The Application of the Stable-Modifiable Model of Vulnerability and Resilience Processes in Those with Endometriosis

Endometriosis is a chronic, multisystemic estrogen-dependent disease of inflammation characterized by the ectopic presence of endometrial-like tissue occurring in areas outside of the uterus, often resulting in significant impacts on social well-being, psychological health, and sexual health. Despite endometriosis being found in individuals with diverse genders and ethnocultural backgrounds, most research has focused on white cisgender women. Few studies have addressed sexuality-related variables in the endometriosis population despite the well-known relationship between sexual health and quality of life. Considering the significant knowledge gaps related to adaptive outcomes in individuals with endometriosis, the current study aimed to use a vulnerability and resilience framework to examine several psychological variables that may be associated with sexual distress and sexual satisfaction in a sample inclusive of anyone (regardless of sex or gender) who has received a diagnosis or suspects a diagnosis of endometriosis. Associations between sexual self-consciousness, sexual flexibility, fear of pain, pain catastrophizing, pain self-efficacy, chronic pain acceptance, trait resilience, sexual distress, and sexual satisfaction were examined using multiple mediation, and multiple moderated moderated mediation models. The current study included 523 individuals in an intimate and/or romantic relationship with a diagnosis or suspected diagnosis of endometriosis. A significant indirect effect of sexual self-consciousness on sexual distress through sexual flexibility and pain catastrophizing was found. There was also a significant indirect effect of sexual self-consciousness on sexual satisfaction through pain catastrophizing when fear of pain was included as a moderator of pain catastrophizing. Thus, the relationship between sexuality and psychological pain experience is more complex than originally thought and requires further attention. Future research should investigate both intra- and interpersonal modifiable and stable vulnerability and resilience factors associated with sexual distress and sexual satisfaction in individuals with endometriosis who are in partnered relationships.