Sexual distress, metacognitive beliefs, and  endometriosis

Cognitions about own worries plays the most important role in the prediction of sexual distress.

Key Points

Importance

• Compared to the general female population, women with endometriosis have a nine-fold increased risk of experiencing dyspareunia.
• Dyspareunia has a negative effect on women’s quality of life and has been associated with sexual dysfunctions such as decreased sexual desire, arousal difficulties, and orgasm disorders.
• Women with endometriosis also experience sexual distress, which refers to personal distress related to a specific sexual difficulty.
• It has been observed that not all women who experience sexual distress have sexual dysfunction. Sexual distress could instead be related to psychological and cognitive factors, including the way an individual copes with their own thoughts about stressors (i.e. pain and sexual dysfunction).
• This is the first study to explore the link between sexual distress and psychological and cognitive factors in women with endometriosis.

What’s Done Here

• Ninety-six women completed surveys through the internet. Surveys assessed general chronic pain intensity, dyspareunia, metacognitive beliefs, and sexual distress.

Key Results

• Participants reported high levels of dyspareunia and sexual distress. Dyspareunia and pain intensity did not predict sexual distress. In contrast, metacognitive beliefs predicted sexual distress.
• Overall, the authors conclude that “cognitions about own worries play the most important role in the prediction of sexual distress, over and above general chronic pain intensity or pain during sexual intercourse”.

Limitations of the Study

• Small sample size, cross-sectional design, and web-based recruitment.

Lay Summary

In this study, researchers from the University of Bergamo in Italy investigated the link between sexual distress and psychological and cognitive factors in women with endometriosis.

Compared to the general female population, women with endometriosis have a nine-fold increased risk of experiencing dyspareunia. Dyspareunia has a negative effect on women’s quality of life and has been associated with sexual dysfunctions such as decreased sexual desire, arousal difficulties, and orgasm disorders. Women with endometriosis have two times more occurrence of sexual dysfunction than women without the condition.

Women with endometriosis also experience sexual distress, which refers to personal distress related to a specific sexual difficulty. Interestingly, it has been observed that not all women experiencing sexual distress have sexual dysfunction. Sexual distress could instead be related to psychological and cognitive factors, including the way an individual copes with their own thoughts about stressors (i.e. pain and sexual dysfunction).

Metacognition refers to the “psychological structures, knowledge, events and processes that are involved in the control, modification, and interpretation of thinking itself”. In the metacognition model, the onset and maintenance of distress are not caused by the negative content of thoughts about stressors but are related to how individuals cope with those thoughts. This study uses the metacognition model to understand sexual distress in women with endometriosis.  

Ninety-six women participated in the study and completed online surveys which assessed general chronic pain intensity, dyspareunia, metacognitive beliefs, and sexual distress. The Metacognitions Questionnaire included five subscales: (1) “positive beliefs” about worry, which assesses the thoughts about the beneficial effect of worrying (e.g., for avoiding problems, or remaining organized); (2) “negative beliefs” about uncontrollability of thoughts and corresponding danger, which includes items about the importance of controlling one’s thoughts in order to prevent dangers related to the uncontrol; (3) “cognitive confidence”, which refers to lack of self-confidence in one’s memory and attention; (4) “need to control thoughts”, which concerns ideas of superstition and punishment related to some thoughts; and (5) “cognitive self-consciousness”, which refers to items reflecting the tendency to be aware of and monitor thinking.

High levels of dyspareunia (66%) and sexual distress (76%) were reported among the participants. While dyspareunia and pain intensity did not predict sexual distress, metacognitive beliefs did. These results show that cognitions about own worries play the most important role in the prediction of sexual distress, over and above general chronic pain intensity or pain during sexual intercourse.

Previous studies have also reported a link between coping strategies and psychological distress among endometriosis patients. Positive correlations have been found between negative coping strategies such as catastrophizing and the experience of pain.

Zarbo et al., suggest that future studies should continue to investigate which factors contribute to sexual distress in women with endometriosis. They also highlight the need for clinicians to address sexual issues in healthcare settings and for psychologists to play a greater role in the care of women with endometriosis.  

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/?term=30446830