Background

Vulvodynia is a chronic vulvar pain disorder of unknown cause, and can be persistent or provoked (with penetration, tampons, pelvic exams, etc.), beginning at any age. Typically, vulvodynia is diagnosed when symptoms occur in the absence of known infections, dermatological conditions, and neurological disorders.

Existing research into vulvodynia indicates that it may involve a combination of neurological, inflammatory, hormonal, musculoskeletal, and psychological mechanisms.

• Nervous system dysfunction may contribute toward pain hypersensitivity, which may exacerbate normally non-painful stimuli.
• Pelvic floor muscle dysfunction and hormone imbalances may contribute to pain interference.

Many women may have trouble getting an accurate diagnosis due to:

• Lack of provider knowledge,
• Misdiagnosis of similar conditions, and
• Stigmatization from social norms.

Sexual distress may be a consequence of vulvodynia that many are unaware of. Because of pain in the vulva, women may avoid sex altogether, resulting in harmful impacts to sexual quality of life and personal relationships.

Study Objectives

• To present the first study looking into the effect of sociocultural factors on women’s experiences with vulvodynia.
  • Sociocultural influences shape both perceptions of one’s own physical appearance and expectations about how their body should function.
• Use the tripartite influence model (TIM) to understand how influences like family, peers, and media contribute toward sexual distress through self-body image.
• Determine which influences play the largest role in negative feelings toward the self.

Methods

• A total of 456 women with vulvodynia between 20 and 67 years old were recruited through social media platforms in Italy.
  • 1% of these women reported primary pain (persistent), while 41.8% reported provoked vulvodynia.
  • 5% of these women reported taking medication for pain management.
• Participants were tasked with completing several questionnaires related to sociocultural influences, sexual distress, and body image.
  • Sociocultural influences were measured using the Media Pressures, Family Pressures, and Peer Pressures subscales of the Sociocultural Attitudes Toward Appearance Questionnaire. Each subscale consists of four items, rated on a 1-5 Likert scale. Higher scores indicate patients feel a higher level of pressure from media, family, or peers.
  • The Physical Appearance Comparison Scale consists of four items rated on a 1-5 Likert scale, where higher scores indicate higher amounts of comparison to others.
  • Beauty ideal internalization was measured using the internalization-general subscale of the Sociocultural Attitudes Toward Appearance Questionnaire. This consists of 10 items, rated on a 1-5 Likert scale, where higher scores indicated more internalization of beauty standards.
  • The Female Sexual Distress Scale consists of 13 items rated on a 0-4 Likert scale based on the past 30 days. Higher scores indicated higher levels of sexual distress.
• Results of these questionnaires were compared against each other, pain severity, and transposed onto the TIM.

Key Results/Analysis

• Pain severity appeared to be the most significant influence on sexual distress overall.
• Family pressures did not directly affect sexual distress (only indirectly through physical appearance comparison).
  • While family expectations may influence body image at a younger age, they may not hold as heavy of an influence in adulthood.
  • Media pressures appear to be the most significant direct sociocultural influence on sexual distress.
• Media and family pressures were significantly associated with physical appearance comparison and beauty ideal internalization.
  • This suggests women with vulvodynia may shape their expectation for how their bodies should function based on what they hear in the media and from their family.
• Women who engaged more frequently in physical appearance comparison reported higher levels of sexual distress.
  • Deviations from the normal expectation for women to experience pain-free sex may lead to higher levels of anxiety and self-consciousness surrounding sex – sometimes leading to avoiding intimacy altogether.
• Peer pressures were only significantly associated with physical appearance comparison, but not with beauty ideal internalization.
  • This suggests women with vulvodynia may only compare their sexual responsiveness to others in the moment (e.g., open discussions with friends) but may not reinforce the sociocultural norms internalized through media and family pressures.
• Beauty ideal internalization did not directly impact women’s reports of sexual distress.
  • Women with vulvodynia may see their sexual dysfunction as more impactful than whether their bodies meet specific aesthetic expectations.

Key Takeaways

• While pain management is an important aspect of vulvodynia care, a biopsychosocial approach may be beneficial to managing sexual distress in this patient population.
• Clinicians might adopt acceptance-based therapies as part of a multidimensional and multidisciplinary approach to vulvodynia care in order to improve treatment outcomes.

Resources

• Di Gesto, C., Spinoni, M., Spoto, C., Porpora, M. G., & Grano, C. (2025). Sociocultural antecedents of female sexual distress: Applying the tripartite influence model in a group of women with vulvodynia. The Journal of Sexual Medicine, 22(11), 2032–2040. https://doi.org/10.1093/jsxmed/qdaf230