Coping with painful sex – A neglected female problem

Abstract

In this issue of the Scandinavian Journal of Pain, Flink and coworkrs [1] present a newly developed instrument for assessing sexual oping strategies in women with vulvar pain. The vulva refers to the xternal genitals located in the outside of the female genital area. ulvar pain is a highly prevalent, and possibly underestimated, roblem [2,3]. From previous studies, we know that recurrent and ersistent vulva pain can have detrimental consequences for a oman’s sex life, but strangely, little is known about how these omen actually cope with sexual activities. The study by Flink and oworkers, where such coping strategies are targeted, is thus both mportant and timely. Previous qualitative studies have indicated hat women use different coping strategies to deal with painful sex, nd this is further supported by Flink and coworkers. They find that here are essentially three different ways of coping with vulva pain hen it comes to sex: (1) by avoiding sex completely, (2) by endurng sex despite the pain, and (3) by engaging in alternative sexual ctivities that do not involve vaginal penetration. One of the main findings is particularly interesting and worth closer look. As hypothesized by the authors, the first two copng strategies seem to imply maladaptive ways of coping. Both ndurance and avoidance were associated with more pain and less exual functioning. The third strategy, however, seemed to be more omplex. Theoretically, one would think that engaging in alternaive sexual strategies would imply coping, since it allows the person o be sexually active while avoiding the associated pain, but the tudy findings revealed a more complex association. While being ositively associated with sexual functioning, it was not correlated ith psychological flexibility, anxiety or depression. In other words, ngaging in alternative sexual activities does not seem to make ou less anxious or depressed, at least not for the group overall. possible explanation is put forward by the authors: Perhaps the arge group of women who report that they engage in alternative exual activities, comprise contrasting subgroups–some who are ell functioning and satisfied and others who are not. Given the omplex nature of intimate relationships, this may not come as a urprise. A strategy of coping does not equal an experience of coping, hich may explain the lack of correlation with anxiety and depresion. Some might engage in alternative activities merely because