Pain catastrophizing, fear of pain, and depression and their association with female sexual pain
2019
Background. Painful sexual intercourse or dyspareunia is a common
complaint among women, affecting 12% - 21% of premenopausal
women. Recent studies have started focusing on the role of fear
avoidance and pain catastrophizing (PC) in genital pain and have
consistently highlighted the importance of psych-affective factors in
sexual pain. Aim. To establish the importance of PC, fear of pain, and depression for
the development and maintenance of female sexual pain.
Methods. A longitudinal study conducted in the UK assessing sexual pain
at two different time points in 2009 and 2013 in a convenience sample of
N = 979 British women. Outcomes. Well validated questionnaires including the Pain
Catastrophizing Scale, the Pain Anxiety Symptom Scale, and the Female
Sexual Function Index (recent and lifelong version) were applied.
Results. Multilevel modeling showed a strong increase of short lived
sexual pain over the four years (π01 = -0.33, p ˂ .001). According to
the moderation analyses, only depression influenced the change in short
lived pain over the four years (π11 = 0.46, p = .016). Similarly, only
depression turned out to be independently associated with sexual pain
when entered into the multiple regression model, with women reporting
higher depression levels also reporting more sexual pain (p ˂ 0.05). Clinical Translation. Clinicians should be aware that the mechanisms
influencing short lived sexual pain and changes in sexual pain seem to
be different from the more enduring psychological factors that lead to
the development and maintenance of “chronic” sexual pain. Strengths & Limitations. A very generic and unidimensional definition of
sexual pain was used without information on pain frequency or intensity
and no information on the possible underlying (medical or psychological
or both) causes was available. However, this represents the first study to
use repeated measure to assess how pain changes over a 4-year period
and to explore the role of potential psychoaffective risk factors. Conclusion. Among the variables studied, symptoms of depression seem
to be the only independent predictor of lifelong sexual pain, over-riding
potential influences of pain catastrophizing or fear of pain.
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