Psychological, Relational, and Fertility-Related Characteristics of Italian Women with Vulvodynia: A Comparative Study with Controls
Abstract
1. Introduction
2. Materials and Methods
2.1. Participants
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- Online Recruitment: Invitations were shared on social media platforms, forums, and through email campaigns.
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- Direct Contact: The researchers approached participants at universities, community centers, and public events, providing them with information about this study and access to the survey. The survey complied with data protection regulations and took approximately 30 min to complete. All participants received no payment and were free to leave this study at any time. The inclusion criteria were as follows: (1) being between 18 and 50 years old; (2) having the ability to read and write the Italian language; and (3) having a diagnosis of vulvodynia confirmed by a gynecologist, for the vulvodynia group, or (4) having no history of chronic pain conditions, for the control group. The exclusion criteria were as follows: (1) consumption of addictive substances (alcohol and drugs) and (2) pre-existing medical conditions. For the control group, all participants with a history of chronic pain were excluded, including conditions such as chronic back pain, fibromyalgia, migraines, or other gynecological or obstetric pathologies. This requirement was verified through a detailed sociodemographic questionnaire administered during the initial screening phase. It is important to note that participants with occasional or transient pain, but not classifiable as chronic pain (i.e., persisting for at least three months), were not excluded from this study. Considering the voluntary nature of participation in this study and the inclusion and exclusion criteria, the final sample includes 203 women, divided into two groups: 96 women (47.3%) with vulvodynia (Group 1, average age 31.9 years, SD =7.31) and 107 women (52.7%) from the general population (Group 2, average age 32.7, SD = 7.32).
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- The diagnosis of vulvodynia was confirmed by a qualified gynecologist following the standardized criteria established by the International Society for the Study of Vulvovaginal Diseases (ISSVD) [1]. According to these criteria, vulvodynia is defined as persistent vulvar pain without an identifiable cause, lasting for at least three months. To be included in this study, participants were required to have received a formal diagnosis of vulvodynia, verified through medical documentation or confirmation letters issued by their healthcare providers. This approach aimed to reduce heterogeneity in the diagnostic process and minimize the risk of selection bias.
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- To further reduce the risk of diagnostic heterogeneity, participants were primarily recruited from Italian regions where specific Diagnostic Therapeutic Care Pathways (PDTAs) for vulvodynia have been implemented, such as those active in Tuscany. These pathways aim to standardize diagnostic procedures and ensure timely and accurate diagnoses.
2.2. Measures
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- Experience in Close Relationship Scale 12 (ECR-12) [22]: The ECR-12 is a 12-item self-report instrument designed to assess adult attachment patterns in romantic relationships. It evaluates two dimensions: attachment avoidance and attachment anxiety. The scale has demonstrated good psychometric properties and is widely used in psychotherapy research. Cronbach’s alpha for the ECR-12 in this study was 0.87.
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- Approach-Avoidance Temperament Questionnaire (ATQ) [23]: The ATQ is a psychometric tool developed to measure individual differences in approach and avoidance temperament. It assesses tendencies toward positive (approach) and negative (avoidance) emotional responses, which are fundamental aspects of personality influencing behavior and emotional experiences. Cronbach’s alpha for the ATQ was 0.82.
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- Resilience Scale 14 (RS-14) [24]: The RS-14 is a 14-item scale designed to measure resilience, defined as the ability to cope with and adapt to adversity. It provides insights into an individual’s capacity to bounce back from stressful situations and maintain psychological well-being. Cronbach’s alpha for the RS-14 was 0.91.
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- Fertility Problem Inventory—Short Form (FPI-SF) [25]: The FPI-SF is a shortened version of the Fertility Problem Inventory, aimed at assessing the perceived stress and impact associated with fertility problems. It evaluates various dimensions, including social, sexual, and relational aspects, providing a comprehensive understanding of the psychological burden of infertility. Cronbach’s alpha for the FPI-SF was 0.85.
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- Female Sexual Function Index (FSFI) [26]: The FSFI is a 19-item self-report questionnaire designed to measure sexual functioning in women. It assesses six domains: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. The FSFI is widely used in both clinical and research settings to evaluate female sexual function and identify potential dysfunctions. Cronbach’s alpha for the FSFI was 0.94.
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- Dyadic Adjustment Scale 7 (DAS-7) [27]: The DAS-7 is a brief version of the Dyadic Adjustment Scale, consisting of 7 items. It measures the quality of adjustment and satisfaction within a romantic relationship, covering aspects such as consensus, cohesion, and satisfaction between partners. Cronbach’s alpha for the DAS-7 was 0.78.
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- Beck Depression Inventory (BDI) [28]: The BDI is a 21-item self-report inventory that assesses the presence and severity of depressive symptoms. It covers a range of emotional, cognitive, and physical symptoms associated with depression and is one of the most widely used instruments for detecting and quantifying depressive states. Cronbach’s alpha for the BDI was 0.89.
2.3. Procedure
2.4. Statistical Analysis
2.4.1. Data Preprocessing and Exclusion Criteria
2.4.2. Data Processing
3. Results
3.1. Sociodemographic Variables
3.2. Clinical Variables
4. Discussion
4.1. Sociodemographic Characteristics
4.2. Clinical Aspects and Implications
4.2.1. Bidirectional Relationship Between Vulvodynia and Psychological Factors
4.2.2. Attachment Styles
4.2.3. Temperament
4.2.4. Resilience
4.2.5. Fertility-Related Stress
4.2.6. Sexual Functioning
4.2.7. Relationship Quality
4.2.8. Depressive Symptoms
4.3. Clinical Implications
5. Conclusions
5.1. Conclusions and Policy Implications
5.2. Limitations and Recommendations for Future Research
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Category | Vulvodynia (n = 96) | Control (n = 107) | χ2 (df) | p |
---|---|---|---|---|---|
Education | High school diploma or vocational degree | 44 (45.8%) | 37 (34.6%) | 2.687 (2) | 0.261 |
University degree or higher | 50 (52.1%) | 67 (62.6%) | |||
Middle school diploma | 2 (2.1%) | 3 (2.8%) | |||
Marital status | Married | 21 (21.9%) | 27 (25.2%) | 15.892 (5) | 0.007 * |
Cohabiting | 3 (3.1%) | 17 (15.9%) | |||
Single | 57 (59.4%) | 58 (54.2%) | |||
Separated or divorced | 12 (12.5%) | 5 (4.7%) | |||
Widowed | 1 (1.0%) | 0 (0.0%) | |||
Living situation | Other | 0 (0.0%) | 1 (0.9%) | 9.920 (4) | 0.042 * |
With other family members or friends | 45 (46.9%) | 38 (35.5%) | |||
With partner | 39 (40.6%) | 63 (58.9%) | |||
Alone | 11 (11.5%) | 5 (4.7%) | |||
With children | 1 (1.0%) | 0 (0.0%) | |||
Sexual orientation | Bisexual | 2 (2.1%) | 5 (4.7%) | 1.281 (2) | 0.527 |
Heterosexual | 93 (96.9%) | 100 (93.5%) | |||
Homosexual | 1 (1.0%) | 2 (1.9%) | |||
Relationship type | Cohabiting | 5 (5.2%) | 6 (5.6%) | 15.467 (6) | 0.017 * |
Common law partnership | 0 (0.0%) | 1 (0.9%) | |||
Engaged | 57 (59.4%) | 72 (67.3%) | |||
In a relationship | 5 (5.2%) | 0 (0.0%) | |||
Single/free | 0 (0.0%) | 1 (0.9%) | |||
Separated or divorced | 9 (9.4%) | 1 (0.9%) | |||
Married | 20 (20.8%) | 26 (24.3%) | |||
Employment status | Housewife | 3 (3.1%) | 1 (0.9%) | 8.338 (6) | 0.214 |
Unemployed/seeking first job | 9 (9.4%) | 2 (1.9%) | |||
Self-employed | 22 (22.9%) | 31 (29.0%) | |||
Temporary contract worker | 13 (13.5%) | 13 (12.1%) | |||
Permanent contract worker | 30 (31.3%) | 36 (33.6%) | |||
Retired | 0 (0.0%) | 1 (0.9%) | |||
Student | 19 (19.8%) | 23 (21.5%) | |||
Income level | Low | 64 (66.7%) | 74 (69.2%) | 2.752 (2) | 0.253 |
Medium | 23 (24.0%) | 29 (27.1%) | |||
High | 9 (9.4%) | 4 (3.7%) | |||
Children | No | 65 (67.7%) | 71 (66.4%) | 3.415 (4) | 0.491 |
Yes, 1 | 19 (19.8%) | 21 (19.6%) | |||
Yes, 2 | 8 (8.3%) | 14 (13.1%) | |||
Yes, more than 2 | 3 (3.1%) | 1 (0.9%) |
Measure | Vulvodynia (n = 96) | Control (n = 107) | t (df) | p | Cohen’s D |
---|---|---|---|---|---|
ECR-12 | |||||
Attachment Anxiety | 29.20 (5.57) | 23.61 (5.77) | 6.96 (198) | <0.001 | 0.98 |
Attachment Avoidance | 26.50 (5.03) | 16.90 (4.54) | 14.27 (200) | <0.001 | 2.01 |
ATQ | |||||
Approach | 28.43 (3.72) | 30.65 (3.86) | −4.16 (200) | <0.001 | −0.58 |
Avoidance | 31.11 (3.7) | 23.21 (4.32) | 13.83 (199) | <0.001 | 1.95 |
RS-14 | |||||
Total Score | 69.97 (8.67) | 78.85 (9.85) | −6.74 (199) | <0.001 | 0.95 |
FPI-SF | |||||
Social Concern | 36.39 (6.09) | 27.75 (6.57) | 9.60 (197) | <0.001 | 0.319 |
Need for Parenthood | 19.07 (7.65) | 20.36 (7.96) | −1.17 (201) | 0.12 | |
Rejection of a Child-Free Lifestyle | 22.69 (5.64) | 21.44 (5.86) | 1.53 (200) | 0.06 | |
Couple Relationship Concern | 15.08 (4.89) | 9.58 (4.42) | 8.39 (199) | <0.001 | 1.18 |
Total Score | 93.17 (13.18) | 79.22 (14.05) | 7.18 (196) | <0.001 | 1.02 |
FSFI | |||||
Desire | 3.69 (1.35) | 4.97 (0.79) | −8.11 (201) | <0.001 | 1.16 |
Arousal | 3.38 (1.89) | 5.21 (0.80) | −8.79 (201) | <0.001 | 1.28 |
Lubrification | 3.16 (1.87) | 5.41 (0.84) | −10.83 (200) | <0.001 | −1.57 |
Orgasm | 3.12 (2.05) | 5.32 (0.87) | −9.74 (200) | <0.001 | 1.43 |
Satisfaction | 2.98 (1.94) | 5.30 (0.88) | −10.74 (201) | <0.001 | −1.56 |
Pain | 2.52 (1.63) | 5.18 (1.06) | −13.57 (201) | <0.001 | 1.94 |
Total Score | 18.77 (9.19) | 31.42 (4.04) | −12.38 (199) | <0.001 | 1.81 |
DAS-7 | |||||
Total Score | 24.48 (4.78) | 31.71 (4.73) | −10.81 (201) | <0.001 | 1.51 |
BDI | |||||
Total Score | 16.69 (7.39) | 4.34 (3.14) | 15.04 (199) | <0.001 | 2.22 |
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Gattamelata, A.; Fioravanti, G.; Zurkirch, V.P.; Moyano, N. Psychological, Relational, and Fertility-Related Characteristics of Italian Women with Vulvodynia: A Comparative Study with Controls. Int. J. Environ. Res. Public Health 2025, 22, 527. https://doi.org/10.3390/ijerph22040527
Gattamelata A, Fioravanti G, Zurkirch VP, Moyano N. Psychological, Relational, and Fertility-Related Characteristics of Italian Women with Vulvodynia: A Comparative Study with Controls. International Journal of Environmental Research and Public Health. 2025; 22(4):527. https://doi.org/10.3390/ijerph22040527
Chicago/Turabian StyleGattamelata, Antonio, Giulia Fioravanti, Vanessa Prisca Zurkirch, and Nieves Moyano. 2025. "Psychological, Relational, and Fertility-Related Characteristics of Italian Women with Vulvodynia: A Comparative Study with Controls" International Journal of Environmental Research and Public Health 22, no. 4: 527. https://doi.org/10.3390/ijerph22040527
APA StyleGattamelata, A., Fioravanti, G., Zurkirch, V. P., & Moyano, N. (2025). Psychological, Relational, and Fertility-Related Characteristics of Italian Women with Vulvodynia: A Comparative Study with Controls. International Journal of Environmental Research and Public Health, 22(4), 527. https://doi.org/10.3390/ijerph22040527