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Hedman‐Lagerlöf, M., Andersson, E., Ljótsson, B., Engelbrektsson, J., Lundbäck, K., Björkander, D., . . . Axelsson, E. (2023). Effect moderators in internet‐based exposure therapy for fibromyalgia: The role of pain intensity. European Journal of Pain, 27(4), 507-517
Open this publication in new window or tab >>Effect moderators in internet‐based exposure therapy for fibromyalgia: The role of pain intensity
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2023 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 27, no 4, p. 507-517Article in journal (Refereed) Published
Abstract [en]

Background: A recent randomized controlled trial (N=140) was indicative of large and sustained average improvements of internet-based exposure for fibromyalgia, as compared to a waitlist. However, little is known about who benefits the most from this treatment.

Objectives: To test for potential moderating effects of age, educational attainment, the duration of fibromyalgia, baseline overall fibromyalgia severity, pain intensity, fibromyalgia-related avoidance behavior, and symptom preoccupation on the waitlist-controlled effect of 10-weeks of internet-based exposure for fibromyalgia.

Methods: Secondary analysis of a randomized controlled trial (ClinicalTrials.gov NCT02638636). We used linear mixed effects models to determine whether the waitlist-controlled effect of exposure therapy on overall fibromyalgia severity (Fibromyalgia Impact Questionnaire) differed as a function of the potential moderators.

Results: Only pain intensity (0-10) was found to be a significant moderator, where a higher baseline pain intensity predicted a more limited waitlist-controlled effect of internet-based exposure (B=3.48, 95% CI: 0.84 – 6.13). Standardized point estimates of effects were small for the sociodemographic variables, and in the moderate range for some clinical variables that did not reach statistical significance such as behavioral avoidance and time with the fibromyalgia diagnosis.

Conclusions: Results suggest that internet-based exposure treatment was more useful for participants with lower baseline levels of pain, and less so for participants with higher baseline levels of pain. The treatment had relatively similar effects across the other tested moderators.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
National Category
Public Health, Global Health, Social Medicine and Epidemiology Psychology
Identifiers
urn:nbn:se:oru:diva-102942 (URN)10.1002/ejp.2074 (DOI)000909899300001 ()36585933 (PubMedID)2-s2.0-85146227681 (Scopus ID)
Funder
Fredrik och Ingrid Thurings StiftelseRegion StockholmKarolinska Institute
Note

Funding agency:

Söderström‐Königska Foundation

Available from: 2023-01-04 Created: 2023-01-04 Last updated: 2023-06-15Bibliographically approved
Flink, I. K., Engström, J., Vastamäki, S., Vixner, L. & Engman, L. (2023). Expecting the uncertain: The applicability of the intolerance of uncertainty model on fear of childbirth. Journal of Psychosomatic Obstetrics and Gynaecology, 44(1), Article ID 2243648.
Open this publication in new window or tab >>Expecting the uncertain: The applicability of the intolerance of uncertainty model on fear of childbirth
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2023 (English)In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 44, no 1, article id 2243648Article in journal (Refereed) Published
Abstract [en]

A considerable number of pregnant women experience fear of childbirth (FOC), characterized by worries and fear of the unpredictable. Despite this, the psychological processes in FOC have received notably little attention. The aim of this study was to advance the understanding by exploring the applicability of the Intolerance of Uncertainty (IU) model on FOC. Anonymous data was collected in a sample of pregnant women (N = 357) with varying levels of FOC. Analyses supported the associations between FOC and all proposed psychological processes: IU, negative problem orientation, positive beliefs about worry and avoidance of inner experiences. The exploration of potential mediators of the relation between IU and FOC revealed that, of the three processes from the model, only positive beliefs about worry were a mediator, and more specifically, a partial mediator between IU and FOC. These findings add to the theoretical understanding of FOC, by indicating that the role of IU may be similar to other conditions inflicted by worry and anxiety, which may inform treatment development.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Fear of childbirth, childbirth, fear, intolerance of uncertainty, pregnancy
National Category
Applied Psychology
Identifiers
urn:nbn:se:oru:diva-107818 (URN)10.1080/0167482X.2023.2243648 (DOI)001049679100001 ()37593941 (PubMedID)2-s2.0-85168266757 (Scopus ID)
Available from: 2023-08-24 Created: 2023-08-24 Last updated: 2023-09-06Bibliographically approved
Grundström, H., Engman, L., Rimhagen, E., Söderstierna, C. & Flink, I. (2023). Experiences of communication in women with endometriosis: perceived validation and invalidation in different contexts, and associations with health-related quality of life. Journal of Psychosomatic Obstetrics and Gynaecology, 44(1), Article ID 2264483.
Open this publication in new window or tab >>Experiences of communication in women with endometriosis: perceived validation and invalidation in different contexts, and associations with health-related quality of life
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2023 (English)In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 44, no 1, article id 2264483Article in journal (Refereed) Published
Abstract [en]

Endometriosis, a chronic gynecological disease affecting approximately 10% of women of reproductive age, has a significant impact on physical and mental health. This cross-sectional study aimed to explore experiences of validating and invalidating communication in three contexts (with healthcare providers, employers, and family/friends), and whether this may predict health-related quality of life (HRQoL) in women with endometriosis. Data was collected through a digital survey distributed to women with self-reported endometriosis in Sweden. The survey included measures of validating and invalidating communication, depressive symptoms, anxiety, and HRQoL. A total of 427 women participated. The results indicated that women experienced varying levels of validating and invalidating communication in different contexts, with close family/friends providing the highest level of validation, and healthcare providers the lowest. Furthermore, a combined construct of high levels of validation and low levels of invalidation from healthcare providers and from close family and friends were significant predictors of HRQoL. These findings highlight the importance of supportive communication and understanding from healthcare providers and close social networks in promoting the well-being of women with endometriosis. Future research should further explore the impact of validating communication within healthcare settings and develop interventions to improve communication and support for women with endometriosis.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Endometriosis, anxiety, communication, depression, invalidation, quality of life, validation
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-108821 (URN)10.1080/0167482X.2023.2264483 (DOI)001074086200001 ()37787069 (PubMedID)2-s2.0-85172992846 (Scopus ID)
Available from: 2023-10-10 Created: 2023-10-10 Last updated: 2023-10-13Bibliographically approved
Abreu-Mendes, P., Baranowski, A. P., Berghmans, B., Borovicka, J., Cottrell, A. M., Dinis-Oliveira, P., . . . Engeler, D. S. (2023). Myofascial Pelvic Pain: Best Orientation and Clinical Practice. Position of the European Association of Urology Guidelines Panel on Chronic Pelvic Pain. European Urology Focus, 9(1), 172-177
Open this publication in new window or tab >>Myofascial Pelvic Pain: Best Orientation and Clinical Practice. Position of the European Association of Urology Guidelines Panel on Chronic Pelvic Pain
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2023 (English)In: European Urology Focus, E-ISSN 2405-4569, Vol. 9, no 1, p. 172-177Article in journal (Refereed) Published
Abstract [en]

CONTEXT: Despite the high prevalence of a myofascial pain component in chronic pelvic pain (CPP) syndromes, awareness and management of this component are lacking among health care providers.

OBJECTIVE: To summarize the current state of the art for the management of myofascial pain in chronic primary pelvic pain syndromes (CPPPS) according to scientific research and input from experts from the European Association of Urology (EAU) guidelines panel on CPP.

EVIDENCE ACQUISITION: A narrative review was undertaken using three sources: (1) information in the EAU guidelines on CPP; (2) information retrieved from the literature on research published in the past 3 yr on myofascial pelvic pain; and (3) expert opinion from panel members.

EVIDENCE SYNTHESIS: Studies confirm a high prevalence of a myofascial pain component in CPPPS. Examination of the pelvic floor muscles should follow published recommendations to standardize findings and disseminate the procedure. Treatment of pelvic floor muscle dysfunction and pain in the context of CPP was found to contribute to CPP control and is feasible via different physiotherapy techniques. A multidisciplinary approach is the most effective.

CONCLUSIONS: Despite its high prevalence, the myofascial component of CPP has been underevaluated and undertreated to date. Myofascial pain must be assessed in all patients with CPPPS. Treatment of the myofascial pain component is relevant for global treatment success. Further studies are imperative to reinforce and better define the role of each physiotherapy technique in CPPPS.

PATIENT SUMMARY: Pain and inflammation of the body's muscle and soft tissues (myofascial pain) frequently occurs in pelvic pain syndromes. Its presence must be evaluated to optimize management for each patient. If diagnosed, myofascial pain should be treated.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Myofascial pain, Pelvic pain, Physical therapy, Therapy
National Category
Physiotherapy
Identifiers
urn:nbn:se:oru:diva-100618 (URN)10.1016/j.euf.2022.07.007 (DOI)000991306500001 ()35945131 (PubMedID)2-s2.0-85135531775 (Scopus ID)
Available from: 2022-08-15 Created: 2022-08-15 Last updated: 2023-06-13Bibliographically approved
Owiredua, C., Flink, I. & Boersma, K. (2023). Prevalence and risk factors for pain-specific school absenteeism in adolescents with recurrent pain: A prospective population-based design. European Journal of Pain, 27(3), 390-400
Open this publication in new window or tab >>Prevalence and risk factors for pain-specific school absenteeism in adolescents with recurrent pain: A prospective population-based design
2023 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 27, no 3, p. 390-400Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Adolescents with recurrent pain miss out from school more often than pain-free peers. Research has so far used cross-sectional designs, focusing on non-specific absenteeism in clinical samples. Hence, it is unknown whether estimates of absenteeism are specifically linked to the pain itself or reflects the characteristics of clinical samples. This study aimed to prospectively explore pain-related school absenteeism in a non-clinical sample, its variance and potential risk factors.

METHODS: This prospective study followed a cohort of 1300 Sweden-based adolescents (mean age =16.9; 17.2% immigrants; 62.7% girls) with recurrent pain (headache, abdominal and/or musculoskeletal pain) through self-reports at two assessment points 12 months apart. RESULTS: Overall, 64.2% reported any absenteeism at follow-up and about half of these (26.2%) reported frequent absenteeism. Adolescents who indicated missing school were more often girls, slightly older, and had a higher overall pain burden and stressor levels. Yet, after adjusting for previous absenteeism, independent predictors were age, pain intensity, medication use, and stress associated with school attendance. Further to this, immigrant status predicted frequent absenteeism.

CONCLUSIONS: Many adolescents with pain frequently miss out from school due to pain. Identified risk factors points at pain characteristics and coping, stressors associated with participation and advancing age. Taken together, the burden of pain and its correlates emerge earlier and escalate with increasing age hence, early interventions targeting broader domains are needed.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-102656 (URN)10.1002/ejp.2065 (DOI)000898707600001 ()36478020 (PubMedID)2-s2.0-85144193898 (Scopus ID)
Available from: 2022-12-12 Created: 2022-12-12 Last updated: 2023-04-28Bibliographically approved
Zetterberg, H., Owiredua, C., Åsenlöf, P., Lennartsson, R., Brodda Jansen, G., Boersma, K., . . . Flink, I. (2023). Preventing Pain and Stress-Related Ill-Health in Employees: A 6-Months Follow-Up of a Psychosocial Program in a Cluster Randomized Controlled Trial. Journal of occupational rehabilitation, 33(2), 316-328
Open this publication in new window or tab >>Preventing Pain and Stress-Related Ill-Health in Employees: A 6-Months Follow-Up of a Psychosocial Program in a Cluster Randomized Controlled Trial
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2023 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 33, no 2, p. 316-328Article in journal (Refereed) Published
Abstract [en]

Purpose: Pain and stress-related ill-health are major causes of long-term disability and sick leave. This study evaluated the effects of a brief psychosocial program, which previously has been tested for an at-risk population of employees.

Methods: The Effective Communication within the Organization (ECO) program, where supervisors and employees were trained in communication and problem solving, was compared to an active control consisting of psychoeducative lectures (PE) about pain and stress in a cluster randomized controlled trial. First-line supervisors were randomized to ECO or PE, and a total of 191 mainly female employees with self-reported pain and/or stress-related ill-health were included. The hybrid format programs consisted of 2-3 group sessions. Sick leave data was collected from social insurance registers, before and 6-months after the program. Secondary outcomes (work ability, work limitations, pain-disability risk, exhaustion symptoms, perceived stress, perceived health, quality of life, perceived communication and support from supervisors) were assessed at baseline, post intervention, and at 6-months follow-up.

Results: No effects were observed on primary or secondary outcome variables. Pain symptoms were common (89%), however a lower proportion (30%) were identified as at risk for long-term pain disability, which might explain the lack of evident effects. The Covid-19 pandemic affected participation rates and delivery of intervention.

Conclusion: In this study, preventive effects of the ECO program were not supported. Altogether, the findings point at the importance of selecting participants for prevention based on screening of psychosocial risk. Further research on workplace communication and support, and impact on employee health is warranted.

Place, publisher, year, edition, pages
Springer, 2023
Keywords
Chronic pain, Communication, Prevention, Problem solving, Randomized controlled trial, Stress symptoms
National Category
Applied Psychology
Identifiers
urn:nbn:se:oru:diva-101995 (URN)10.1007/s10926-022-10074-3 (DOI)000875807400001 ()36308628 (PubMedID)2-s2.0-85140993966 (Scopus ID)
Funder
Uppsala UniversityForte, Swedish Research Council for Health, Working Life and Welfare, 2018-01273
Available from: 2022-10-31 Created: 2022-10-31 Last updated: 2023-06-16Bibliographically approved
Zetterberg, H., Wagner, S., Ekselius, L., Karlsten, R., Flink, I. & Åsenlöf, P. (2023). Psychometric Assessment of the Swedish version of the Work Ability Index in Patients with Chronic Pain in Specialized Care. Journal of Rehabilitation Medicine, 55, Article ID jrm7146.
Open this publication in new window or tab >>Psychometric Assessment of the Swedish version of the Work Ability Index in Patients with Chronic Pain in Specialized Care
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2023 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 55, article id jrm7146Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate the construct validity and internal consistency of the Work Ability Index (WAI) in patients with chronic pain in secondary and tertiary care.

METHODS: Cross-sectional study based on 200 patients with chronic pain (> 3 months), with a final sample of 118 participants, 18-64-years-old. Construct validity was assessed by exploratory factor analysis for the structural validity of the WAI, and by correlating the WAI with EuroQol EQ-5D, Brief Pain Inventory pain severity and interference, Patient Health Questionnaire and Generalized Anxiety Disorder scales. The study also assessed the discriminant validity of the WAI for occupational status, and the validity of the single-item work ability score. Reliability was assessed by internal consistency.

RESULTS: A single-factor model of WAI was supported. Internal consistency was good. Moderate correlations were found, except for Brief Pain Inventory pain severity, where the correlation was weak; hence, both convergent and divergent validity of the WAI were supported. The work ability score correlated strongly with the total WAI, and the discriminant validity for both was good.

CONCLUSION: In patients with chronic pain in specialized care, the WAI and the work ability score displayed acceptable construct validity and internal consistency, supporting their use in a clinical context and research.

Place, publisher, year, edition, pages
Foundation for Rehabilitation Information, 2023
National Category
Physiotherapy
Identifiers
urn:nbn:se:oru:diva-108593 (URN)10.2340/jrm.v55.7146 (DOI)37753551 (PubMedID)2-s2.0-85180886521 (Scopus ID)
Available from: 2023-09-28 Created: 2023-09-28 Last updated: 2024-02-05Bibliographically approved
Ekholm, E., Blaker, H., Gottlander, L., Zhao, X., Linton, S. J., Dewitte, M. & Flink, I. K. (2023). Sexual communication patterns in couples with vulvodynia: a case-control behavioral observation study. Journal of Sexual Medicine, 20(8), 1103-1114
Open this publication in new window or tab >>Sexual communication patterns in couples with vulvodynia: a case-control behavioral observation study
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2023 (English)In: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 20, no 8, p. 1103-1114Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Sexual communication is a common target in psychological treatments for vulvodynia, and associations with sexual function and distress, as well as pain intensity, have been demonstrated. However, structured observations of the communication patterns of couples with vulvodynia are lacking, as these are needed to guide treatment efforts.

AIM: To explore (1) the sexual communication patterns in couples with vulvodynia in terms of observed communication quality (operationalized as validating and invalidating responses), self-reported sexual assertiveness, and self-disclosure and (2) associations between sexual communication quality and pain intensity.

METHODS: In a case-control design with within- and between-group comparisons, 62 couples engaged in videotaped discussions about their sexual relationship. Trained coders assessed the discussions by rating sexual communication (validation and invalidation) according to a structured behavioral coding scheme. Group differences in sexual communication quality were examined with parametric and nonparametric tests. Dyadic associations among observed communication quality, self-rated sexual assertiveness, and self-disclosure were examined within the actor-partner interdependence model. Multiple regression was used to test the predictive value of partners' validation/invalidation on the pain intensity of the women with vulvodynia.

OUTCOMES: Observed communication quality (ie, validation and invalidation), self-reported sexual assertiveness, self-disclosure, and pain intensity.

RESULTS: Partners of women with vulvodynia were more invalidating toward their partners than those of women without pain. There were no significant differences in validating/invalidating communication between women in the 2 groups or in validation between partners. Partners' validating communication were significantly associated with women's lower pain intensity. The sexual communication patterns differed between couples with and without vulvodynia, and the associations between validating/invalidating responses and sexual assertiveness were stronger in the vulvodynia group than in the group without pain. Results on validation/invalidation and self-disclosure were inconclusive.

CLINICAL IMPLICATIONS: The results indicate a need to direct treatment interventions toward couples' sexual communication quality (ie, levels of validation and invalidation).

STRENGTHS AND LIMITATIONS: Strengths include systematic behavioral coding and dyadic analyses. Limitations include the cross-sectional design and self-selection of participants.

CONCLUSION: This study demonstrated sexual communication patterns specific to couples with vulvodynia, and we conclude that validation and invalidation are important components of the sexual communication of couples with vulvodynia as they relate to sexual assertiveness, women's self-disclosure, and pain intensity.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
APIM, couples, emotion regulation, empathy, genital pain, responsiveness, sexual assertiveness, sexual communication, vulvodynia
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-106573 (URN)10.1093/jsxmed/qdad085 (DOI)001029451900001 ()37350134 (PubMedID)2-s2.0-85166383868 (Scopus ID)
Available from: 2023-06-26 Created: 2023-06-26 Last updated: 2024-01-30Bibliographically approved
Bartels, S. L., Taygar, A. S., Johnsson, S. I., Petersson, S., Flink, I., Boersma, K., . . . Wicksell, R. K. (2023). Using Personas in the development of eHealth interventions for chronic pain: A scoping review and narrative synthesis. Internet Interventions, 32, Article ID 100619.
Open this publication in new window or tab >>Using Personas in the development of eHealth interventions for chronic pain: A scoping review and narrative synthesis
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2023 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 32, article id 100619Article, review/survey (Refereed) Published
Abstract [en]

OBJECTIVES: Behavioral eHealth interventions can enhance self-management and improve well-being in people with chronic pain. The development of these interventions calls for a user-centered approach to ensure that patient needs are appreciated. However, it may be challenging to involve patients; particularly during the early stages of the process. Fictional user profiles, known as Personas, can represent needs and guide designing eHealth interventions. This article provides a comprehensive overview of the use of Personas in the development of behavioral eHealth interventions for people with chronic pain with the aim to identify benefits and challenges.

METHODS: Bibliographic databases (Medline, Web of Science Core Collection, PsycInfo, CINAHL) and registries (PubMed Central, medaRxiv) were systematically searched. In a double-reviewing process, n = 6830 hits and n = 351 full-texts were screened and read. Ten peer-reviewed studies published between 2017 and 2022 were included in the narrative synthesis.

FINDINGS: Ten studies reported using "Pain Personas" in the development of eHealth interventions for such purposes as to gain a shared understanding of the user and to discuss solutions in team meetings, or for patients to identify with (if Personas are included in the intervention). Personas were based on qualitative and/or quantitative data. However, the procedure for creating Personas was only described in half of the included studies (n = 5). These five studies provided descriptive details of the Personas (i.e., picture, name, narrative of their pain behavior, technological skills, and motivation).

CONCLUSIONS: Although Personas have been used by pain researchers in recent projects and were highlighted as an important ingredient in the development process, available design guidelines for the creation and use of Personas are not followed or communicated transparently. Benefits and challenges when using Personas in the development of eHealth interventions for people with chronic pain are discussed to support future eHealth efforts and to improve the quality of eHealth innovation in the field of pain.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Chronic pain, Development, Internet, Intervention, Personas, User research
National Category
Nursing Applied Psychology
Identifiers
urn:nbn:se:oru:diva-106571 (URN)10.1016/j.invent.2023.100619 (DOI)001006192200001 ()37273935 (PubMedID)2-s2.0-85152248690 (Scopus ID)
Funder
AFA Insurance, 190 252
Available from: 2023-06-26 Created: 2023-06-26 Last updated: 2023-06-26Bibliographically approved
Ekholm, E., Lundberg, T., Carlsson, J., Norberg, J., Linton, S. J. & Flink, I. K. (2022). "A lot to fall back on": experiences of dyspareunia among queer women. Psychology & Sexuality, 13(5), 1242-1255
Open this publication in new window or tab >>"A lot to fall back on": experiences of dyspareunia among queer women
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2022 (English)In: Psychology & Sexuality, ISSN 1941-9899, E-ISSN 1941-9902, Vol. 13, no 5, p. 1242-1255Article in journal (Refereed) Published
Abstract [en]

This study explores the subjective experiences of dyspareunia among queer women in Sweden. Ten semi-structured, in-depth interviews were conducted with five participants who were all interviewed on two separate occasions. Interviews were analysed using thematic analysis. Dyspareunia was described as affecting the participants' sexual activities, intimate relationships, and identity constructs. Reported struggles involved feelings of sadness, guilt, frustration, and fear of pain. Dyspareunia was described as threatening the participants' queer identities through its effect on their ability to be sexual in idealised ways. However, queer experiences and communities were also found to be associated with advantages in pain management, such as well-developed sexual communication skills, anatomic similarity to their partner, access to non-heteronormative sexual scripts and a focus on nurturing desire. Queer related advantages in pain management are proposed to buffer to some extent against pain interference with sexual function and desire. Findings indicate that it is important to consider the unique relational and social context of queer women to understand their experiences of dyspareunia. More research is needed on the role of differences of normativities, context and communication in dyspareunia.

Place, publisher, year, edition, pages
Routledge, 2022
Keywords
Dyspareunia, vulvodynia, female genital pain, sexual communication, queer, lesbian
National Category
Psychology
Identifiers
urn:nbn:se:oru:diva-95715 (URN)10.1080/19419899.2021.2007988 (DOI)000721745500001 ()2-s2.0-85119829599 (Scopus ID)
Available from: 2021-12-03 Created: 2021-12-03 Last updated: 2024-01-30Bibliographically approved
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