The experience of chronic vulvar pain: psychosocial dimensions and the sense of self

Abstract

Unexplainable chronic vulvar pain affects a significant number of women, although the problem is not widely recognized. For many, the condition does not resolve spontaneously or respond to current treatment. Vulvar pain is a substantive and meaningful event in the lives of those who suffer from it. Recent literature suggests the significance of psychosocial factors in the course of illness and chronic pain. The prevalence of the condition and the mixed treatment outcomes indicated a need for exploratory studies of psychosocial dimensions of the condition. Prior to this study there had been no research on the lived experience in women with the condition. Research in pain and chronic illness suggests that mastery in the treatment and management of unpredictable physical symptoms may involve interconnections between one or more of the following factors: symptom perception, cognitive and emotional responses, social situation, and identity issues. The current study utilized these four psychological reference points in a textual analytic exploration of the ways women make sense of their chronic vulvar pain. The 16 participants in this study represent a diverse sample of women who have had ongoing or recurrent vulvar pain symptoms for 1 year minimum (average 5.4 yrs). The research design was based upon pilot interviews, a background questionnaire, a narrative interview and a semi-structured follow-up interview. The transcribed texts were analyzed by means of constant comparative methods. The results of this investigation suggest an interactive model of the experience of chronic vulvar pain. This model offers a preliminary conceptual basis from which to understand the lived experience of chronic vulvar pain. When a wearing, pervasive, and unexplainable pain occurs in the vulva, a woman's sense of her self is diminished in significant ways. The relationship she establishes with the pain is shaped by the meanings she makes of her situation. These meanings emerge within the context of physical, emotional, and relational elements in her life. Reciprocal interactions occur between ongoing core identity and somatic perception, self state responses, and relational interchanges with significant others, including health care providers. These experiences occur in a dynamic, interactive manner that is simultaneous and continuous. The woman with chronic vulvar pain makes sense of its presence in her life by engaging in this ongoing process. The findings of this study suggest that the quality of these interactions may help or hinder the mobilization of resources to deal with chronic vulvar pain. Relationships which enhance a woman's sense of self worth help her manage the physical and emotional experience of the condition. The study substantiates the need for sensitivity to psychosocial experience in the treatment of chronic vulvar pain.