Fear avoidance and self-efficacy in relation to pain and sexual impairment in women with provoked vestibulodynia.

BACKGROUND Provoked vestibulodynia is believed to be the most frequent cause of vulvodynia in women of childbearing age, with prevalence rates of up to 12% in the general population. Despite this high prevalence and the fact that vestibulodynia impacts negatively on quality of life, in particular sexual functioning, there has been a paucity of sound research to elucidate the condition's etiology. More specifically, few studies have focused on the role of psychologic factors in the experience of vulvo-vaginal pain and associated sexual impairment. OBJECTIVES The present study aimed to determine the extent to which fear avoidance variables (catastrophizing, anxiety, fear of pain, hypervigilance) and self-efficacy differentially influenced changes in levels of induced and intercourse pain and also associated sexual dysfunction in these women. METHODS Data were obtained from 75 vestibulodynia participants who completed a gynecologic examination, structured interview, and standardized questionnaires. RESULTS The results of regression analyses revealed that higher catastrophizing, fear of pain, and hypervigilance in addition to lower self-efficacy together accounted for 15% of the variation in increased intercourse pain intensity. Among these, only catastrophizing contributed unique variance to intercourse pain. Results also showed that higher state anxiety and fear of pain (escape/avoidance) and also lower self-efficacy explained 22% of the variation in women's sexual impairment. However, only self-efficacy was found to be an independent correlate of sexual impairment. CONCLUSION Findings support a theoretical model of vestibulodynia as a pain disorder influenced among others by cognitive and affective factors.