Application of the psychological flexibility model in the context of vulvar pain and sexual dysfunction

Psychological processes are known to influence the development and impact of chronic pain. Moreover, psychological treatments have been shown to reduce the suffering that people with chronic pain experience. Still, limited work has considered the role of psychological processes in vulvar pain, and many aspects of vulvar pain remain largely unexplored. Given the relevance of psychological flexibility and ACT in chronic pain, the applicability of the psychological flexibility model to vulvar pain appears worth exploring. The overarching aim of this thesis was to explore the psychological flexibility model in the context of vulvar pain and develop an intervention based on this model, for women living with vulvodynia. Study I aimed specifically to examine the contribution of psychological inflexibility to sexual dysfunction over time, among women with vulvar pain. Findings demonstrated that psychological inflexibility predicted later sexual dysfunction. The aim of Study II was to examine the contribution of mindfulness during sexual activity to sexual wellbeing among women who experience pain with sexual activity as compared to women who do not. Study II found that higher levels of mindfulness during sexual activity was associated with better sexual functioning and less sexual distress. Additionally, the contribution of mindfulness to sexual function and distress was similar in the two groups. Study III aimed specifically to examine the feasibility of a larger trial investigating the efficacy of online ACT for vulvodynia and conduct a preliminary examination of the effects of the intervention. Findings largely suggest that a full scale randomized controlled trial is feasible and indicate that women with provoked vestibulodynia could potentially benefit from receiving ACT. This thesis contributes to the understanding of vulvar pain and sexual dysfunction by demonstrating that psychological flexibility is associated with the personal impact of pain. It provides initial evidence of the potential value of the psychological flexibility model in the context of vulvodynia, and encourage further studies entailing a contextual behavioural approach.