Psychosexual aspects of vulvovaginal pain

Abstract

Vulvovaginal pain problems are major health concerns in women of childbearing age.Controlled studies have shown that vulvovaginal pain can adversely affect women and their partners' general psychological well-being, relationship adjustment and overall quality of life. These women have significantly lower levels of sexual desire, arousal, and satisfaction, as well as a lower intercourse frequency than normal controls. They also report more anxiety and depression, in addition to more distress about their body image and genital self-image. Empirical studies indicate that specific psychological and relationship factors may increase vulvovaginal pain intensity and its psychosexual sequelae. Randomized clinical trials have shown that psychosexual interventions, namely cognitive-behavioral therapy (CBT), are efficacious in reducing vulvovaginal pain and improving associated psychosexual outcomes. Women reporting significant psychological, sexual and/or relationship distress should be referred for psychosexual treatment. A multimodal approach to care integrating psychosexual and medical management is thought to be optimal.Keywords: vulvovaginal pain, vulvodynia, provoked vestibulodynia, psychological adjustment, sexual function, cognitive-behavioral therapy 3 Vulvovaginal pain problems are major health concerns in women of all ages. As conditions which are often misdiagnosed, mismanaged, trivialized or ignored, they entail a great personal cost to patients and a significant financial cost to society [1]. A case in point is vulvodynia: a population-based study suggests that the lifetime cumulative incidence of vulvodynia is 16% [2, 3] and its incidence is thought to be increasing in young women [4,5]. In fact, many women suffering from vulvovaginal pain are under the age of 30, with community estimates showing that one in five women aged 18-29 report chronic dyspareunia [6]. In addition to disrupting all aspects of sexual function, controlled studies have shown that vulvovaginal pain can adversely affect women and their partners' general psychological well-being, relationship adjustment and overall quality of life [7, 8]. Because of their deleterious impact on sexuality and romantic relationships, vulvovaginal pain problems may indeed carry a heavier psychosocial burden in comparison to other pain problems common in women, with many patients reporting feelings of shame, inadequacy and low self-esteem [9]. Further, up to 45% of women with vulvodynia report a comorbid-pain condition, and having a comorbidity is associated with increased feelings of isolation and invalidation [10]. In terms of helpseeking behaviors, epidemiological results indicate that only 60% of women who report chronic vulvovaginal pain seek treatment, and 40% of these never receive a formal diagnosis [5]. A recent study involving a community sample showed that women saw an average of five physicians before diagnosis [10]. The quality of health care received by this patient population is thus less than optimal. It has been suggested that a multi...

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

“…STIs are a known direct cause of genital pain34 and although this may explain the association we found, it is also possible that previous experience of an STI leads some individuals to associate sex with disease, possibly engendering difficulties with arousal, and in turn, leading to painful sex 2. In contrast to previous research,7, 12, 31 we did not find an association of pain with frequency of intercourse. It has been suggested that some women simply endure their symptoms in order to continue having sex with their partner2, 35 and our inclusion of women with milder symptoms (compared with clinical samples) may have resulted in a higher proportion of women who continue to have sex despite their symptoms.…”

“…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.…”

“…We found that reporting painful sex was associated with menopausal status, although several studies have failed to find such an association 5, 17, 38. Our finding of an association with depressive symptoms is supported by case–control studies7, 12, 14 but has not always been found in population studies 15, 31…”

“…It can lead to feelings of isolation, shame, sexual inadequacy, loss of confidence and feeling out of control 7, 8, 38. Only a fraction of women affected by genital pain disorders ever receive an official diagnosis: 1.4% in a study of women meeting criteria for vulvodynia 30.…”

“…The underlying conditions are often difficult to diagnose and treat,2, 5, 6 and the aetiological factors are complex, and poorly understood. Partly because of this, sexual pain disorders are often overlooked or badly managed, significantly exacerbating patient distress 7. There are many potential causes, and efforts to understand and characterise the problem are hampered by classificatory challenges1, 8 and scant empirical evidence 9.…”