Journal of Midwifery and Reproductive Health

Journal of Midwifery and Reproductive Health

The Significance of Primary Incompatible Schema Differentiation in Women with Primary and Secondary Dyspareunia: A Comparative Cross-Sectional Study

Document Type : Original Research Article

Authors
Maryam Moghadasin 1
Hossein Rezaei Aderyani 2
Yasaman Merci 2
1 Associate Professor, Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Kharazmi University, Tehran, Iran
2 Graduated of Clinical Psychology, Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Kharazmi University, Tehran, Iran
10.22038/jmrh.2026.83240.2499
Abstract
Background & aim: Dyspareunia negatively affects women’s intimate relationships. Although early maladaptive schemas (EMS) have been linked to sexual dysfunction, few comparative studies were conducted in non-Western contexts. This study compared EMS among women with primary and secondary dyspareunia with a control group.
Methods: This comparative cross-sectional study was conducted between January and May 2023, including 1912 women (primary dyspareunia: n=402, secondary dyspareunia: n=104, control: n=1406(, who referred to the sexual/reproductive health clinic of a private hospital in Tehran, Iran. Women aged 18 to 45, married for at least one year with experience of dyspareunia were included. Participants were recruited through convenience sampling. The control group was matched for demographic characteristics. Data were collected using the validated Persian version of the Young Schema Questionnaire and analyzed using one-way multivariate analysis of variance and discriminant analysis in SPSS version 26.0.
Results: Mean ages in the control, primary, and secondary dyspareunia groups were 29.49, 28.40, and 30.57 years, respectively. Women with dyspareunia exhibited significantly higher scores on EMS domains including disconnection/rejection, impaired autonomy, and over-vigilance/inhibition compared with controls (P< 0.001). Discriminant analysis yielded two significant functions (eigenvalues: 0.044 and 0.018), with a modest overall classification accuracy of 48.6%. No significant schema-pattern differences were found between two groups of primary and secondary dyspareunia (P > 0.05).
Conclusion: EMS significantly contribute to dyspareunia, indicating potential benefits of schema-focused interventions. Further research should examine long-term treatment outcomes.
Keywords
Dyspareunia
Sexual Dysfunctions
Psychological
Cognitive Behavioral Therapy
Sexual Health
Subjects
1.           American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th editor. Washington, DC: American Psychiatric Publishing; 2013.
2.           Meana M, Binik YM. The biopsychosocial puzzle of painful sex. Annual Review of Clinical Psychology. 2022;18(1): 471–495.
3.           Gandhi J, Chen A, Dagur G, Suh Y, Smith N, Cali B, et al. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. American Journal of Obstetrics and Gynecology. 2016; 215(6): 704–711.
4.           Erbil N. Relationship between sexual myths and sexual function of women. International Journal of Caring Sciences. 2019; 12(3): 1570–1579.
5.           Carlson K, Mikes BA. Dyspareunia: StatPearls Publishing; 2026. Available from: https:// www.ncbi. nlm.nih.gov/ books/NBK562159/.
6.           Alizadeh A, Farnam F, Raisi F, Parsaeian M. Prevalence of and risk factors for genito-pelvic pain/penetration disorder: a population-based study of Iranian women. The Journal of Sexual Medicine. 2019; 16(7): 1068–1077.
7.           Banaei M, Kariman N, Ozgoli G, Nasiri M. Bio-psychosocial factor of vaginismus in Iranian women. Reproductive Health. 2021; 18(1): 210.
8.           Banaei M, Kariman N, Ozgoli G, Nasiri M, Ghasemi V, Khiabani A, et al. Prevalence of postpartum dyspareunia: a systematic review and meta‐analysis. International Journal of Gynecology & Obstetrics. 2021; 153(1): 14–24.
9.           Young JE, Klosko JS, Weishaar ME. Schema therapy: A practitioner's guide. 1st ed. New York: Guilford Press, 2003.
10.    Gong J, Chan RC. Early maladaptive schemas as mediators between childhood maltreatment and later psychological distress among Chinese college students. Psychiatry Research. 2018; 259: 493–500.
11.    Oliveira C, Nobre PJ. Cognitive structures in women with sexual dysfunction: the role of early maladaptive schemas. The Journal of Sexual Medicine. 2013; 10(7): 1755–1763.
12.    Tariq A, Reid C, Chan SW. A meta-analysis of the relationship between early maladaptive schemas and depression in adolescence and young adulthood. Psychological Medicine. 2021; 51(8): 1233–1248.
13.    Roemmele M, Messman-Moore TL. Child abuse, early maladaptive schemas, and risky sexual behavior in college women. Journal of Child Sexual Abuse. 2011; 20(3): 264–283.
14.    Nobre PJ, Pinto-Gouveia J. Questionnaire of cognitive schema activation in sexual context: A measure to assess cognitive schemas activated in unsuccessful sexual situations. Journal of Sex Research. 2009; 46(5): 425–437.
15.    Gálfi B, Cobeanu O, Kálcza-Jánosi K, Balázsi R. Sex (Is Not) On Fire: The Mediating Role of Cognitive Schemas Between Symptoms of Endometriosis and Sexual Distress. Studia Universitatis Babeş-Bolyai, Psychologia-Paedagogia. 2024; 69(1): 167 – 182.
16.    Dikmen SNT, Safak Y. Effect of early maladaptive schemas and sexual self-schemas in vaginismus. International Journal of Medical Case Reports. 2020; 4(11): 15–21.
17.    Cherner RA, Reissing ED. A comparative study of sexual function, behavior, and cognitions of women with lifelong vaginismus. Archives of Sexual Behavior. 2013; 42(8): 1605–1614.
18.    Thaler L. Cognitive processing in women with dyspareunia: What is more salient, the pain or the sex? [Master's thesis]. Las Vegas, NV: University of Nevada, Las Vegas; 2008.
19.    Alimoradi Z, Zarabadipour S, Arrato NA, Griffiths MD, Andersen BL, Bahrami N. The relationship between cognitive schemas activated in sexual context and early maladaptive schemas among married women of childbearing age. BMC Psychology. 2022; 10(1): 131.
20.    Waller G, Meyer C, Ohanian V. Psychometric properties of the long and short versions of the Young Schema Questionnaire: Core beliefs among bulimic and comparison women. Cognitive Therapy and Research. 2001; 25(2): 137–147.
21.    Malogiannis I, Aggeli A, Garoni D, Tzavara C, Michopoulos I, Pehlivanidis A, et al. Validation of the Greek version of the Young Schema Questionnaire-Short Form 3: Internal consistency reliability and validity. Psychiatrike= Psychiatriki. 2018; 29(3): 220–230.
22.    Khosravani V, Najafi M, Mohammadzadeh A. The Young Schema questionnaire-short form: A Persian version among a large sample of psychiatric patients. International Journal of Mental Health and Addiction. 2020; 18(4): 949–967.
23.    Saritas-Atalar D, Altan-Atalay A. Differential roles of early maladaptive schema domains on the link between perceived parenting behaviors and depression, anxiety, and anger. Current Psychology. 2020; 39(4): 1466–1475.
24.    Hashemian SS, Shayan S, Omidvar A, Modarres GM. Relationship between early maladaptive schemas and sexual satisfaction in working women in Mashhad Ferdowsi University and Shiraz University, Iran. 2015.
25.    Birnbaum GE, Reis HT, Mikulincer M, Gillath O, Orpaz A. When sex is more than just sex: attachment orientations, sexual experience, and relationship quality. Journal of Personality and Social Psychology. 2006; 91(5): 929-943.
26.    Yazdkhasti M, Molaeinezhad M, Tarrahi MJ, Karahmadi M, Salimi H. Investigating the relationship between early maladaptive schemas and sexual Self-Confidence and sexual Self-Efficacy in individuals with gender dysphoria. Advanced Biomedical Research. 2023; 12: 232.
Journal of Midwifery and Reproductive Health
Volume 14, Issue 4
Autumn 2026
Pages 5687-5695