To Say or not to Say: Dyadic Ambivalence over Emotional Expression and its Associations with Sexual Function, Satisfaction, Depression, Dyadic Adjustment, and Pain in Women with Provoked Vestibulodynia and their Partners

Essai doctoral présenté à la Faculté des Arts et des Sciences en vue de l’obtention du grade de Doctorat en Psychologie Clinique

In search of protection : sexual minority women in Canadian refugee determination

Le Canada accepte des demandes d’asile sur la base de l'orientation sexuelle depuis plus de 20 ans. Quoi qu’il en soit, cette recherche permet de douter du fait que les demandes sur la base de l’orientation sexuelle déposées par des femmes soient traitées de façon adéquate. Pour garantir l’accès à la protection des femmes appartenant à des minorités sexuelles, une analyse du risque de persécution fondé sur l'orientation sexuelle doit incorporer des considérations de genre ainsi que divers autres facteurs d’ordre social et culturel. À partir d’une étude de cas de demandes du statut de refugié déposées par des femmes sur la base de l’orientation sexuelle et rejetées par la Commission de l'immigration et du statut de réfugié entre 2010 et 2013, cette recherche identifie des procédés décisionnels problématiques qui font obstacle au droit d’asile de ces femmes. Les résultats de cette étude révèlent qu’une analyse intersectionnelle, laquelle prend acte des formes variées et multiples de l’oppression dans un contexte social donné, est d’importance cruciale pour une évaluation éclairée et non tronquée des risques de persécution pour les minorités sexuelles féminines. À la lumière de ces résultats, ce mémoire propose qu’une analyse intersectionnelle accompagne une nécessaire formation pour les membres de la Commission de l'immigration et du statut de réfugié du Canada sur des questions particulières à des minorités sexuelles.

Sexual and relationship intimacy among women with provoked vestibulodynia and their partners : associations with sexual satisfaction, sexual function, and pain self-efficacy

Introduction Provoked vestibulodynia (PVD) is the most frequent subtype of vulvodynia. Women report negative consequences of PVD on their sexual and romantic relationships. Researchers have recently highlighted the importance of examining interpersonal factors such as intimacy, and of including both women and their partners in study designs. Aim The aim of this study was to investigate sexual and relationship intimacy as defined by the Interpersonal Process Model of Intimacy and their associations with sexual satisfaction, sexual function, pain self-efficacy, and pain intensity among women with PVD and their partners. Methods Ninety-one heterosexual women (M age = 27.38, SD = 6.04) diagnosed with PVD and their partners (M age = 29.37, SD = 7.79) completed measures of sexual and relationship intimacy, sexual satisfaction, sexual function, pain self-efficacy, and pain intensity. Main Outcome Measures Dependent measures were the (i) Global Measure of Sexual Satisfaction Scale; (ii) Female Sexual Function Index; (iii) Painful Intercourse Self-Efficacy Scale; and (iv) visual analog scale of pain intensity during intercourse. Results After controlling for women's age, women's greater sexual intimacy (β = 0.49, P < 0.001) was associated with women's greater sexual satisfaction and higher pain self-efficacy (β = 0.39, P = 0.001), beyond the effects of partners’ sexual intimacy. Also, women's greater sexual intimacy (β = 0.24, P = 0.05) and women's greater relationship intimacy (β = 0.54, P = 0.003) were associated with greater women's sexual function, beyond the effects of partners’ sexual and relationship intimacy. Conclusions Women's self-reported sexual and relationship intimacy in the couple relationship may promote higher sexual satisfaction, sexual function, and pain self-efficacy, as well as possibly foster greater sexual well-being among women with PVD. The authors discuss implications for the inclusion of emotional and interpersonal aspects of the couple's dynamic in clinical interventions and future research in PVD.

Attachment, sexual assertiveness and sexual outcomes in women with provoked vestibulodynia and their partners : a mediation model.

Provoked vestibulodynia (PVD) is a prevalent women’s sexual pain disorder, which is associated with sexual function difficulties. Attachment theory has been used to understand adult sexual outcomes, providing a useful framework for examining sexual adaptation in couples confronted with PVD. Research to date indicates that anxious and avoidant attachment dimensions correlate with worse sexual outcomes in community and clinical samples. The present study examined the association between attachment, pain, sexual function and sexual satisfaction in a sample of 101 couples in which the women presented with PVD. The Actor-Partner Interdependence Model was used in order to investigate both actor and partner effects. This study also examined the role of sexual assertiveness as a mediator of these associations via structural equation modeling. Women completed measures of pain intensity and both members of the couple completed measures of romantic attachment, sexual assertiveness, sexual function and satisfaction. Results indicated that attachment dimensions did not predict pain intensity. Both anxious and avoidant attachment were associated with lower sexual satisfaction. Only attachment avoidance predicted lower sexual function in women. Partner effects indicated that higher sexual assertiveness in men predicted better sexual function in women, while higher sexual assertiveness in women predicted higher sexual satisfaction in men. Finally, women’s sexual assertiveness was found to be a significant mediator of the relationship between their attachment dimensions, sexual function and satisfaction. Findings highlight the importance of examining how anxious and avoidant attachment may lead to difficulties in sexual assertiveness and to less satisfying sexual interactions in couples where women suffer from PVD.

Impact of male partner responses on sexual function in women with vulvodynia and their partners: a dyadic daily experience study.

Note de l'éditeur : This article may not exactly replicate the final version published in the APA journal. It is not the copy of record. / Cet article ne constitue pas la version officielle, et peut différer de la version publiée dans la revue.

Why us? Perceived injustice is associated with more sexual and psychological distress in couples coping with genito-pelvic pain.

Introduction Provoked vestibulodynia (PVD) is the most frequent cause of genito-pelvic pain/penetration disorder (GPPPD) and is associated with negative psychological and sexual consequences for affected women and their partners. PVD is often misdiagnosed or ignored and many couples may experience a sense of injustice, due to the loss of their ability to have a normal sexual life. Perceiving injustice has been documented to have important consequences in individuals with chronic pain. However, no quantitative research has investigated the experience of injustice in this population. Aim The aim of this study was to investigate the associations between perceived injustice and pain, sexual satisfaction, sexual distress, and depression among women with PVD and their partners. Methods Women diagnosed with PVD (N = 50) and their partners completed questionnaires of perceived injustice, pain, sexual satisfaction, sexual distress, and depression. Main Outcome Measures (1) Global Measure of Sexual Satisfaction Scale; (2) Female Sexual Distress Scale; (3) Beck Depression Inventory-II; and (4) McGill-Melzack Pain Questionnaire. Results After controlling for partners' age, women's higher level of perceived injustice was associated with their own greater sexual distress, and the same pattern was found for partners. Women's higher level of perceived injustice was associated with their own greater depression, and the same pattern was found for partners. Women's higher perceived injustice was not associated with their own lower sexual satisfaction but partners' higher perceived injustice was associated with their own lower sexual satisfaction. Perceived injustice was not associated with women's pain intensity. Conclusion Results suggest that perceiving injustice may have negative consequences for the couple's sexual and psychological outcomes. However, the effects of perceived injustice appear to be intra-individual. Targeting perceived injustice could enhance the efficacy of psychological interventions for women with PVD and their partners.

Are primary and secondary provoked vestibulodynia two different entities? A comparison of pain, psychosocial and sexual characteristics.

Introduction Provoked vestibulodynia (PVD) is suspected to be the most frequent cause of vulvodynia in premenopausal women. Based on the onset of PVD relative to the start of sexual experience, PVD can be divided into primary (PVD1) and secondary PVD (PVD2). Studies comparing these PVD subgroups are inconclusive as to whether differences exist in sexual and psychosocial functioning. Aim The aim of this study was to compare the pain, sexual and psychosocial functioning of a large clinical and community-based sample of premenopausal women with PVD1 and PVD2. Methods A total of 269 women (n = 94 PVD1; n = 175 PVD2) completed measures on sociodemographics, pain, sexual, and psychosocial functioning. Main Outcome Measures Dependent variables were the 0–10 pain numerical rating scale, McGill–Melzack Pain Questionnaire, Female Sexual Function Index, Global Measure of Sexual Satisfaction, Beck Depression Inventory-II, Painful Intercourse Self-Efficacy Scale, Pain Catastrophizing Scale, State-Trait Anxiety Inventory Trait Subscale, Ambivalence over Emotional Expression Questionnaire, Hurlbert Index of Sexual Assertiveness, Experiences in Close Relationships Scale—Revised, and Dyadic Adjustment Scale-Revised. Results At first sexual relationship, women with PVD2 were significantly younger than women with PVD1 (P < 0.01). The average relationship duration was significantly longer in women with PVD2 compared with women with PVD1 (P < 0.01). Although women with PVD1 described a significantly longer duration of pain compared with women with PVD2 (P < 0.01), no significant subtype differences were found in pain intensity during intercourse. When controlling for the sociodemographics mentioned earlier, no significant differences were found in sexual, psychological, and relational functioning between the PVD subgroups. Nevertheless, on average, both groups were in the clinical range of sexual dysfunction and reported impaired psychological functioning. Conclusions The findings show that there are no significant differences in the sexual and psychosocial profiles of women with PVD1 and PVD2. Results suggest that similar psychosocial and sex therapy interventions should be offered to both subgroups of PVD.

Provoked vestibulodynia : mediators of the associations between partner responses, pain, and sexual satisfaction.

Provoked vestibulodynia (PVD) is a chronic, recurrent vulvo-vaginal pain condition affecting 12% of the general population, and is associated with sexual dysfunction, psychological distress, and reduced quality of life. There is growing interest in the role of interpersonal variables in PVD, which have been widely neglected. In a sample of 175 couples, the present study examined the mediating roles of partner and participant catastrophizing and self-efficacy in the association between solicitous partner responses and pain intensity, and that of dyadic adjustment in the association between solicitous and negative partner responses and sexual satisfaction. Couples completed measures of partner responses, catastrophizing, self-efficacy, dyadic adjustment, and depression. Women also completed measures of pain, sexual satisfaction, and sexual function. Controlling for depression and solicitousness perceived by the other member of the couple, catastrophizing and self-efficacy partially mediated the association between higher solicitous responses and higher pain during intercourse, accounting for 26 and 25% of the variance in this association for participant and partner-perceived responses, respectively. For both participant and partners, only pain catastrophizing was a unique mediator. Controlling for depression, sexual function and partner-perceived responses, dyadic adjustment partially mediated the association between higher participant-perceived solicitous responses and higher sexual satisfaction, and between higher participant-perceived negative responses and lower sexual satisfaction, accounting for 26% of the variance in each association. The current findings suggest that catastrophizing and dyadic adjustment may constitute a route by which partner responses exacerbate pain and increase or decrease sexual satisfaction in PVD couples.

Harmful or helpful : perceived solicitous and facilitative partner responses are differentially associated with pain and sexual satisfaction in women with provoked vestibulodynia.

Introduction.  Provoked vestibulodynia (PVD) is a highly prevalent vulvovaginal pain condition that negatively affects women's emotional, sexual, and relationship well-being. Recent studies have investigated the role of interpersonal variables, including partner responses. Aim.  We examined whether solicitous and facilitative partner responses were differentially associated with vulvovaginal pain and sexual satisfaction in women with PVD by examining each predictor while controlling for the other. Methods.  One hundred twenty-one women (M age = 30.60, SD = 10.53) with PVD or self-reported symptoms of PVD completed the solicitous subscale of the spouse response scale of the Multidimensional Pain Inventory, and the facilitative subscale of the Spouse Response Inventory. Participants also completed measures of pain, sexual function, sexual satisfaction, trait anxiety, and avoidance of pain and sexual behaviors (referred to as “avoidance”). Main Outcome Measures.  Dependent measures were the (i) Pain Rating Index of the McGill Pain Questionnaire with reference to pain during vaginal intercourse and (ii) Global Measure of Sexual Satisfaction Scale. Results.  Controlling for trait anxiety and avoidance, higher solicitous partner responses were associated with higher vulvovaginal pain intensity (β = 0.20, P = 0.03), and higher facilitative partner responses were associated with lower pain intensity (β = −0.20, P = 0.04). Controlling for sexual function, trait anxiety, and avoidance, higher facilitative partner responses were associated with higher sexual satisfaction (β = 0.15, P = 0.05). Conclusions.  Findings suggest that facilitative partner responses may aid in alleviating vulvovaginal pain and improving sexual satisfaction, whereas solicitous partner responses may contribute to greater pain.

Woman and partner-perceived partner responses predict pain and sexual satisfaction in vestibulodynia couples

Introduction.  Provoked vestibulodynia (PVD) is a highly prevalent vulvovaginal pain condition that results in significant sexual dysfunction, psychological distress, and reduced quality of life. Although some intra-individual psychological factors have been associated with PVD, studies to date have neglected the interpersonal context of this condition. Aim.  We examined whether partner responses to women's pain experience—from the perspective of both the woman and her partner—are associated with pain intensity, sexual function, and sexual satisfaction. Methods.  One hundred ninety-one couples (M age for women = 33.28, standard deviation [SD] = 12.07, M age for men = 35.79, SD = 12.44) in which the woman suffered from PVD completed the spouse response scale of the Multidimensional Pain Inventory, assessing perceptions of partners' responses to the pain. Women with PVD also completed measures of pain, sexual function, sexual satisfaction, depression, and dyadic adjustment. Main Outcome Measures.  Dependent measures were women's responses to: (i) a horizontal analog scale assessing the intensity of their pain during intercourse; (ii) the Female Sexual Function Index; and (iii) the Global Measure of Sexual Satisfaction Scale. Results.  Controlling for depression, higher solicitous partner responses were associated with higher levels of women's vulvovaginal pain intensity. This association was significant for partner-perceived responses (β = 0.29, P < 0.001) and for woman-perceived partner responses (β = 0.16, P = 0.04). After controlling for sexual function and dyadic adjustment, woman-perceived greater solicitous partner responses (β = 0.16, P = 0.02) predicted greater sexual satisfaction. Partner-perceived responses did not predict women's sexual satisfaction. Partner responses were not associated with women's sexual function. Conclusions.  Findings support the integration of dyadic processes in the conceptualization and treatment of PVD by suggesting that partner responses to pain affect pain intensity and sexual satisfaction in affected women.

Democracia y diferencia sexual.

Monográfico con el título: 'Educar para la igualdad y la libertad'. Resumen basado en el de la publicación

Experiencia de Educaci??n Sexual en el ciclo superior

Experiencia llevada a cabo en un centro de Ense??anza Primaria con alumnos de sexto de EGB sobre educaci??n sexual. Los objetivos fundamentales que se pretenden son: 1. Que el alumno conozca su sexualidad, sin traumas. 2. Ayudar al alumno en su desarrollo psicofisiol??gico. 3. Fomentar la coeducaci??n para evitar discriminaci??n en funci??n del sexo. 4. Concienciar a los padres en la importancia de informar a sus hijos. El trabajo se realiza siguiendo, entre otros, de los siguientes apartados: un per??odo de confianza con los alumnos al objeto de suprimir el miedo y expresen sus preguntas en las clases correspondientes de educaci??n sexual; encuesta an??nima; encuesta a padres; reuni??n con padres; autorizaci??n paterna, todo ello durante dos meses. Una vez transcurrido este periodo se realizan una serie de actividades (diapositivas, debates, informaci??n detallada de los temas a tratar, vocabulario, murales, etc.). El trabajo expone los datos estad??sticos resultantes de la experiencia, las actividades pr??cticas, ejercicios, los modelos de encuestas utilizados as?? como las conclusiones y los objetivos conseguidos.

Hacia una educación no sexista : la discriminación sexual a lo largo de la historia y su incidencia en el contexto educativo.

La publicación presenta una sección de enlaces web recomendados y un glosario de términos para favorecer la comprensión de los contenidos. - Parte de la bibliografía está comentada

La Diversitat ignorada: escola i diversitat sexual

Tot i que el sistema educatiu actual promou la possibilitat que es parli de diversitat sexual a l'aula, a la practica continua el silenci. Aquest article pretén constatar aquesta absència, tant el l'àmbit de les ciències de l'educació, com de la pròpia pràctica docent

La educación afectivo sexual en la etapa infantil : un proceso de formación del profesorado.

a) Detectar las necesidades de formación del profesorado en relación a la Educación Afectivo-Sexual en Educación Infantil; b) Diseñar un programa de formación en base a las necesidades detectadas; c) Desarrollo de un programa de formación que abarque: conocimientos, sensibilización del profesorado en materia de Educación Sexual y adquisición de habilidades para orientar a padres y madres; d) Seguimiento del programa de formación. El trabajo se encuentra dividido en tres fases: una primera fase en donde se realiza una revisión teórica de los antecedentes y los fundamentos que sirven de base al estudio, así como el estudio exploratorio y el diseño del programa de formación. En la segunda fase es donde se materializa el proceso de formación, recolección y análisis de los datos y que se divide, a su vez, en cuatro etapas: a) La primera etapa se corresponde con el inicio del Programa de Formación en el que se expone la teoría necesaria para iniciar un trabajo en materia de Educación Afectivo Sexual; b) En la segunda etapa se incluyen actividades en donde se ponen en juego los conocimientos adquiridos en la etapa anterior; c) La tercera etapa está destinada a la preparación del profesorado para el trabajo con padres y madres, al tiempo que se les ofrece la información y herramientas necesarias que facilitan su labor educativa; d) La cuarta etapa está destinada al seguimiento del profesorado que ha realizado el proceso de formación y el desarrollo del trabajo en materia de Educación Afectivo Sexual. Finalmente, en la tercera fase se expone el análisis y valoración final de los resultados, para llegar a la propuesta de conclusiones y recomendaciones. Para conocer el estado de la situación en cuanto a la Educación Sexual en la Etapa de Infantil de Asturias se diseña una entrevista exploratoria (entrevista estructurada abierta) que se aplica a los 9 Coordinadores de la etapa de Educación Infantil de los CPRs asturianos. Se elabora un cuestionario de 25 ítems destinado al diagnóstico inicial, que es aplicado a 8 profesores que participan en el curso de formación que se plantea. Se realiza una entrevista en grupo el primer día de encuentro con los participantes en el curso de formación, entrevista estructurada no presencuencializada que permite alterar las secuencias de las preguntas según la dinámica de la entrevista. También se elabora un cuestionario final compuesto por 17 ítems que es aplicado a los 8 profesores que desarrollan el curso de formación. Otras estrategias utilizadas en la recogida de información han sido: el vagabundeo (medio informal que permite familiarizarse con los participantes), hoja de valoración del curso, entrevistas individuales no estructuradas y no dirigidas. a) El profesorado desconoce el papel que ejerce de manera incidental en su trabajo diario pero, cuando el profesorado recibe la información necesaria, reflexiona sobre la función que desempeña y se ve impulsado al trabajo y la lucha para que la Educación Sexual sea una realidad en su aula y su centro educativo; b) Existen temores injustificados en los asesores para proponer cursos de formación en Educación Sexual en la etapa de Educación Infantil; reticencias en el profesorado para trabajar en materia de Educación Sexual con padres y madres; reticencias en el profesorado y algunas directoras ante la escasa participación de padres y madres a las charlas que se convoquen; c) Existe interés por parte del profesorado para formarse en Educación Sexual, el profesorado puede enfrentarse a padres y madres de manera satisfactoria; d) Los padres y las madres son los primeros interesados en recibir información en materia de Educación Sexual; e) El éxito del Programa de Formación realizado se debe al esfuerzo continuo por adaptarse a las necesidades que surgen durante el proceso de formación; f) La preparación del profesorado a partir de un programa de formación que está dirigido a desarrollar un trabajo de manera transversal se mantiene; g) Como resultado de este tipo de programas el alumnado es el primer beneficiario y después los padres y madres con la información que el profesorado les aporta; h) La Educación Sexual de la Etapa Infantil ha sido olvidada, a pesar de ser incluida en los contenidos de la LOGSE; i) Un trabajo integral entre padres-madres, profesorado y personal directivo ofrece razones para advertir que el modelo integral en el que se basa este estudio no será realmente integral si no se incluye el derecho que tienen los niños y niñas de vivir su propia sexualidad.