(174) Let's Talk about it: Daily Associations between Shame and Pain and Sexual Distress in Couples Coping with Vulvodynia

Vulvodynia is a chronic vulvovaginal pain condition with a prevalence of 8% in population samples. It is associated with significant negative psychological and sexual consequences for affected women and their partners. Unfortunately, vulvodynia is often misdiagnosed or ignored by health professionals. Epidemiological studies indicate that only 60% of women with vulvovaginal pain seek medical help and among those, 40% never receive a diagnosis. The lack of support from the health care system may contribute to feelings of invalidation and stigmatization often experienced by women with vulvodynia. Qualitative studies have reported that many of them feel inadequate, are apprehensive to speak about their pain, and fear this condition spells the end of their romantic relationship. Thus, many women come to blame themselves and internalise feelings of shame, as well do the partners for being the potential cause of the pain. However, it remains unclear how daily feelings of shame may impact the pain and its associated distress for the couple. Using a dyadic daily experience method, 71 women diagnosed with vulvodynia and their partners reported on pain-related shame, pain intensity, and sexual distress over a period of eight weeks. Multilevel structural equation modeling was used to examine how daily deviations in shame from a participant's own mean were associated with pain and sexual distress. On days of sexual activity, when women reported feeling more pain-related shame (compared to their average), they reported greater pain and both women and partners reported greater levels of sexual distress. On days of sexual activity, when partners reported feeling more pain-related shame, they reported greater levels of sexual distress. Addressing feelings of shame in therapy and providing women with information about vulvodynia could facilitate communication within their relationships as well as with health care professionals, and break their narratives to remain silent about their pain.