| 1. |
- Ekdahl, Johanna, 1978-, et al.
(författare)
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Vulvovaginal pain from a fear-avoidance perspective : a prospective study among female university students in Sweden
- 2018
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Ingår i: International Journal of Sexual Health. - : Routledge. - 1931-7611 .- 1931-762X. ; 30:1, s. 49-59
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To examine how fear-avoidance influences vulvovaginal pain and sexual function over time.Method: At baseline and at 10-month follow-up, self-report measures for sexual- and fear avoidance factors were obtained from 483 female university students with and without self-reported vulvovaginal pain.Results: Individuals with pain at both times reported lower sexual function, and higher levels of fear-avoidance compared to the pain-free group. Fear-avoidance beliefs predicted the occurrence of vulvovaginal pain at follow up and the level of pain intensity.Conclusion: The results points to the relevance of the components of the fear-avoidance model in vulvovaginal pain over time.
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| 2. |
- Engman, Linnéa, 1987-, et al.
(författare)
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A longitudinal study of coping strategies in women with vulvovaginal pain
- 2016
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Ingår i: EABCT 2016. - : The European Association for Behaviour and Cognitive Therapies.
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Konferensbidrag (refereegranskat)abstract
- Introduction: Recurring vulvovaginal pain is common, affecting between 8-30 % of women in reproductive age. In addition to evident negative effects regarding sexual function and -satisfaction, vulvovaginal pain also has an impact on sufferers overall quality of life. Despite these extensive consequences little is known about how women with vulvovaginal pain actually cope with pain-triggering sexual activities. Knowledge about coping strategies in this area would give important clinical implications in both creating and targeting effective treatment interventions.Aims: The study aims to explore if the use of coping strategies in relation to pain-triggering sexual activities are stable over time, or if different strategies are used dependent of pain level or situation. A further aim is to explore the relationship between coping and a spectrum of psychosexual aspects over time.Method. The study consists of a student sample of women between 18-35 years old with recurring vulvovaginal pain who responded to a questionnaire at three separate time points (Base line: N=289; 6 months: N=153; 12 months: N= 126). Based on the CHAMP Sexual Pain Coping Scale (CSPCS), which measures avoidance- and endurance coping, cluster analysis was performed to group participants into distinct subgroups of individuals who reported similar coping strategies. The same procedure was performed at each assessment point to explore whether the individuals moved between the subgroups. Lastly the subgroups were compared in regards to several psychosexual factors.Discussion. The results will be discussed at the presentation when analyses are completed.
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| 3. |
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| 4. |
- Engman, Linnea, 1987-, et al.
(författare)
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An initial proof of concept : A replicated single-case study of a CBT group treatment with partner involvement for vulvodynia.
- 2022
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Ingår i: Cognitive Behaviour Therapy. - : Routledge. - 1650-6073 .- 1651-2316. ; 51:6, s. 503-519
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Tidskriftsartikel (refereegranskat)abstract
- Vulvodynia is common and has an immense impact on affected women and their partners. Psychological factors have been found to contribute to pain maintenance and exacerbation, and treatments addressing psychological factors have yielded positive results. This study employed a replicated single-case experimental design to examine a cognitive behavioral therapy (CBT) group treatment with partner involvement in vulvodynia. Repeated measures of pain intensity related to pain-inflicting behaviors were collected weekly throughout baseline and treatment phases. Associated outcomes were measured pre-, post- and at two follow-up assessments. Participants were 18-45-year-old women, in a stable sexual relationship with a man, experiencing vulvodynia. Five women completed the treatment consisting of 10 group sessions and 3 couple sessions. Data were analyzed through visual inspection and supplementary nonparametric calculations. The study showed promising results of the CBT treatment in alleviating pain intensity in connection to specific pain-inflicting behavior since three out of five participants showed improvements. For the participants who improved, sexual function, pain catastrophizing, avoidance, and endurance behavior changed during treatment and were maintained at follow-ups. These results warrant further study of the CBT treatment, in larger, and controlled formats.
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| 5. |
- Engman, Linnea, 1987-, et al.
(författare)
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Avoiding or enduring painful sex? : A longitudinal study of coping patterns and sexual function in women with vulvovaginal pain
- 2017
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Ingår i: SSTAR (Society for Sex Therapy and Research) 42nd annual meeting.
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Konferensbidrag (refereegranskat)abstract
- Introduction: Recurring pain in the vulvar- or vaginal region induced by touch or pressure is common, affecting between 10-28% of women in reproductive age (e.g., Harlow et al., 2014). In addition to evident negative effects on sexual aspects such as frequency of sexual activity, sexual satisfaction and sexual function (for a review see Bergeron et al., 2015), vulvovaginal pain has an impact on women’s overall quality of life (Arnold et al., 2006). Despite these extensive consequences little is known about how women with vulvovaginal pain actually cope with sexual activities and the subsequent pain, and how their coping may affect the pain experience and sexual function over time. While avoidance (of pain associated activities) seem to be a commonly used strategy (for a review see Thomtén and Linton, 2013) amongst women with vulvovaginal pain, there is also evidence of endurance (of sexual activity despite pain) as a prevalent strategy (Brauer et al., 2014; Elmerstig et al., 2013). Method: The study used questionnaire data from female university students between 18 and 35 years old, with two measurement points of five months apart. Women who reported experiencing recurring vulvovaginal pain during the last six months, and who responded at both measurement points constitute the sample of the study (N=117). First, multiple regression analysis was executed to test whether avoidance and endurance coping had a predictive value of sexual function beyond the pain experience in itself. Then, cluster analyses based on the respondent’s answers to the CHAMP Sexual Pain Coping Scale (CSPCS) were performed at both time points. Finally, common pathways over time was investigated to explore whether the same coping was used at baseline and follow-up. Results: The multiple regression model exploring if pain, avoidance and endurance at baseline predicted sexual function at follow-up was significant, explaining 25% of the variance (F(2, 90) = 10.22, p < .001). Avoidance at baseline was the only significant predictor in the model, explaining unique variance of sexual function over time. The cluster analyses at baseline and follow up resulted in four distinct clusters respectively; Low scores, Avoidance, Endurance and High scores. The common pathways analyses, exploring typical pathways of change, revealed high stability within the clusters over time meaning that it was common for individuals in all clusters to use the same patterns of coping at both measurement points. Discussion: The results of the study further manifests findings from earlier research while also making an important attribution in quantifying coping strategies in relation to vulvovaginal pain. The study reveals a strong association between vulvovaginal pain and how women cope with sexual activities, the stability of the use of coping over time, as well as the connection between coping and sexual function. Utility/Limitations/Risks: Further knowledge about the relationship between coping and vulvovaginal pain will provide important theoretical and clinical implications regarding the development of the pain as well as potential clinical interventions. Behavioral learning objectives:After attending this poster presentation, the participants will be able to:1. Recognize the importance of avoidance coping in relation to sexual function2. Discuss the use of avoidance and endurance coping as a combined pattern3. Identify the stability of the use of coping patterns over time References:Arnold, L. D., Bachmann, G. A., Kelly, S., Rosen, R., & Rhoads, G. G. (2006). Vulvodynia: characteristics and associations with co-morbidities and quality of life. Obstetrics and gynecology, 107(3), 617. Bergeron, S., Corsini-Munt, S., Aerts, L., Rancourt, K., & Rosen, N. O. (2015). Female sexual pain disorders: a review of the literature on etiology and treatment. Current Sexual Health Reports, 7(3), 159-169. Brauer, M., Lakeman, M., Lunsen, R., & Laan, E. (2014). Predictors of task‐persistent and fear‐avoiding behaviors in women with sexual pain disorders. The journal of sexual medicine, 11(12), 3051-3063. Elmerstig, E., Wijma, B., & Swahnberg, K. (2013). Prioritizing the partner’s enjoyment: a population-based study on young Swedish women with experience of pain during vaginal intercourse. Journal of Psychosomatic Obstetrics & Gynecology, 34(2), 82-89. Harlow, B. L., Kunitz, C. G., Nguyen, R. H., Rydell, S. A., Turner, R. M., & MacLehose, R. F. (2014). Prevalence of symptoms consistent with a diagnosis of vulvodynia: population-based estimates from 2 geographic regions. American journal of obstetrics and gynecology, 210(1), 40-e1. Thomtén, J., & Linton, S. J. (2013). A psychological view of sexual pain among women: applying the fear-avoidance model. Women’s Health, 9(3), 251-263.
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| 6. |
- Engman, Linnea, 1987-, et al.
(författare)
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Avoiding or enduring painful sex? : A prospective study of coping and psychosexual function in vulvovaginal pain
- 2018
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Ingår i: European Journal of Pain. - : John Wiley & Sons. - 1090-3801 .- 1532-2149. ; 22:8, s. 1388-1398
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Tidskriftsartikel (refereegranskat)abstract
- Background: Recurring vulvovaginal pain is common, with evident effects on affected women's lives. Little is known about how affected women cope with painful sexual activities and how coping relates to pain intensity and psychosexual functioning over time. This prospective study explored the impact of avoidance and endurance on sexual function over time. Additionally, patterns of coping were studied on an individual level to increase knowledge about coping and its relation to psychosexual functioning.Methods: One hundred and seventeen women, 18-35years old, with recurring vulvovaginal pain answered questionnaires at two measurement points, five months apart, assessing avoidance and endurance coping, pain intensity and psychosexual functioning. A multiple regression model explored the predictive value of avoidance and endurance on sexual function over time. Cluster analyses investigated patterns of coping and stability within the clusters. These subgroups were compared on psychosexual outcomes.Results: Avoidance at baseline was the only significant predictor of sexual function five months later. Distinct and stable subgroups with different patterns of coping were identified, where avoidance and endurance coping were used both separately and combined. Women who both avoided and endured had the most unfavourable outcomes in terms of psychosexual functioning.Conclusions: Avoidance of sexual activities was related to reduced sexual function over time, which calls for attention and clinical interventions targeting avoidance. Additionally, women who both avoid and endure sexual activities despite pain possibly need tailored interventions, as women with this coping pattern reported the lowest levels of psychosexual functioning.Significance: In this prospective study, avoidance of sexual activities predicted sexual function over time, when controlling for pain intensity. Subgroups of women using distinct patterns of coping were identified. Those who both avoided and endured had the lowest levels of psychosexual functioning.
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| 7. |
- Engman, Linnea, 1987-, et al.
(författare)
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CBT group treatment for vulvovaginal pain with partner involvement : a single case experimental design pilot
- 2018
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Konferensbidrag (refereegranskat)abstract
- Background: Recurring pain in the vulvovaginal regional induced by touch or pressure is thought to be the most frequent cause of superficial dyspareunia in premenopausal women. Its prevalence is 7-15% in community samples and has a serious impact on couples sexual function, sexual satisfaction, general psychological well-being and overall quality of life.The last decade of research suggests that psychological factors, such as fear of pain, catastrophizing, and avoidance behavior may contribute to the maintenance and exacerbation of dyspareunia. Conventional cognitive behavioral therapy (CBT) interventions aim at reducing pain, restoring sexual function and improving the romantic relationship by targeting the thoughts, emotions, behaviors and couple interactions associated with the experience of dyspareunia. Furthermore, given the interpersonal sexual context in which dyspareunia is most often triggered, relationship factors is an important area to address.Research Questions: The primary purpose is to evaluate whether a CBT group program with partner involvement improves pain during penetration in women with superficial dyspareunia. Secondary objectives are to evaluate women’s (and their partner’s) sexuality (sexual function & satisfaction), psychological adjustment (negative and positive penetration beliefs, pain coping behaviour) and relationship factors (relationship satisfaction). Methods: The current study consists of a CBT group treatment program of 10 group sessions and 3 individual couple sessions distributed over a period of 6 months. The study will employ a single case experimental design with multiple baselines (N=6) where each individual represents a case and is randomized to a specific length of baseline. The primary and secondary outcomes will be measured weekly through both baseline and treatment phase to enable investigation of changes in outcome between the two phases. Additionally, secondary outcomes for both women and their partners are measured pre- and post-treatment. Single case experimental designs are recommended as a first step to investigate individual responses to psychological interventions as well as testing interventions as a pilot before implementing treatments in extensive RCT studies (Morley, 2017).Results: Data collection is in progress and will be completed early June 2018. The results of the study will be presented at the conference.
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| 8. |
- Engman, Linnéa, 1987-
(författare)
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Copingstrategier vid vulvovaginal smärta
- 2016
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Konferensbidrag (refereegranskat)abstract
- Det pågående forskningsprojektet Sex och Smärta (SOS) vid Örebro universitet syftar till att undersöka psykologiska faktorer och mekanismer kring vulvovaginal smärta. Mer specifikt undersöker vi utvecklingen från akut till kronisk smärta och vidmakthållandet av smärtan, det vill säga faktorer som kan påverka om smärtan kvarstår eller ej. I förlängningen kan denna typ av kunskap öka förståelsen av problematiken, men även leda till viktiga kliniska implikationer och därmed främja utvecklingen av psykologisk behandling i den aktuella patientgruppen.Föreläsningen ”Copingstrategier vid vulvovaginal smärta” fokuserar på hanterandet av den sexuella situationen hos kvinnor som lider av vulvovaginal smärta. Detta då copingstrategier så som undvikande och uthärdande av smärtsamma aktiviteter visats vara viktiga vid både utvecklandet och vidmakthållandet av annan typ av kronisk smärta. Copingstrategierna undersöks i relation till viktiga psykologiska mekanismer gällande smärta, men även i relation till kvinnornas generella mående både tvärsnittligt och över tid. Avslutningsvis diskuteras generella slutsatser samt möjliga kliniska implikationer av de aktuella fynden.
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| 9. |
- Engman, Linnéa, 1987-
(författare)
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Vulvodynia : Understanding the Role of Pain-related Behavior
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Over the last decades, psychological mechanisms have been identified as key in the understanding of pain development and maintenance of vulvodynia. Furthermore, psychological treatments in the form of cognitive behavioral therapy (CBT) have proven helpful for those suffering. Still, prospective studies investigating psychological mechanisms over time are lacking, as are clinical studies investigating their role in treatment.The overall aim of this dissertation is to further the understanding of pain-related behavior and its role in the development and maintenance of vulvodynia by applying a fear-avoidance-endurance theoretical framework. It further aimed at consolidating the understanding of such a framework through a clinical proof of concept investigating the effect of a CBT treatment. Study I investigated the mediating role of avoidance and endurance behavior on the relationship between pain catastrophizing and pain. Study II prospectively investigated the predictive value of avoidance and endurance behavior on sexual function. Further, avoidance and endurance behavior were examined on an individual level to gain information on potential patterns of behavior. Study III investigated the effect of a CBT group treatment with partner involvement on pain and associated outcomes.Taken together, the overall findings of this dissertation further point at the importance of psychological mechanisms such as pain catastrophizing, avoidance behavior, and endurance behavior in the development and maintenance of vulvodynia. While further manifesting similarities between mechanisms involved in vulvodynia and those involved in other persistent pain conditions, the findings also verify the relevance of the Fear-avoidance model and the complementary Avoidance-endurance model for vulvodynia. Finally, a new model of understanding was proposed: the Fear-avoidance-endurance model of vulvodynia, summarizing pain-related behavior involved in the development and maintenance of vulvodynia.
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| 10. |
- Engman, Linnéa, 1987-, et al.
(författare)
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When sex hurts : Avoid, endure or try something different?
- 2016
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Ingår i: IASR 42nd annual meeting.
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Konferensbidrag (refereegranskat)abstract
- Rationale/Background: Recurring vulvovaginal pain is a common problem among women, affecting between 8-30 % of women in reproductive age. In addition to evident negative effects regarding sexual activities, -function and -satisfaction, vulvovaginal pain also has an impact on the individual’s daily life as well as overall quality of life. Despite these extensive consequences little is known about how women with vulvovaginal pain actually cope with sexual activities and the subsequent pain.Research Questions: The study aims to explore how women with vulvovaginal pain cope with sexual activities that has an impact on their pain, and whether certain ways to cope are more or less adaptive in regards to a spectrum of psychosexual aspects.Methods: The study is based on a student sample of women between 18 and 35 years old with recurring vulvovaginal pain (N=289). The CHAMP Sexual Pain Coping Scale (CSPCS) was created to measure coping behaviors among women with vulvovaginal pain. The scale was based on previous qualitative research where three apparent patterns of coping strategies has emerged; avoidance-, endurance- and alternative coping. Based on how the women responded to the avoidance- and endurance subscales of the CSPCS, cluster analysis resulted in four distinct groups of women with different profiles of coping. The coping subgroups were then compared in regards to several psychosexual factors.Results: The results showed that women suffering from vulvovaginal pain cope with sexual activities and the subsequent pain in different ways. Women who showed a pattern of high avoidance and endurance coping strategies reported significantly higher levels of pain, lower sexual function, less sexual satisfaction and lower quality of life. In contrast, women who reported low levels of avoidance and endurance coping strategies showed significantly lower levels of pain, higher sexual function, as well as a higher satisfaction with their sex life and life in general.Conclusions: The results of the study further manifests findings from earlier research while also making an important attribution in quantifying coping strategies in relation to vulvovaginal pain. Causal conclusions can not be drawn since the study is based on cross-sectional data. Hence, there is no knowledge to whether the coping strategy is a result of the individual’s current pain level or if the coping has an effect on the pain and associated psychosexual aspects. However, the study clearly reveals a strong association between vulvovaginal pain and how women cope with sexual activities. Future knowledge about this relationship will provide important theoretical and clinical implications regarding the development of the pain as well as potential clinical interventions.
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