Understanding vulvodynia: intersecting psychology, pain, and identity

Introduction: Vulvodynia is a complex condition reported by up to 16% of women in the general population. It is defined as a disorder of chronic localized pelvic pain in the vulvar area, lasting from 3 to 6 months, with no definable cause (Eppsteiner et al., 2014). Vulvodynia is a diagnosis of exclusion with an unknown etiology and may involve multiple sources of pain in the same woman. Research on vulvodynia has been growing steadily in recent years (Pukall et al., 2016). However, most studies in the psychological field have focused on its impact and consequent distress (Graziottin & Murina, 2011). Few studies delve into its somatic aspects and psychological etiology, partly due to the medical field's reluctance to accept a psychophysiological cause or an emotional liability at the origin of vulvodynia (Mascherpa et al., 2007). Therefore, the purpose of the present study is to explore the complexity of affected women’s experiences, identify protective and risk factors of vulvodynia, and differentiate between psychogenic and adaptive aspects. Methods: Twenty participants diagnosed with vulvodynia, aged over 18 years, were administered the Clinical Diagnostic Interview (CDI), supplemented with additional questions to investigate the development of the condition and personal experience. Following the interview, personality profiles were assessed through the SWAP-200. The interviews are part of a larger study that also includes an online survey with the following instruments: the Brief-Mentalized Affectivity Scale (B-MAS) to measure mentalized affectivity; the Body Uneasiness Test (BUT) to assess body image; the Childhood Trauma Questionnaire - Short Form (CTQ-SF) to investigate childhood trauma; the Identity and Eating Disorders Questionnaire (IDEA) to assess identity in relation to the body; the Sexual Satisfaction Scale (SSS) for sexual satisfaction; and the Sexual Modes Questionnaire (SMQ), focused on the activation of thoughts associated with sexuality. Results: Using Reflexive Thematic Analysis (Terry & Hayfield, 2020), several common themes were identified, including the relationship with the body, experiences with sexuality (satisfaction and functioning), the domain of relationships, experiences of violence, and gender representations. The qualitative data were analyzed alongside preliminary quantitative data from the assessment instruments. Conclusion: The results of this study are discussed from a psychodynamic perspective, with special emphasis on the relationship between condition experience, personality organization, and mentalizing ability. These findings support the importance of adopting a biopsychosocial perspective on vulvodynia and suggest an integrated mind-body treatment approach.