SEXUAL COMMUNICATION IN COUPLES COPING WITH PROVOKED VESTIBULODYNIA: ASSOCIATIONS WITH BIOPSYCHOSOCIAL OUTCOMES AND TRAJECTORIES OF CHANGE WITH INTERVENTION

Abstract

Provoked vestibulodynia (PVD) – a recurrent vulvovaginal pain condition – has physical, psychological, sexual, and relational consequences for affected women and their partners. The pain is often provoked during partnered sexual activity, emphasizing the need to integrate dyadic perspectives into PVD research. Sexual communication is a relevant interpersonal construct for these couples, and is associated with sexual well-being in community and clinical samples. However, couples’ coping with vulvovaginal pain experience difficulties with sexual communication, supporting the necessity of better understanding this interpersonal factor in PVD. This dissertation aimed to examine the associations between sexual communication and couples’ adjustment to PVD, and the trajectory of change in women’s and partners’ sexual communication over the course of cognitive-behavioural couple therapy (CBCT) for PVD. Three studies were conducted with couples where the affected woman was diagnosed with PVD. Study 1 was a cross-sectional investigation of the associations between women’s and partners’ (N = 107 couples) perceptions of their dyadic sexual communication (DSC) and women’s pain intensity during intercourse, and women’s and partners’ sexual satisfaction, sexual functioning, and depressive symptoms. Overall, greater DSC was associated with higher sexual satisfaction and function, and lower depressive symptoms for both women and partners, as well as women’s lower pain. Study 2 was a cross-sectional examination of the associations between women’s and partners’ (N = 87 couples) perceptions of their collaborative and negative sexual communication patterns (CSCP and NSCP) and women’s pain intensity, and women’s and partners’ sexual functioning, sexual satisfaction, sexual distress, and relationship satisfaction. Overall, CSCP were associated with more favourable sexual and relational outcomes, whereas NSCP were associated with poorer sexual and relational outcomes, for both women and partners. Study 3 compared the change trajectories of CSCP and NSCP for women and partners (N = 84 couples) randomized to CBCT (N = 41) or lidocaine intervention (N = 43). Improvements in CSCP were greater for couples receiving CBCT than lidocaine; findings were less clear for NSCP. Importantly, sexual communication is associated with multiple aspects of couples’ adjustment to this distressing pain condition, and demonstrates promise as a potential mediator or mechanism of change in CBCT for PVD.