Psychosocial factors related to women’s persistent or recurrent vulvovaginal pain: a systematic review and suggestions for future research

OBJECTIVE: Vulvovaginal pain is a prevalent condition that can be accompanied by psychological and social difficulties. This review summarised studies of vulvovaginal pain as related to women's psychological and social adjustment. METHOD AND MEASURES: A systematic search identified 35 studies of vulvovaginal pain as related to women's psychological and social adjustment. RESULTS: Most identified studies investigated anxiety, depression, sexual dissatisfaction, pain catastrophising or sexual abuse as correlates of pain. Experiencing or having more intense pain was associated with increased anxiety (or fear) and depressive symptoms (or distress), decreased sexual satisfaction (or more sexual distress) and experience of sexual or other abuse. Additionally, pain was universally associated with more pain catastrophising when studied. A few studies were located on other topics: pain avoidance behaviours, relationship satisfaction, partner communication, and multiple other psychological and social adjustment indicators (e.g. pain coping self-efficacy). There was mixed evidence that vulvovaginal pain was associated with poorer outcomes across all these other topics. CONCLUSIONS: Vulvovaginal pain tends to be associated with poorer emotional and social adjustment. Research is needed to differentiate covariates (or comorbidities) from precursors or outcomes of pain, and to identify positive resources and adaptive coping strategies to assist to guide recommendations for women's healthcare.