To Örebro University

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.

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.