Genital pain in a daily relationship context: The role of attachment orientation.

Genital pain during sexual activities is common among women. Although much
research has been done on genital pain as an individual diagnosis, only few
studies have focused on the impact of genital pain on the partner and vice
versa. As a result, the underlying processes of genital pain in a relationship
context are largely unknown. Furthermore, it is unclear how genital pain
unfolds in the daily context of the relationship. To understand the
interpersonal dynamics of genital pain, it is relevant to rely on broader
relationship theories. Attachment theory (Bowlby, 1969) offers a coherent and
well-validated heuristic framework to gain insight into the development,
manifestation and impact of genital pain within a relationship. Until now,
little research has focused on the role of attachment orientations of both the
woman and her partner in the context of genital pain. A core idea of attachment
theory is that early attachment experiences are stored in cognitive schemas
that reflect one*s perception of the self as being worthy of love and others as
being available and trustworthy. In the context of an attachment relationship,
both the self-concept and the belief that the partner will be available and
responsive when needed (i.e., perceived partner responsiveness) are thus key
components to understand how sexuality unfolds between partners, thereby
gaining more insight into the development, manifestation and impact of genital
pain within a relationship. Considering the self-concept and (perceived)
partner responses as important targets of treatment, the results of this study
may contribute to the improvement of current treatment of genital pain, such as
integrating elements of EFT.

We will study the associations between pain-related (pain intensity,
pain-related fear, behavioral coping with pain), sexual (sexual function,
sexual activity, sexual satisfaction), and relational variables (relationship
satisfaction) as measured in a daily context and examine the moderating role of
both partners* attachment orientation. In addition, we will study the
associations between these outcome variables and the daily self-concept (actual
self-concept, ideal self-concept, discrepancy between actual and ideal
self-concept), and (perceived) partner responses (both from the perspective of
the woman and the partner). Again, we will explore whether and how these
associations are moderated by attachment orientation.

This is a prospective diary study that will be implemented in Maastricht
University Medical Centre. The study will start with a baseline assessment.
Next, we will investigate within-couple associations using a daily diary during
three weeks. This study is dyadic in nature, because both women with genital
pain as well their partners will participate in the study. Participants
complete the daily diary at home, via an online application (Mema). The
questionnaires will be applied via Qualtrics.

Participants have to complete a baseline assessment (questionnaires) once (at
the start of the study) and a daily diary twice a day over the course of three
weeks. The baseline assessment, takes less than 30 minutes. The daily diaries
need to be completed in the morning and in the evening during 3 weeks. It takes
5-8 minutes to respond to the questions in the evening and 3-5 minutes for the
morning questions. Based on previous research (by the research supervisor)
using a similar design, we expect no risks or side effects for the
participants. The only possible inconvenience could be discomfort when
completing the questions about sexuality. However, given that the participants
are couples facing sexual problems of which the majority will be seeking help,
we expect that the topic of sexuality will be more familiar to them. The
questionnaires/daily diary questions will collect information about
relationship variables, self-concept, pain, sexual functioning and partner
responsiveness in daily life. Although reporting on sexuality is a sensitive
topic, previous research on this topic (also within a sample of women with
genital pain) has indicated that participants do not consider this as offensive
or violating their privacy. Furthermore, the participation is strictly
voluntary. The current study will focus on couples in which the woman reports
genital pain in order to gain more insight in genital pain in a relationship
context. The results may contribute to the improvement of current treatments of
genital pain, such as integrating elements of EFT.