Provoked vestibulodynia (PVD), which used to be called vulvar vestibulitis, is a female genital pain condition of unknown cause that is usually felt as a burning sensation right at the opening of the vagina. It is called provoked, because for most women the pain only occurs during the insertion of a tampon or during intercourse. Needless to say, PVD triggers a number of negative sexual and psychological consequences for women and their partners.

Now a new study from researchers at the University of Montreal finds that partners who are comfortable expressing their emotions have better sexual, psychological, and relational well-being, despite the difficulties of PVD. Even more, women who are comfortable expressing their emotions feel less pain. “This result may be suggesting that women who are less satisfied with their emotional regulation perhaps engage in less effective coping strategies (that is... perceive their pain in more catastrophic ways) which, in turn, perhaps makes them experience pain as more intense," Nayla Awada, a doctoral candidate in psychology at the Université de Montréal, told Medical Daily in an email.

Self-Expression and Pain

Sadly, the total number of women with PVD is surprisingly high: It affects up to 15 percent of women of childbearing age. For her study, which appears in the Journal of Sexual Medicine, Awada and her team of researchers wanted to investigate the relationship between emotional expression and PVD. Psychologists believe some (if not all) health difficulties may be closely connected to emotional adjustment problems. Emotional regulation is the ability to respond in a healthy way to negative or uncomfortable emotions, such as anger or jealousy, without resorting to ugly behaviors, such as aggression or self-harm. One aspect of emotional regulation is ease: How comfortable do you feel with the way you express emotions?

"Ambivalence over emotional expression quantifies a disconnect between what a person wishes to do with his/her emotions and what he/she does in reality," Awada told Medical Daily. In some situations, people may believe they are incapable of doing so; in other situations, they may overly express their emotions and later regret the emotions they expressed. When an angry person doesn’t speak, for instance, to avoid hurting someone or being misunderstood, this is ambivalent communication. A person's ambivalence over emotional expression, then, is the level of "dissatisfation" he or she feels, and the Ambivalence Over Emotional Expressiveness (AEE) is a questionnaire designed to identify a person's level of frustration. "But of course, it is best conceptualized on a continuum in which we all have some degree of ambivalence in the way we express emotions, but some people are more regularly dissatisfied than others," Awada said. Plus, she explained in a prepared statement, "The more ambivalent you are, the less you are able to communicate your emotions satisfactorily, and the more you are likely to be uncomfortable with your partner."

Awada began her study by enlisting the help of 254 couples (in which the woman suffered from PVD). Among these couples, the woman had suffered from PVD for more than five years on average. Next, Awada and her team asked all the participants to complete an AEE questionnaire, which were examined and analyzed in order to create a typology for each couple — how did communication styles blend? Next, the research team examined whether each couple’s AEE was somehow related to the level of the women's pain as well as the couples' psychological and sexual functioning.

What did Awada discover? When at least one of the partners is ambivalent in expressing his or her emotions, the couple is more likely to experience psychological distress and dissatisfaction with their relationship. And, "ambivalence of both partners is related to greater emotional distress and more sexual and relational difficulties," Awada said. Finally, the women who expressed greater emotional ambivalence also felt greater vestibular pain compared to less ambivalent women.

To further enrich her understanding of PVD, Awada is currently completing a specialized internship in chronic pain. Awada believes good communication may simply mean discussing the sexual side of their relationship. By negotiating sexual activities that do not require penetration, a couple can still have a satisfying intimacy.

 

Source: Awada N, Bergeron S, Steben M, Hainault VA, McDuff P. To Say or not to Say: Dyadic Ambivalence over Emotional Expression and Its Associations with Pain, Sexuality, and Distress in Couples Coping with Provoked Vestibulodynia. Journal of Sexual Medicine. 2014.