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ABSTRACT: Introduction. Women with provoked vestibulodynia (PVD) report lower sexual arousal than nonaffected women, however, laboratory studies of arousal have reported contradictory results about whether group differences exist in genital and subjective arousal. Aim. To examine genital and subjective sexual arousal in women with and without PVD. Methods. Eligible women with and without PVD (N = 42) attended a laboratory session that included an interview, questionnaire completion, and genital imaging. A direct measure of superficial blood flow-laser Doppler imaging-was used to assess vulvar blood flow levels while participants watched three films, including an erotic film. Participants answered questions about their level of sexual arousal before, during, and after the erotic film. Main Outcome Measures. Average vulvar blood flow levels during the baseline and erotic films, numerical ratings of subjective sexual arousal and anxiety, as well as questionnaire measures of arousal. Results. There was a significant group difference in genital arousal, whereby the PVD group showed a lower genital response to the erotic film, as well as a significant interaction between baseline blood flow and group membership. Separate group regression analyses demonstrated that baseline blood flow explained a substantial amount of the variance in erotic film blood flow in the control group (70%), while only 27% was explained by this variable in the PVD group. There were no differences in subjective sexual arousal or anxiety between the groups. Across questionnaire measures, women with PVD reported lower sexual arousal than the control group. Conclusions. The results suggest that women with PVD show lower genital responsiveness than nonaffected women to sexual stimuli in a laboratory setting and that their genital arousal is likely impacted by a number of biopsychosocial factors. Boyer SC, Pukall CF, and Chamberlain SM. Sexual arousal in women with provoked vestibulodynia: The application of laser Doppler imaging to sexual pain. J Sex Med **;**:**-**.
Journal of Sexual Medicine 07/2012; · 3.55 Impact Factor
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ABSTRACT: There are few studies examining the relationship between lubricant use and sexual functioning, and no studies have examined this relationship in women with dyspareunia. Vaginal dryness is a prevalent complaint among women of all ages. There is an association between vaginal dryness and painful intercourse; therefore, women with dyspareunia represent a particularly relevant sample of women in which to investigate lubricant use.
The aim of this study was to examine differences between women with and without dyspareunia in self-reported natural lubrication and attitudes toward and use of personal lubricants.
Respondents completed an online survey including questions on demographics, gynecological/medical history, sexual functioning, and lubricant use and attitudes.
The main outcome measures used were the Female Sexual Function Index (FSFI) and questions regarding attitudes toward and use of lubricants.
Controls scored higher on the lubrication subscale of the FSFI than women with dyspareunia (P < 0.001). Women with dyspareunia reported greater frequency of lubricant use during sexual activity over the last year (P < 0.01). They were also more likely to use lubricant prior to penetration (P < 0.05). The most common use for controls was to enhance sexual experiences. This was also a common answer for women with dyspareunia; however, in this group, the most common reason was to reduce/alleviate pain. Lubricants were rated as less effective among women with dyspareunia vs. controls across all reported reasons for use. Nevertheless, lubricant use was still rated as being moderately effective in alleviating pain for women with dyspareunia.
Women with dyspareunia have more difficulty with natural lubrication; it is consequently not surprising that they reported using lubricant more frequently than control women. Women with dyspareunia reported using lubricants more often than controls to try to prevent or alleviate pain and reported this as being a moderately effective strategy, suggesting that it may be a useful tool for some women with dyspareunia.
Journal of Sexual Medicine 11/2011; 9(1):240-50. · 3.55 Impact Factor
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ABSTRACT: Smaller correlations have typically been found between genital and subjective sexual arousal in female versus male samples. This study evaluated the association between response bias and the relationship between genital and subjective arousal (i.e., concordance) in women with (n = 20) and without (n = 21) provoked vestibulodynia. Participants (M = 21.27 years, SD = 2.27) underwent blood flow imaging via a laser Doppler imager to assess genital responsiveness to a visual erotic stimulus; subjective arousal was assessed during and following the film. The relationships between three types of subjective arousal ratings (perceived sexual arousal, perceived genital responsiveness, and reported desire to engage in sexual activity) and two forms of socially desirable responding (impression management and self-deceptive enhancement) were examined. Concordance estimates were statistically non-significant in both groups, with the exception of the desire to engage in sexual activity, which was moderately correlated with genital arousal in the control group. Impression management was not a statistically significant moderator of the relationship between genital and subjective arousal, but was moderately negatively related to the three forms of subjective arousal ratings in the provoked vestibulodynia group. The results highlight the importance of assessing response bias in laboratory studies comparing women with and without sexual dysfunction.
The Journal of Sex Research 08/2011; 49(6):519-32. · 2.53 Impact Factor
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ABSTRACT: Our understanding of the sexual pain disorders vaginismus and dyspareunia has been fundamentally altered over the past two decades due to increased attention and empirically sound research in this domain. This increased knowledge base has included a shift from a dualistic view of the etiology of painful and/or difficult vaginal penetration being due to either psychological or physiological causes, to a multifactorial perspective. The present chapter reviews current classification and prevalence rates, including ongoing definitional debates. Research regarding the etiology, assessment and management of sexual pain disorders is discussed from a biopsychosocial perspective. Cyclical theories of the development and maintenance of sexual pain disorders, which highlight the complex interplay among physiological, psychological and social factors, are described. Medical/surgical treatment options, pelvic floor rehabilitation and psychological approaches are reviewed, as well as future directions in treatment research.
Advances in psychosomatic medicine 01/2011; 31:83-104.
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ABSTRACT: Vulvodynia, or chronic vulvar pain, is a common but poorly understood condition. Although its etiology is not well understood, it appears to be multifactorial. As such, treatment options are targeted to reduce singular symptoms in a piecemeal fashion. A number of randomized, controlled trials have been conducted and at least one paper on combination therapy has been published; however, further systematic research is needed in order to more fully inform clinical practice.
Women s Health 08/2009; 5(4):423-36.
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03/2009: pages 208 - 212; , ISBN: 9781444308136
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ABSTRACT: The internal pelvic exam is a critical component of women's reproductive health care; however, it can be perceived as uncomfortable, embarrassing, and painful, which may lead some women to avoid this procedure.
The purpose of this study was to survey physicians with respect to their experiences with female patients who are difficult or impossible to examine gynecologically.
Six hundred and fifty-eight obstetrician-gynecologist and family physicians were sent a 15-item questionnaire by mail and 424 participants responded (64% response rate). The survey consisted of questions pertaining to demographic variables, professional training and practice information, the frequency with which they encounter female patients who are difficult or impossible to examine, and the strategies employed with and beliefs surrounding such patients.
The main outcome measures were the frequency of patients who are difficult or impossible to examine, strategies used to manage such patients, and beliefs as to why these patients are difficult or impossible to examine.
The results, based on a final sample size of 401, indicated that most respondents have had some experience with patients who are difficult or impossible to examine. In such cases, most physicians (87%) reported attempting to address their patients' lack of relaxation. The majority of physicians in this study believed that a previous negative experience with (87%), and heightened anxiety about (79%), the exam were to blame. Twelve percent of respondents specifically reported that a previous history of sexual abuse was an important factor.
This study reinforces the importance of being aware of patient discomfort during pelvic exams and of developing strategies that fit the individual patient and her needs. Future research should examine women's perceptions of their reproductive care, particularly correlates of pain and anxiety during pelvic exams, prevalence of negative experiences, and doctor-patient interactions in this context.
Journal of Sexual Medicine 01/2009; 6(3):791-9. · 3.55 Impact Factor
