The Association Between Illness Representations, Coping Strategies, Optimism, Social Support, and Health-Related Quality of Life in Women with Vulvodynia: Comparison Between Non-Religious Women and Ultra-Orthodox Women

Background: Vulvodynia is a chronic pain condition defined as vulvar pain lasting at least three months, without an identifiable infectious, dermatological, or neurological cause. Its prevalence is estimated at approximately 8%–10% among women across the lifespan. Beyond its physical manifestations, vulvodynia is associated with significant psychological and social consequences, including impairments in health-related quality of life (HRQoL). Previous research on chronic pain conditions suggests that cognitive and psychosocial factors, such as illness perceptions, coping strategies, optimism, and perceived social support, play a central role in shaping patients’ quality of life. However, these variables have been less systematically examined in the context of vulvodynia, particularly within an integrative framework.

Objective: The present study aimed to examine the associations between illness perceptions, coping strategies, optimism, and perceived social support, and health-related quality of life among women with vulvodynia, based on Leventhal’s Self-Regulation Model (Leventhal et al., 1980).

Method: A cross-sectional quantitative study was conducted among 207 women diagnosed with vulvodynia (77.3% not in a romantic relationship), recruited through an online survey disseminated via social media platforms. Participants completed a battery of validated questionnaires, including the Short Form Health Survey (SF-12; Ware & Sherbourne, 1992), the Brief Illness Perception Questionnaire (Broadbent et al., 2006), the COPE inventory (Carver et al., 1989), the Life Orientation Test–Revised (Scheier & Carver, 1985), the Multidimensional Scale of Perceived Social Support (Zimet et al., 1988), and additional measures assessing demographic and clinical characteristics.

Results: Findings indicated a significant association between illness perceptions and HRQoL, such that more negative illness perceptions were linked to poorer quality of life. In addition, optimism and perceived social support were positively associated with HRQoL. Coping strategies demonstrated a more complex pattern: maladaptive coping was negatively associated with HRQoL, whereas adaptive coping did not show a consistent independent contribution when other variables were considered. Furthermore, relationship status was significantly associated with HRQoL, with women in romantic relationships reporting a higher quality of life compared to single women. A regression model revealed that illness perceptions, optimism, and perceived social support jointly accounted for 45.7% of the variance in HRQoL, whereas coping strategies did not contribute significantly beyond these factors.

Conclusions: The findings underscore the central role of cognitive and social factors in shaping health-related quality of life among women with vulvodynia. In particular, illness perceptions emerged as a key determinant, alongside optimism and perceived social support. These results support the relevance of Leventhal’s Self-Regulation Model in understanding adaptation to vulvodynia and highlight the importance of addressing maladaptive illness beliefs in clinical interventions. At the same time, strengthening personal and social resources may contribute to improved psychological adjustment and quality of life in this population.

Implications: This study contributes to the limited literature examining psychosocial determinants of HRQoL in vulvodynia and provides a theoretical and empirical basis for developing targeted interventions. Clinical approaches that integrate cognitive restructuring of illness perceptions with the enhancement of social support and optimism may be particularly beneficial.