Aspects of Sexual Self-Schema in Premenopausal Women with Dyspareunia: Associations with Pain, Sexual Function, and Sexual Distress

Els Pazmany MA^1,*, Sophie Bergeron PhD², Lukas Van Oudenhove MD, PhD³, Johan Verhaeghe MD, PhD⁴, Paul Enzlin PhD^1,5

Article first published online: 11 JUL 2013 The Journal of Sexual Medicine

Introduction Although it is known that women with dyspareunia suffer from impaired psychological and sexual functioning, the study of the various dimensions of sexual self-schema and their associations with these outcomes has been neglected.

Aim To examine whether self-image cognitions about vaginal penetration, body image, and feelings and beliefs about one's own genitals contribute to the variance in pain, sexual functioning, and sexual distress.

Methods Premenopausal women (n = 231; M age = 24.85, SD = 5.55) with self-reported dyspareunia completed an online survey focusing on self-image cognitions about vaginal penetration, body image, female genital self-image, pain during intercourse, sexual functioning, sexual distress, anxiety, and catastrophizing.

Main Outcome Measures (i) Pain intensity during intercourse, (ii) the Female Sexual Function Index without the Pain subscale, and (iii) the Female Sexual Distress Scale.

Results Controlling for anxiety and catastrophizing, negative self-image cognitions about vaginal penetration, negative body image, and negative genital self-image together accounted for a portion of the variance in increased pain intensity, sexual dysfunction, and sexual distress. However, only self-image cognitions about vaginal penetration (β = 0.25, P =  0.005) contributed uniquely to the variance in pain intensity, whereas self-image cognitions about vaginal penetration (β = −0.18, P = 0.048) and genital self-image (β = 0.21, P  = 0.008) contributed independently to the variance in sexual functioning. Finally, self-image cognitions about vaginal penetration (β = 0.28, P < 0.001), body image (β = 0.24, P < 0.001) and genital self-image (β = −0.14, P = 0.006) each contributed independently to the variance in sexual distress.

Conclusions Findings suggest that self-image cognitions about vaginal penetration and feelings and beliefs about one's own body and genitals are associated with pain and sexuality outcomes in women with dyspareunia.