Sociocultural antecedents of female sexual distress: applying the tripartite influence model in a group of women with vulvodynia

Background: While most studies on vulvodynia—a chronic vulvar pain condition often associated with sexual distress—have focused on its biomedical and psychological underpinnings, little is known about the sociocultural factors that may shape women’s experience of such distress. Aim: This study aimed to apply the tripartite influence model—a framework for understanding how sociocultural messages on body image influence self-evaluative processes—to examine whether sociocultural pressures from media, peers, and family predict sexual distress through the mediating roles of physical appearance comparison and beauty ideal internalization, controlling for pain severity. Methods: A total of 456 women with vulvodynia (Mage =33.96, SD=4.27) were recruited via online Italian patient associations. Participants completed self-report measures assessing sociocultural influences (media, peers, family), physical appearance comparison, beauty ideal internalization, sexual distress, and pain severity. Path analysis was conducted to evaluate the hypothesized model and estimate direct and indirect effects. Outcomes: Using a path analysis, this study analyzed both the direct and indirect effects of sociocultural pressures on body image (ie, media, peers, and family) on sexual distress among women with vulvodynia, through a mediation by physical appearance comparison and beauty ideal internalization. Results: The model demonstrated excellent fit. Media and family pressures were significantly associated with both physical appearance comparison and beauty ideal internalization, while peer pressure was linked only to appearance comparison. Appearance comparison predicted higher sexual distress, whereas internalization did not. Pain severity was the strongest predictor of sexual distress. Bootstrapping analysis revealed significant indirect effects of media and peer pressures on sexual distress through appearance comparison. The model explained 34% of the variance in sexual distress. Clinical implications: These findings suggest that sociocultural standards regarding appearance and sexual functioning contribute to distress beyond pain alone, indicating that interventions targeting appearance-based social comparison and unrealistic cultural norms—such as media literacy and acceptance-based strategies—could inform psychological support for women with vulvodynia. Strengths and limitations: This is the first study to apply the tripartite influence model to sexual distress in vulvodynia, highlighting the mediating role of self-evaluative processes. However, the cross-sectional design precludes causal inferences, and the use of self-report measures may introduce bias. The findings are also limited to a sample of Italian women. Conclusion: Sexual distress in vulvodynia is shaped not only by pain but also by sociocultural expectations and appearance-related comparisons, suggesting that a biopsychosocial approach incorporating these dimensions may offer more comprehensive care.