The Actual and Ideal Sexual Self Concept in the Context of Genital Pain Using Implicit and Explicit Measures

Background: The experience of pain during sexual intercourse generates significant distress and sexual impairments, which is likely to affect sexual identity and become a threat to the sense of self.

Aim: To explore the role of the concept of the sexual self in the context of genital pain by measuring different states of self (ie, actual vs ideal) at different levels of responding (ie, explicit vs implicit) and examine their associations with sexual, emotional, and pain-related variables.

Methods and main outcomes: Thirty young women who identified with genital pain and 29 women without pain completed (i) two versions of the Relational Responding Task as a measurement of implicit actual and ideal sexual self; (ii) explicit ratings of the actual and the ideal sexual self; and (iii) measurements of sexual self-esteem, global self-esteem, depression, sexual satisfaction, sexual distress or depression, sexual frequency, and pain experiences.

Results: Women with genital pain scored lower on the explicit and implicit actual-self measurements than women without pain but did not differ in their ideal self. Furthermore, the pain group reported higher ideal- than actual-self scores at the explicit level. Actual- and ideal-self measurements had differential effects on sexual, emotional, and behavioral outcome variables. In general, rating the ideal self higher than the actual self was related to more negative outcomes. Pain-related variables were predicted only by the implicit measurements, showing that the high pain group reported more pain, fear of pain, and a stronger tendency to continue with sex despite the pain when perceiving themselves as sexually less competent and when this perception did not match their ideal self.

Clinical implications: Therapeutic interventions might benefit from discussing women's internal guides for self, decreasing potential discrepancies, and developing identity-related motivational treatments that target the emotional discomfort and maladaptive behavioral strategies that result from trying to conform with their guides of self. Setting idealistically high sexual standards, feeling pressure to perform as a sexual partner, and fearing to be sexually unqualified could be key factors in developing, maintaining, and exacerbating sexual dysfunctions.

Strengths and limitations: This is the first study to systematically examine different components of the concept of the sexual self in the context of genital pain. Despite the small sample and the use of a non-clinical group of women, we found a theoretically and clinically interesting pattern of results.

Conclusions: Differentiating between different components of the sexual self is relevant to explain sexual, emotional, and pain-related responses. Dewitte M, De Schryver M, Heider N, De Houwer J. The Actual and Ideal Sexual Self Concept in the Context of Genital Pain Using Implicit and Explicit Measures. J Sex Med 2017;14:702-714.