Aspects of Sexual Self-Schema in Premenopausal Women with Dyspareunia: Associations with Pain, Sexual Function, and Sexual Distress

INTRODUCTION: Although it is known that women with dyspareunia suffer from impaired psychological and sexual functioning, the study of the various dimensions of sexual self-schema and their associations with these outcomes has been neglected. AIM: To examine whether self-image cognitions about vaginal penetration, body image, and feelings and beliefs about one's own genitals contribute to the variance in pain, sexual functioning, and sexual distress. METHODS: Premenopausal women (n = 231; M age = 24.85, SD = 5.55) with self-reported dyspareunia completed an online survey focusing on self-image cognitions about vaginal penetration, body image, female genital self-image, pain during intercourse, sexual functioning, sexual distress, anxiety, and catastrophizing. MAIN OUTCOME MEASURES: (i) Pain intensity during intercourse, (ii) the Female Sexual Function Index without the Pain subscale, and (iii) the Female Sexual Distress Scale. RESULTS: Controlling for anxiety and catastrophizing, negative self-image cognitions about vaginal penetration, negative body image, and negative genital self-image together accounted for a portion of the variance in increased pain intensity, sexual dysfunction, and sexual distress. However, only self-image cognitions about vaginal penetration (β = 0.25, P = 0.005) contributed uniquely to the variance in pain intensity, whereas self-image cognitions about vaginal penetration (β = -0.18, P = 0.048) and genital self-image (β = 0.21, P = 0.008) contributed independently to the variance in sexual functioning. Finally, self-image cognitions about vaginal penetration (β = 0.28, P < 0.001), body image (β = 0.24, P < 0.001) and genital self-image (β = -0.14, P = 0.006) each contributed independently to the variance in sexual distress. CONCLUSIONS: Findings suggest that self-image cognitions about vaginal penetration and feelings and beliefs about one's own body and genitals are associated with pain and sexuality outcomes in women with dyspareunia.