{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T05:53:20Z","timestamp":1788587600451,"version":"build-2803163510"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"vor","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Bosko Foundation's Good Fruit Faith Initiative"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,6]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Aim<\/jats:title>\n 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).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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\u2014with and without OP\u2014 using multinomial and binary logistic regression.<\/jats:p>\n <\/jats:sec>\n \n Outcomes<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Clinical Implications<\/jats:title>\n 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\u2014such as sexual scripts in addition to abuse history\u2014when developing care plans.<\/jats:p>\n <\/jats:sec>\n \n Strengths and Limitations<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/jsxmed\/qdag020","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T12:11:52Z","timestamp":1769515912000},"source":"Crossref","is-referenced-by-count":2,"title":["The etiology of sexual pain in American Christian women: associations of sexual debut, maternal teachings on sex, and abuse history with pain severity"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5885-6263","authenticated-orcid":false,"given":"Joanna","family":"Sawatsky","sequence":"first","affiliation":[{"name":"Bare Marriage, Incorporated"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori","family":"Mize","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy and Athletic Training, University of Utah , Logan 84108 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"Gregoire","sequence":"additional","affiliation":[{"name":"Bare Marriage, Incorporated"},{"name":"Department of Paediatrics, Queen's University , Kingston K7N 3N6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arielle Leonard","family":"Hodges","sequence":"additional","affiliation":[{"name":"Department of Communications, George Fox University , Newberg , Oregon 97132,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Lindenbach","sequence":"additional","affiliation":[{"name":"Bare Marriage, Incorporated"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila Wray","family":"Gregoire","sequence":"additional","affiliation":[{"name":"Bare Marriage, Incorporated"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"2026061208342334000_ref1","volume-title":"StatPearls [Internet]","author":"Tayyeb","year":"2023"},{"issue":"3","key":"2026061208342334000_ref2","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1111\/j.1743-6109.2005.20347.x","article-title":"Women\u2019s sexual pain and its management","volume":"2","author":"Weijmar Schultz","year":"2005","journal-title":"J Sex Med"},{"key":"2026061208342334000_ref3","doi-asserted-by":"publisher","first-page":"519\u2013543. srae031","DOI":"10.1093\/socrel\/srae031","article-title":"Sanctified sexism: effects of purity culture tropes on white Christian Women\u2019s marital and sexual satisfaction and experience of sexual pain","volume":"86","author":"Sawatsky","year":"2024","journal-title":"Sociol Relig"},{"issue":"0","key":"2026061208342334000_ref4","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1080\/0092623X.2025.2593329","article-title":"Potential mechanisms through which sexual sanctification may influence sexual outcomes: sexual mindfulness, sexual intercourse frequency, sexual communication, and orgasmic consistency","volume":"52","author":"Busby","year":"2025","journal-title":"J Sex Marital Ther"},{"issue":"4","key":"2026061208342334000_ref5","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1016\/j.jsxm.2021.02.003","article-title":"Exploring relationships between Genito-pelvic pain\/penetration disorder, sex guilt, and religiosity among college women in the U.S","volume":"18","author":"Azim","year":"2021","journal-title":"J Sex Med"},{"issue":"11","key":"2026061208342334000_ref6","doi-asserted-by":"publisher","first-page":"2355","DOI":"10.1093\/aje\/kwy142","article-title":"Associations of religious upbringing with subsequent health and well-being from adolescence to young adulthood: an outcome-wide analysis","volume":"187","author":"Chen","year":"2018","journal-title":"Am J Epidemiol"},{"key":"2026061208342334000_ref7","doi-asserted-by":"publisher","first-page":"278730","DOI":"10.5402\/2012\/278730","article-title":"Religion, spirituality, and health: the research and clinical implications","volume":"2012","author":"Koenig","year":"2012","journal-title":"ISRN Psychiatry"},{"issue":"2","key":"2026061208342334000_ref8","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1037\/rel0000245","article-title":"Sex guilt or sanctification? 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