A Psychophysiological Investigation of Sexual Arousal in Women with Lifelong Vaginismus

Abstract

Introduction Relatively little is known about the subjective reactions of women with lifelong vaginismus to erotic stimuli and genital arousal has never been investigated. Reports of maladaptive cognitions and fears regarding sexuality and intercourse suggest that anxiety may interfere with sexual arousal in women with vaginismus. Aims To examine the genital and subjective responses to sexually explicit film stimuli of women with lifelong vaginismus compared with women with lifelong dyspareunia and women with no pain. Methods Forty-five women (15 vaginismus, 15 dyspareunia, and 15 no pain) viewed two neutral and two erotic film sets, one depicting sexual activity without vaginal penetration and the other depicting intercourse, over two testing sessions. Main Outcome Measures Vulvar temperature was recorded using an infrared camera. Participants completed a measure of subjective responses after viewing each film. Results All groups experienced increased vulvar temperature during the erotic films regardless of activity depicted. In response to the erotic films, the vaginismus group reported less mental arousal than the no-pain group and a range of negative subjective responses, including threat and disgust. Overall, participants showed concordance between peak subjective sexual arousal and temperature change from baseline to peak arousal. Conclusion Despite negative subjective responses, women with vaginismus responded with increased genital sexual arousal to erotic films. The resilience of genital arousal may have resulted from moderate levels of anxiety experienced in the laboratory setting facilitating sexual response regardless of subjective appraisal; however, anxiety experienced in a dyadic context may interfere more substantially.

Automatic and Deliberate Affective Associations with Sexual Stimuli in Women with Lifelong Vaginismus Before and After Therapist-Aided Exposure Treatment

“…The current study in women with vaginismus showed that enhanced levels of more negative affect occurred not only in response to penetration stimuli but also following nonpenetration stimuli. These findings are consistent with the outcome of a recent study in which more negative subjective responses were found not only following scenes of intercourse, but, specific in women with vaginismus, also in response to erotic films [50]. These findings underline the suggestion of a more generally enhanced dispositional disgust propensity in women with vaginismus [51].…”

“…Clearly, this pattern of results of the sex AST casts doubt on the role of automatic global affective associations in vaginismus. The current results with the sex AST are in line with earlier findings indicating that ambivalent emotions and negative affect in response to erotic stimuli do not impede automatic responses revealing genital arousal [47,49,50,53]. Together, the current findings suggest that only if women with vaginismus have sufficient opportunity to utilize additional information and have sufficient resources for more deliberate information processing, more negative appraisals of sex stimuli may arise.…”

Brain Processing of Visual Stimuli Representing Sexual Penetration versus Core and Animal-Reminder Disgust in Women with Lifelong Vaginismus

“…Thus no evidence emerged to suggest that pictures representing core or A-R stimuli elicited relatively strong feelings of disgust in women with vaginismus. Yet, in line with previous studies [24], [40], [19], [41] women with vaginismus subjectively rated the disorder-specific PEN stimuli as more disgusting, more threatening and less pleasurable than the group of sexually asymptomatic women. A similar pattern was evident for women suffering from dyspareunia.…”

“…Clearly, the disgust-associations with sexual stimuli vary across individuals and has been shown to be especially pronounced in women with primary vaginismus or dyspareunia [24], [19]. This pattern of findings thus led to the current hypothesis that the overlap in brain areas activated in response to sexual penetration and disgust would be especially pronounced in those who have a problem with sexual penetration (e.g., vaginismus).…”

Peripheral Female Genital Arousal as Assessed by Thermography Following Topical Genital Application of Alprostadil vs Placebo Arousal Gel: A Proof-of-Principle Study Without Visual Sexual Stimulation

“…The use of thermography as a method of measuring female sexual arousal has been well validated 27, 28, 29, 30, 31, 32. This was an investigator-initiated pilot study to determine whether a larger study in women with FSAD might be feasible.…”