The effect of pain‐related fear on sexual arousal in women with superficial dyspareunia

Abstract

The role of pain-related fear in the etiology and/or maintenance of superficial dyspareunia is still unclear. The objective of this experiment was to investigate the effects of pain-related fear on sexual arousal in women with superficial dyspareunia (n=48) and women without sexual complaints (n=48). To induce pain-related fear, participants were told that they had a 60% chance of receiving painful stimuli while being exposed to one of two erotic film clips. Genital arousal was assessed using vaginal photoplethysmography. Self-reported ratings of genital sensations and affect were collected after both erotic stimulus presentations. Elevated levels of skin conductance and higher ratings of experienced threat during the pain threat condition indicated that fear was successfully elicited. Pain-related fear impeded genital arousal in all women. Women of both groups reported significantly less positive affect and more negative affect when threatened. Although women with dyspareunia did not differ in their genital responsiveness from women without sexual complaints, they experienced overall significantly more negative affect than the control group. The present results indicate that pain-related fear reduces genital and subjective sexual responding in women with and without sexual problems. We conclude that emotional appraisal of the sexual situation determines genital responsiveness in both sexually dysfunctional and functional women.

Psychosexual aspects of vulvovaginal pain

“…Research conducted in laboratory settings indicates that there are no significant differences between women with vulvovaginal pain and non afflicted women relative to their physiological level of sexual arousal when exposed to an erotic stimulus, although women with pain tend to report more negative feelings toward the stimulus [13][14][15].…”

“…Specifically, controlled studies have shown that they report significantly less sexual desire, arousal and satisfaction, more difficulty reaching orgasm, as well as lower frequencies of intercourse and more negative attitudes toward sexuality than pain-free controls [12]. Research conducted in laboratory settings indicates that there are no significant differences between women with vulvovaginal pain and non afflicted women relative to their physiological level of sexual arousal when exposed to an erotic stimulus, although women with pain tend to report more negative feelings toward the stimulus [13][14][15].…”

“…Many controlled studies have also found that these women display more state and trait anxiety than pain-free controls [30][31][32]. Further, there is evidence suggesting that anxiety may decrease the level of physiological sexual arousal in this population [15]. In summary, vulvovaginal pain results in several psychosexual sequelae, many of which require targeted interventions.…”

“…Specifically, controlled studies have shown that they report significantly less sexual desire, arousal and satisfaction, more difficulty reaching orgasm, as well as lower frequencies of intercourse and more negative attitudes toward sexuality than pain-free controls [12]. Research conducted in laboratory settings indicates that there are no significant differences between women with vulvovaginal pain and non afflicted women relative to their physiological level of sexual arousal when exposed to an erotic stimulus, although women with pain tend to report more negative feelings toward the stimulus [13][14][15].Both quantitative and qualitative studies show that many women with vulvovaginal pain also report negative changes in their sexual self-esteem and in their body image, such as feeling less sexually desirable, feeling less confident about their sexuality and feeling less feminine than before [16][17][18][19]. Specifically, a study conducted among a community sample of 330 women showed that, in comparison to pain-free controls, women with vulvovaginal pain reported significantly more distress about their body image and a more negative genital self-image.…”

Understanding sexual pain: A cognitive-motivational account

“…Hence, critical for the development of dyspareunia is the lack of genital arousal that is marked by insufficient lubrication and driven by anticipation-anxiety. In support of this model, research has shown that women react with involuntary pelvic floor muscle activity in response to threatening sexual stimuli [34] and impeded genital arousal -as measured through vaginal pulse amplitude signals -in response to appraisal (i.e., suggestion that a female actor experiences pain) and pain threat (i.e., threat of electrical pulses on the ankle) manipulations [6,7].Genital responsiveness was, however, not different in women with dyspareunia compared to healthy controls, although they did report lower subjective sexual arousal. Note that such discordance between physiological (i.e., genital) and psychological (i.e., subjective experience of) sexual arousal is commonly observed in women [26].…”