Fear has been suggested as the crucial diagnostic variable that may distinguish vaginismus from dyspareunia. Unfortunately, this has not been systematically investigated. The primary purpose of this study, therefore, was to investigate whether fear as evaluated by subjective, behavioral, and psychophysiological measures could differentiate women with vaginismus from those with dyspareunia/provoked vestibulodynia (PVD) and controls. A second aim was to re-examine whether genital pain and pelvic floor muscle tension differed between vaginismus and dyspareunia/PVD sufferers. Fifty women with vaginismus, 50 women with dyspareunia/PVD, and 43 controls participated in an experimental session comprising a structured interview, pain sensitivity testing, a filmed gynecological examination, and several self-report measures. Results demonstrated that fear and vaginal muscle tension were significantly greater in the vaginismus group as compared to the dyspareunia/PVD and no-pain control groups. Moreover, behavioral measures of fear and vaginal muscle tension were found to discriminate the vaginismus group from the dyspareunia/PVD and no-pain control groups. Genital pain did not differ significantly between the vaginismus and dyspareunia/PVD groups; however, genital pain was found to discriminate both clinical groups from controls. Despite significant statistical differences on fear and vaginal muscle tension variables between women suffering from vaginismus and dyspareunia/PVD, a large overlap was observed between these conditions. These findings may explain the great difficulty health professionals experience in attempting to reliably differentiate vaginismus from dyspareunia/PVD. The implications of these data for the new DSM-5 diagnosis of Genito-Pelvic Pain/Penetration Disorder are discussed.

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Erectile dysfunction (ED) has been associated with considerable mental health and interpersonal problems, an increase in risky sex, and is particularly prevalent among gay and bisexual men. Psychological treatment protocols for sexual dysfunctions often aim at challenging beliefs and cognitions about the importance of a “perfect sexual performance,” known as sexual stereotypes. However, to date, little empirical evidence exists for the relationship between ED and belief in sexual stereotypes (BSS). To address this gap, 70 gay men were recruited; 30 with ED and 40 healthy controls. Participants completed a battery of questionnaires, including a measure of BSS, followed by having their genital temperature measured using a thermal imaging camera, while viewing a sexually explicit film. The study had four main objectives: (1) to evaluate between group differences in subjective sexual arousal and physiological arousal; (2) to examine within group differences in the effects of BSS on physiological and self-reported sexual arousal; (3) to evaluate the relationship between BSS, negative automatic thoughts during sex, and ED; and (4) to evaluate the relationship between ED and risky sex among gay men. Results revealed significant between-group differences in physiological arousal, but not in subjective sexual arousal. While between-group differences were found in BSS, no within-group differences were found in the relation of BSS on physiological and self-reported sexual arousal. No significant relationships were found between BSS, negative automatic thoughts, and ED. Participants with ED were found to be significantly more likely to use erectile enhancing drugs, but no significant differences in condom removal were found between groups; however, substantially more individuals with ED (23.3%) reported removing condoms prior to the completion of sexual activity, as compared to healthy controls (5%). Findings of this study contribute to improving psychological treatments for gay men with ED, as well as better understanding pathways leading to risky sex in gay men.

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Sexual dysfunction has been associated with considerable mental health and interpersonal problems. Gay and bisexual men report a higher rate of sexual dysfunction and childhood sexual abuse (CSA) compared to heterosexual men. The relationship between CSA and adult sexual health problems has been well established; however, the pathways leading from CSA to erectile dysfunction are poorly understood. The role that coping strategies, emotion dysregulation, and substance use play in the association between CSA and erectile dysfunction was examined using a mediational model. Results were not found to be statistically significant, with the exception of a significant relationship between CSA and avoidant coping. Possible explanations for the lack of significant findings are discussed, including problems with the measurement of ED. This study provided support for the disproportionately high rates of CSA among gay men.