Chronic pain is known to affect sexual functioning and sexual relationships. Both pain and sexual functioning are multidimensional constructs. Different aspects of the experience of chronic pain are related to psychological, physical, and social health and to overall well-being (Penny, Purves, Smith, Chambers, & Smith, 1999), as well as to various dimensions of sexual functioning, such as arousal, drive, sexual behavior, and satisfaction with sexual relationships (Flor, Turk, & Scholz, 1987; Monga, Tan, Ostermann, Monga, & Grabois, 1998).

In studying these effects, much of the research on chronic pain and sexuality has focused on patients involved in chronic pain treatment programs or other types of medical care and, in particular, on the sexual functioning of men with various disabilities. In the broader research literature, the experience of chronic pain, depression, the quality of intimate relationships, and child sexual abuse have all been shown to be related to sexual function; however, no study has looked at these factors in combination.

This study contributes to research in this area by examining sexual functioning in a nonclinical sample of women with chronic pain who may or may not have been involved in treatment and thus are more diverse than patient samples. The aim of the study was to clarify and extend the results of previous studies with primarily male participants who were receiving medical care (Coates & Ferroni, 1991; Flor et al., 1987; Monga et al., 1998; Tan, Monga, Thornby, & Monga, 1998). This study focused on women who suffer from chronic pelvic pain, as research has shown them to have difficulty with sexual functioning due to the pain (Fry, Crisp, & Beard, 1991; Collett, Cordle, Stewart, & Jagger, 1998) and a higher probability of having experienced childhood abuse (Collett et al., 1998; Walling et al., 1994). The main objective of the study was to develop a model of sexual functioning in women with chronic pelvic pain, incorporating key predictor variables such as pain experience, depression, relationship mutual support (i.e., support in intimate relationships), and childhood sexual abuse.

Chronic Pain

Chronic pain has a deleterious effect on sexual functioning. Factors that have been addressed in the area of chronic pain and sexuality include pain-related variables such as pain severity and frequency of pain (Ambler, Williams, Hill, Gunary, & Cratchley, 2001), as well as appraisal of control over life, the extent of interference caused by chronic pain (Monga et al., 1998), depression (Averill, Novy, Nelson, & Berry, 1996; Tan et al., 1998), and marital satisfaction (Flor et al., 1987). Work-related and demographic factors also affect sexual functioning in people with chronic pain, specifically unemployment, disability status (Monga et al., 1998), and age, with older age having a negative correlation with sexual frequency, drive/interest, and satisfaction (Monga et al., 1998; Tan et al., 1998).

Being a gynecological condition, chronic pelvic pain is, to some degree, more directly associated with sexual dysfunction than chronic pain at other sites. In one study of chronic pelvic pain patients’ feelings and beliefs about their pain or illness, 40 out of 64 participants cited sexual dysfunction as one of the chief problems the illness had caused, making it the most frequent complaint (Fry et al., 1991).

Relationship Mutual Support

The quality of intimate relationships is closely connected with sexual function (McCabe, 1999; Metz & Epstein, 2002; Trudel, 2002). Satisfaction with the sexual relationship appears to be associated with higher marital functioning (Flor et al., 1987; Trudel). In addition to its relationship with marital dissatisfaction, sexual dissatisfaction is related to sexual dysfunction (Flor et al., 1987). In cases in which one partner suffers from chronic pain, the ability of both partners to cope with the pain and the extent to which partners are supportive of the chronic pain sufferer have been found to be a predictor of sexual functioning (Flor et al., 1987; Jenson, 1985).

Depression

Depression is one of the most frequently-studied aspects of chronic pain’s impact on psychological health. Rates for probable depression in pain patients range from 38% to 87% (Flor et al., 1987; Holzberg, Robinson, & Geisser, 1993; Monga et al., 1998; Tan et al., 1998). Independently, pain-related factors such as pain duration and pain intensity do not appear to account for significant variation in depression scores (Averill et al., 1996; Turner, Jensen, & Romano, 2000), though Heinberg, Fisher, Wesselmann, Reed, and Haythornthwaite (2004) found that pain severity independently predicted depression. Other factors may mediate the effects of pain on depression, such as work status, education, and marital status (Averill et al.).

Apart from its link with chronic pain, depression also independently has a powerful influence on sexual relationships. A problematic issue in addressing the relationship between depression and sexual function is that while depression is closely associated with decreased sexual function (Basson, 2001; Philipp et al., 1999), sexual function is also often negatively impacted by medication taken for depression (see Ferguson, 2001 for a review). However, Michelson, Schmidt, Lee, and Tepner (2001) evaluated the effects of the drug fluoxetine in treating depression and found the sexual function improved for the majority of patients. Deterioration in sexual function appeared to be related to increases in depressive symptoms rather than to side effects of the drug.