A prospective study of the impact of fear-avoidance variables and anxiety sensitivity on genital pain and sexual impairment after childbirth.

Chronic pain problems involving the female reproductive system are major health concerns and entail a great personal cost to affected women and their families since they are poorly understood and often ignored. One such condition is genital pain that develops after childbirth. The majority of women resume regular intercourse by three months postpartum, and about half experience it as painful. Under treated genital pain is a risk factor for developing chronic pain. According to the fear-avoidance model of pain, a woman may interpret pain as threatening leading to a fear of pain, anxiety, and excessive attention to the pain. Consequently, the woman avoids the painful activity, further strengthening the interpretation of the pain as threatening. Extensions of this model suggest that a higher fear of anxiety-related body sensations (anxiety sensitivity) may lead to excessive fear-avoidance. This model has been partially supported in a retrospective study of women with chronic genital pain. However, women from this study were previously diagnosed with genital pain and the study did not include anxiety sensitivity so the influence of fear-avoidance on the development of the pain could not be examined. The aim of the proposed study is to examine whether greater fear-avoidance and anxiety sensitivity in pregnancy predict the onset and severity of genital pain and decreased sexual functioning postpartum. First time mothers will complete measures of fear-avoidance and anxiety sensitivity during pregnancy, and measures of genital pain intensity and sexual functioning three months after childbirth. Results may identify women at greater risk for this condition and inform the development of interventions, which may lower genital pain intensity, improve sexual functioning, and reduce the risk of developing chronic pain. Findings could thus improve the health and quality of life of many women, since postpartum genital pain is a highly prevalent but neglected women's health problem.