Psychosexual correlates of persistent postsurgical pain in patients with vulvodynia

Abstract

Objective To examine long-term reports of pain and psychologic correlates of pain in women after vestibulectomy. Methods In a retrospective cross-sectional exploratory study, 37 women who had undergone vestibulectomy between January 1989 and January 2008 completed questionnaires assessing demographic information, self-reported levels of pain, anxiety, somatization, psychologic distress, and sexual function. Results Eight women reported being completely pain free after surgery. The remaining 29 women reported various levels of pain during intercourse (as measured by the Gracely pain scale) and decreased sexual function (as measured by a sexual functioning questionnaire). Various measures of psychologic distress were associated with average intercourse-related pain, including brief symptom inventory (P=0.002), Pennebaker inventory of limbic languidness (P=0.002), perceived stress scale (P=0.04), and Spielberger trait–anxiety inventory (P=0.01). These same measures of psychological distress were similarly associated with general, unprovoked vaginal pain. Conclusion The present data suggest that the pathophysiology of localized vulvodynia may be more complex in some women, leading to a suboptimal response to surgical treatment.

Natural History of Comorbid Orofacial Pain Among Women With Vestibulodynia

“…13, 14 This is consistent with the hypothesis that many forms of vestibulodynia are idiopathic pain conditions mediated by dysregulation in the CNS. If vestibulodynia is centrally mediated, patients will experience symptoms common to other idiopathic pain conditions (e.g., psychological distress).…”

“…10–12 Women with higher non-genital pain sensitivity and anxiety tended to respond poorly to conventional treatments for vestibulodynia. 4 This work, as well as that of others, 13–15 has led to a gradual shift away from the traditional conceptualization of vestibulodynia as primarily a local mucosal inflammatory process.…”

Biopsychosocial correlates of persistent postsurgical pain in women with endometriosis

“…These varying responses to surgery indicate that endometriosis pain may be mediated by psychological and social factors [9] rather than only pathologic findings. It is known that high psychological distress is associated with postsurgical pain [23] and, specifically, the presence of catastrophization may contribute to the development of PPSP [23,24]. Pinto et al [22] recently described risk factors for PPSP in women who undergo hysterectomy for benign disease, including younger age, those with pre‐existing mental illness (including high levels of catastrophizing characteristics) and type of surgery performed (open abdominal procedures are associated with an increased risk of PPSP).…”

Vulvar Vestibulodynia

“…Increased trait anxiety has been long recognized to be more common in women with this condition. 29,31,[34][35][36][37] Heightened levels of hypervigilance (the process of continually scanning the body for pain), pain catastrophizing (possessing exaggerated negative thoughts about pain or the meaning of pain), and avoidance have been noted with this condition 29,35 and are associated with lower treatment efficacy, whereas patients with higher levels of pain self-efficacy (the belief that one will be able to cope with pain and control it) demonstrate improved response to treatment. 35 Zolnoun et al 38 found that women with primary VVD demonstrate higher levels of somatization, anxiety, and psychological distress than women with secondary disease, but this did not translate into higher levels of intercourse pain.…”