Introduction A significant proportion of women report a reduction of symptoms over time—even without treatment—yet the natural progression of vulvodynia and which factors may explain decrease vs persistence of pain remain unclear. Aim To identify subgroups of pain trajectories in women with vulvodynia and to predict these different trajectories by treatments undertaken, pain characteristics, and psychosocial factors. Methods Data on pain intensity, treatments undertaken, pain characteristics, and psychosocial factors were collected 3 times over a 7-year period from 173 women who screened positive for vulvodynia. Latent class growth analysis was conducted to identify homogeneous subgroups with distinct pain trajectories. A multivariate binomial logistic regression was used to examine whether treatments, pain characteristics, and psychosocial factors predicted these trajectories. Main Outcome Measure The main outcome was pain intensity (0–10), measured at 3 time points with the numerical rating scale. Results 2 pain trajectories were identified: 1 where pain persisted (28.9%), and 1 where pain decreased over time (71.1%). Whether a treatment had been undertaken was not predictive of the course of pain over time. Women who were older at first pain onset, had pain at another location than the entrance of the vagina, and reported more anxiety were more likely to have a persistent pain trajectory relative to the decreased pain trajectory. Clinical Implications Findings suggest that the evolution of pain differs among women with vulvodynia depending on pain characteristics and anxiety. Strengths & Limitations Strengths of the study include the 7-year longitudinal design to examine the natural history of provoked vestibulodynia and the inclusion of biopsychosocial factors as predictors of pain trajectories. However, women with major medical and psychiatric illnesses or deep dyspareunia were not included, and, thus, these factors could not be examined as predictors. Conclusion Assessing baseline characteristics associated with different pain trajectories during medical visits could have positive implications for the management of vulvodynia.

Recent studies show that sexual approach (SA) motives, i.e., having sex to achieve a positive state such as sexual pleasure, are associated with higher sexual and relationship satisfaction. However, mechanisms linking SA motives to these outcomes are poorly understood, and the important distinction between SA motives that are self-directed (e.g., selfgratification) and other-directed (e.g., pleasing one's partner) has received little empirical attention, particularly in the everyday context of couples' sexuality. The present study focused, at an event level, on the associations between self-directed and other-directed SA motives, and sexual satisfaction and perceived partner responsiveness (PPR, an aspect of relationship intimacy). We also examined the mediating role of the couple's sexual behavior in these associations. Data were collected over a month-long daily diary study involving 35 newlywed heterosexual couples and analyzed using the Actor Partner Interdependence Model. Results showed that men and women's self-directed SA motives were associated with their own higher sexual satisfaction, and in men, with their female partners' sexual satisfaction as well. For both men and women, these associations were mediated by sexual behavior: self-directed SA motives were associated with more genitally focused sexual behavior (e.g., vaginal intercourse, oral sex), in turn associated with higher sexual satisfaction. For men, other-directed SA motives were associated with their own greater PPR and with that of their female partners. For women, self-directed SA motives were associated with their own greater PPR and with that of their male partners. Sexual behavior did not mediate associations with PPR. Theoretically, these findings support dyadic models of sexual satisfaction and intimacy, and indicate that selfdirected SA motives may be more important to sexual satisfaction than other-directed motives.SEXUAL MOTIVATION, BEHAVIOR AND OUTCOMES 2 Clinically, they support sex therapy approaches that integrate both partners and suggest that sexual motives and behavior may be relevant targets for intervention.

Introduction Many sexual difficulties encountered by couples in their day-to-day lives, although of insufficient intensity and persistence to warrant a clinical diagnosis of sexual disorder, are nevertheless frequent and a source of individual and relational distress. Aim The aim of this study was to assess the event-level associations between couples’ everyday, subclinical sexual difficulties (specifically, low subjective sexual arousal, low physiological sexual arousal, and genito-pelvic pain), the range of sexual behaviors that these couples engage in, and their sexual satisfaction. Methods 70 Newlywed participants (35 couples, average age = 25.6 years, SD = 3.2 years; average duration of relationship = 5.4 years, SD = 3.4 years) individually completed daily diaries about sexual difficulties, range of activities performed during sex, and sexual satisfaction over the course of 5 weeks. Analyses were guided by the actor-partner interdependence model. Main Outcome Measure The main outcome was sexual satisfaction, measured at the event-level on a 5-point Likert scale using a single-item question. Results On days of sexual activity, men and women’s difficulties with subjective sexual arousal were associated with lower sexual satisfaction in both partners (actor and partner effects). This association was mediated by the range of couples’ sexual behaviors, such that lower subjective arousal was associated with a more restricted range of sexual activities, which in turn was associated with lower sexual satisfaction. Men’s and women’s difficulties with physiological sexual arousal, and women’s genito-pelvic pain, were each associated with their own lower sexual satisfaction. No partner effects were observed for these sexual difficulties, nor were they mediated by the range of couples’ sexual activities. Clinical Implications The study’s results highlight how couples’ sexual difficulties can interfere with same-day sexual satisfaction, and how for subjective sexual arousal, this interference is reflected by a more restricted range of sexual behaviors. Strength & Limitations Strengths of the study include the daily diary methodology, which allowed a focus on event-level sexual activities with minimal retrospective bias. Further, the dyadic analyses allowed both intra-individual and inter-individual effects to be assessed. Limitations include the lack of a more general measure of sexual desire and of a more diverse sample, in terms of age, race, and sexual orientation. Conclusion These findings underscore the importance of treatments that include both partners, and that target the types as well as range of sexual activities in which couples engage.

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