Can Fear, Pain, and Muscle Tension Discriminate Vaginismus from Dyspareunia/Provoked Vestibulodynia? Implications for the New DSM-5 Diagnosis of Genito-Pelvic Pain/Penetration Disorder

Abstract

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.

A treatment model for anxiety-related sexual dysfunctions using mindfulness meditation within a sex-positive framework

“…A number of authors have addressed this debate about distinctions between genital pain disorders (e.g. Lahaie et al, 2014;Reissing et al, 2014) and what factors help differentiate. Lahaie and colleagues (2014) findings support that fear and vaginal tension better describe vaginismus than PVD.…”

Psychosexual health in gynecological cancer

“…If not, this is diagnostic of primary vaginismus, and apart from close inspection of the vulva and offer of gentle digital vaginal examination to determine the extent of the vaginismus, no further clinical investigation is warranted. Women with gynecological cancer are more likely to have secondary vaginismus caused by pain experienced from the disease or its treatment, and fear of the pain occurring during sex [10].…”

Vaginal penetration: pain or pleasure?

“…Women with genital pain reported lower levels of sexual arousal in response to various sexual stimuli than sexually functional women 46,47 . In addition, women with genital pain showed higher levels of pelvic floor muscle tension during a gynaecological examination than sexually functional women 13,18,48 . Based on the CB model for genital pain avoidance behaviour towards vaginal penetration can be expected.…”

“…The prevalence of vaginismus is not well established, although it is estimated to range between 1% and 6% 16 . Many women with vaginismus also experience pain upon touch (40-100%) 17,18 .…”

“…Based on the CB model for genital pain avoidance behaviour towards vaginal penetration can be expected. Accordingly, women with vaginismus showed relatively strong fear-avoidance tendencies to vaginal penetration or attempts of penetration (see Figure. 2) 2,18,49 . Also, a proportion of the dyspareunia group showed decreasing motivation to engage in sex over time 50,51 .…”