Attachment, Sexual Assertiveness, and Sexual Outcomes in Women with Provoked Vestibulodynia and Their Partners: A Mediation Model

Abstract

Provoked vestibulodynia (PVD) is a prevalent women's sexual pain disorder, which is associated with sexual function difficulties. Attachment theory has been used to understand adult sexual outcomes, providing a useful framework for examining sexual

Beyond a “Woman’s Problem”: The Role of Relationship Processes in Female Genital Pain

“…Insecure attachment styles, characterized by high attachment anxiety (i.e., anxiety about rejection or the loss of a partner) and/or high avoidance (i.e., emotional distancing from one's partner), are associated with poorer sexual function, satisfaction, and differences in motivation for sex and the frequency of sexual activity in community samples of both men and women [76]. Given that genital pain is elicited in the context of a sexual and intimate relationship, researchers have proposed that attachment theory may further our understanding of the pain experience and sexual well-being of women suffering from genital pain [64,77].…”

“…Two recent studies in genital pain populations have examined the role of women's attachment styles in their pain and sexual adjustment [64,77]. Granot et al…”

“…These findings suggest that the pain associated with sexual activity may be related to women distancing themselves from their partner rather than seeking their partner's closeness for fear of losing them. In a sample of women with PVD and their partners, Leclerc et al [64] found that controlling for partners' level of attachment, women's higher attachment anxiety and attachment avoidance were associated with their lower sexual satisfaction, and that women's higher attachment avoidance was associated with their lower sexual function. Moreover, sexual assertiveness was found to fully mediate the relationship between attachment anxiety and sexual satisfaction in women, and between attachment avoidance and both sexual satisfaction and function in women.…”

“…In the context of genital pain, being more ambivalent about one's emotional expression may contribute to greater discomfort and difficulties when communicating about sexuality, making it more difficult for the couple to navigate adaptive coping strategies (e.g., expansion of sexual repertoire) [84]. In line with this notion, higher sexual assertiveness in partners has been associated with higher sexual function among women with genital pain, suggesting that being sexually assertive is important to help these couples navigate their shared sexuality [64]. Given that poor communication has been associated with impaired sexual In addition to the importance of the couple's emotional expression to the navigation of genital pain, cognitions or thoughts surrounding pain are also integral players.…”

The Effectiveness of Sexual Enrichment Counseling on Sexual Assertiveness in Married Women: A Randomized Controlled Trial

“…This kind of intimacy arouses sexual desires in couples, and it has an important role in sexual and marital satisfaction (4). One of the important factors in marital and sexual satisfaction in females towards their husbands is sexual assertiveness (5). Assertiveness is a mental and social sense to the personal perceptions or interpretation concerning how to show emotions in sexual relations (6) and includes the ability of individuals in commencing the required sexual activity, refusing unwanted sexual activity, and protecting one from unwanted pregnancies and sexually transmitted diseases (7).…”