Do Psychosexual Factors Play a Role in the Etiology of Provoked Vestibulodynia? A Critical Review

Abstract

The aim of this review was to critically examine published studies concerning the psychosexual aspects of provoked vestibulodynia. Despite the presence of several methodological limitations, some findings were consistently replicated. Overall, women with vestibulodynia demonstrate impaired sexual functioning, namely, lower levels of sexual desire, arousal, and frequency of intercourse. Childhood physical and sexual abuse represent potential risk factors for the development of this condition. Additionally, specific psychological states such as anxiety, fear of pain, hypervigilance, catastrophizing, and depression, are more frequently reported by these women. More rigorous studies are needed to establish which psychosexual variables may exacerbate and/or maintain vestibulodynia.

Painful sex (dyspareunia) in women: prevalence and associated factors in a British population probability survey

“…Our data confirm the strong link between pain and impaired sexual function found in the literature 2, 7, 12, 31. The relationship context of pain is beginning to receive more attention,7 but evidence of the link between sexual pain and relationship adjustment and satisfaction is equivocal 32.…”

“…A number of studies have linked childhood abuse with later experience of painful sex 12, 33. We found a link with sex against one's will, after the age of 13 years, suggesting that nonvolitional sex in adolescence and adulthood is also important.…”

“…lichen sclerosus), vulvovaginal and urinary tract infections, sexually transmitted infections (STIs) and endometriosis 11. Dyspareunia is often co‐morbid with sexual difficulties such as lack of desire and arousal,12 and strain within the sexual relationship 13. Psychosocial correlates include negative body image, catastrophising, hypervigilance to pain, depression and anxiety, and low self‐esteem 12, 14, 15, 16.…”

“…Dyspareunia is often co‐morbid with sexual difficulties such as lack of desire and arousal,12 and strain within the sexual relationship 13. Psychosocial correlates include negative body image, catastrophising, hypervigilance to pain, depression and anxiety, and low self‐esteem 12, 14, 15, 16. Although these psychosocial variables may be both aetiological and sequelae, the cross‐sectional nature of most studies limits understanding of causal direction 8…”

“…To date, most research on painful sex has been based on small clinical samples 5, 12. These studies exclude women who have not sought help3 and are therefore not representative of the general population.…”