00242-010781906 Nicholas MK, George SZ. Psychologically informed interventions for low back pain: an update for physical therapists. Phys Ther 2011;91:765–76.2145109010.2522/ptj.20100278 Vlayen JWS, Linton SJ. Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain 2012;153:1144–7.10.1016/j.pain.2011.12.00922321917 Basson R. The recurrent pain and sexual sequelae of provoked vestibulodynia: a perpetuating cycle. J Sex Med 2012;9:2077–92.10.1111/j.1743-6109.2012.02803.x22672388 Bergeron S, Rosen NO, Morin M. Genital pain in women: beyond interference with intercourse. Pain 2011;152:1223–5.10.1016/j.pain.2011.01.03521324589 Landry T, Bergeron S. Biopsychosocial factors associated with dyspareunia in a community sample of adolescent girls. Arch Sex Behav 2011;40:877–89.10.1007/s10508-010-9637-9 Reissing ED, Binik YM, Khalife S, Cohen D, Amsel R. Vaginal spasm, pain and behavior: an empirical investigation of the reliability of the diagnosis of vaginismus. Arch Sex Behav 2004;33:5–17.10.1023/B:ASEB.0000007458.32852.c8 Desrochers G, Bergeron S, Khalife S, Dupuis M, Jodoin M. Fear avoidance and self-efficacy in relation to pain and sexual impairment in women with provoked vestibulodynia. Clin J Pain 2009;25:520–7.10.1097/AJP.0b013e31819976e319542801 Pukall CF, Baron M, Amsel R, Khalifé S, Binik YM. Tender point examination in women with vulvar vestibulitis syndrome. Clin J Pain 2006;22:601–9.10.1097/01.ajp.0000210903.67849.af16926575 Payne KA, Binik YM, Amsel R, Khalife S. When sex hurts, anxiety and fear orient attention towards pain. Eur J Pain 2005;9:427–36.10.1016/j.ejpain.2004.10.00315979023 Thomtén J, Linton SJ. A psychological view of sexual pain among women: applying the fear-avoidance model. J Women Health 2013;9:1–13. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983;67:361–70.688082010.1111/j.1600-0447.1983.tb09716.x Bjelland I, Dahl AA, Tangen Haug T, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res 2002;52:69–77.1183225210.1016/S0022-3999(01)00296-3 Lisspers J, Nygren A, Söderman E. Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample. Acta Psychiatr Scand 1997;96:281–6.10.1111/j.1600-0447.1997.tb10164.x9350957 Kemper CJ, Lutz J, Bähr T, Rüddel H, Hock M. Construct validity of the Anxiety Sensitivity Index-3 in clinical samples. Assessment 2012;19:89–100.10.1177/107319111142938922156717 Reiss S, Peterson RA, Gursky DM, McNally RJ. Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behav Res Ther 1986;24:1–8.10.1016/0005-7967(86)90143-93947307 Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: development and validation. Psych Assess 1995;7:524–32.10.1037/1040-3590.7.4.524 Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 1993;52:157–68.845596310.1016/0304-3959(93)90127-B Lee K-C, Chiu TTW, Lam T-H. Psychometric properties of the Fear-Avoidance-Beliefs Questionnaire in patients with neck pain. Clin Rehab 2006;20:909–20.10.1177/026921550506072186 Van der Velde J, Everaerd W. The relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus. Behav Res Ther 2001;39:395–408.10.1016/S0005-7967(00)00007-311280339 Ridley CM. Vulvodynia: evolution of classification and management. J Eur Acad Dermatol Venereol 1996;7:129–34.10.1111/j.1468-3083.1996.tb00608.x Arnold LD, Bachman GA, Rosen R, Rhoads GG. Assessment of vulvodynia symptoms in a sample of US women: a prevalence survey with nested case control study. Am J Obstet Gynecol 2007;196:128e1–6e. Khandker M, Brady SS, Vitonis AF, MacLehouse RF, Stewart EG, Harlow BL. The influence of depression and anxiety on risk of adult onset vulvodynia. J Women Health 2011;20:1445–51.10.1089/jwh.2010.2661 Asmundson GJG, Katz J. Understanding the co-occurrence of anxiety disorders and chronic pain: state of the art. Depress Anxiety 2009;26:888–901.1969103110.1002/da.20600 Sharp TJ, Harvey AG. Chronic pain and posttraumatic stress disorder: mutual maintenance? Clin Psych Rev 2001;21:857–77.10.1016/S0272-7358(00)00071-4 Both S, Laan E, Spiering M, Nilsson T, Oormens S, Everaerd W. Appetitive and aversive classical conditioning of female sexual response. J Sex Med 2008;5:1386–401.1837352510.1111/j.1743-6109.2008.00815.x Dove NL, Wiederman MW. Cognitive distraction and women’s sexual functioning. J Sex Marital Ther 2000;26:67–78.10.1080/00926230027865010693117 van den Hout M, Barlow D. Attention, arousal and expectancies in anxiety and sexual disorders. J Affect Disord 2000;61:241–56.1116342510.1016/S0165-0327(00)00341-4 Payne KA, Binik YM, Pukall CF, Thaler L, Amsel R, Khalife S. Effects of arousal on genital and non-genital sensation: a comparison of women with vulvar vestibulitis syndrome and healthy controls. Arch Sex Behav 2007;36:289–300.10.1007/s10508-006-9089-417136588 Borg C, Peters ML, Schultz WW, de Jong PJ, Vaginismus:. heightened harm avoidance and pain catastrophizing cognitions. J Sex Med 2012;9:558–67.2202437810.1111/j.1743-6109.2011.02535.x Desrochers G, Bergeron S, Landry T, Jodoin M. Do psychosexual factors play a role in the etiology of provoked vestibulodynia? A critical review. J Marital Ther 2008;34:198–226.10.1080/00926230701866083 Masheb RM, Lozano-Blanco C, Kohorn EI, Minkin MJ, Kerns RD. Assessing sexual function and dyspareunia with the Female Sexual Function Index (FSFI) in women with dyspareunia. J Sex Marital Ther 2004;30:315–24.1567259910.1080/00926230490463264 Brauer M, Laan E, ter Kuile MM. Sexual arousal in women with superficial dyspareunia. Arch Sex Behav 2006;35:191–200.16752121 Spano L, Lamont JA, Dyspareunia: a symptom of female sexual dysfunction. Can Nurse 1957;71:22–5. Kao A, Binik YM, Amsel R, Funaro D, Leroux N, Khalife S. Biopsychosocial predictors of postmenopausal dyspareunia: the role of steroid hormones, vulvovaginal atrophy, cognitive-emotional factors, and dyadic adjustment. J Sex Med 2012;9:2066–76.2262179210.1111/j.1743-6109.2012.02771.x Brotto LA, Basson R, Gehring D. Psychological profiles among women with vulvar vestibulitis syndrome: a chart review. J Psychosom Obstet Gynecol 2003;24:195–203.10.3109/01674820309039673 Sackett S, Gates E, Heckman-Stone C, Mee-Ran Kobus A, Galask R. Psychosexual aspects of vulvar vestibulitis. J Repr Med 2001;46:593–8. Linton SJ, Bergbom S. Understanding the link between depression and pain. Scand J Pain 2011;2:47–54.10.1016/j.sjpain.2011.01.005 Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E, Wang T. Sexual problems among women and men aged 40–80y: prevalence and correlates identified in the global study of sexual attitudes and behaviors. Int J Impot Res 2005;17:39–57.10.1038/sj.ijir.390125015215881 Hayes D, Bennett C, Dennerstein L, Gurrin L, Fairly C. Modeling response rates in surveys of female sexual difficulty and dysfunction. J Sex Med 2007;4:286–95.10.1111/j.1743-6109.2007.00433.x17367424 Costa D, Soares JJF, Lindert J, Hatzidimitriadou E, Karlsson A, Sundin Ö, Toth O, Ioannidi-Kapolou E, Degomme O, Cervilla J, Barros H. Intimate partner violence in Europe: design and methods of a multinational study. Gaceta Sanitaria 2013;27:558–61.2364371710.1016/j.gaceta.2013.03.001
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Scandinavian Journal of Pain

Tập 5

193-199

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