Abstract Background Sexual pain (SP) affects a significant proportion of women, with lifetime prevalence ranging from 7% to 46%, but is poorly understood. While conservative religious affiliation has been identified as a potential risk factor since the 1970s, the mechanisms underpinning this association remain insufficiently characterized. Aim To investigate the etiological factors contributing to SP among Christian women in the United States who attended church frequently in adolescence, with a focus on the roles of sexual debut timing, maternal explanations of sex and abuse history. The study also explores variation in SP presentation by severity, distinguishing cases by the presence or absence of obstructed penetration (OP). Methods Data were drawn from the Sexual Satisfaction and Function Survey (SSFS), a cross-sectional survey of American Christian women. Multinomial and binary logistic regression analyses were used to examine associations between SP and key psychosocial variables, including sexual debut (pre-marital vs post-marital), satisfaction with maternal sexual explanations, and abuse history (sexual and non-sexual). Analyses controlled for demographic covariates and evangelical self-identification. We estimated lifetime odds of SP—with and without OP— using multinomial and binary logistic regression. Outcomes Lifetime odds of developing SP by OP status were evaluated based on sexual debut, abuse history, and maternal sex communication while controlling for demographics and evangelical self-identification. Results Post-marital sexual debut was significantly associated with higher odds of SP with OP. In contrast, a history of abuse (sexual, non-sexual, or both) was associated with increased odds of SP without OP in all models and SP with OP in the full model only except for non-sexual abuse. Maternal sexual explanations were not significantly associated with SP outcomes except in SP with OP which satisfaction with maternal sex explanations was a risk factor for SP OP in a univariate model but was protective in the full model. Clinical Implications Findings highlight the importance of integrating sociocultural and religious context into the assessment and management of SP. Clinicians should incorporate routine assessment of psychosocial contributors—such as sexual scripts in addition to abuse history—when developing care plans. Strengths and Limitations This is the largest known dataset examining SP in Christian women, offering unique insights into underexplored psychosocial contributors. Limitations include non-probabilistic sampling and a racially homogeneous cohort, limiting generalizability. Conclusion SP among Christian women is differentially associated with psychosocial and religious factors depending on symptom severity. These findings extend prior research by distinguishing etiologic pathways by penetration status and underscore the need for nuanced, culturally informed approaches to both research and clinical intervention.
Sawatsky et al. (Tue,) studied this question.