Caroline F Pukall

Caroline F Pukall
Queen's University | QueensU · Department of Psychology

PhD, CPsych (she/her)

About

208
Publications
96,020
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Introduction
My main focus is in the area of human sexuality, particularly sexual function, dysfunction, and sexual health. My perspective is a clinical one, and my methods of investigation range from self-report studies (face-to-face, online), observational studies, to basic science methodologies including: quantitative sensory testing (to assess sensitivity in various areas of the body), blood flow imaging (primarily via laser Doppler imaging), and brain imaging (using a variety of techniques).
Additional affiliations
July 2014 - present
Queen's University
Position
  • Professor (Full)
July 2009 - June 2014
Queen's University
Position
  • Professor (Associate)
January 2008 - present
Queen's University
Position
  • Director, Sex Therapy Service

Publications

Publications (208)
Article
Purpose To investigate the relationship among sexual functioning, sexual script flexibility, and sexual satisfaction in individuals diagnosed with prostate cancer. Design Cross-sectional online survey. Participants Sixty-one men diagnosed with localized prostate cancer. Methods Online survey of sexual functioning, sexual script flexibility, and...
Article
Anodyspareunia is the experience of recurrent or persistent anal pain during receptive anal penetration. We aimed to further our understanding of pain characteristics and the role of control cognitions and sexual flexibility in those with anodyspareunia. We recruited two online convenience samples (N = 96, N = 123) of individuals who experienced pa...
Article
Introduction Chronic, idiopathic vulvar pain (vulvodynia) is often treated as a unilateral condition. However, there are likely multiple causes to vulvar pain, relating to nerves, muscles, hormones, and inflammation, as well as psychosocial factors. Pain-related anxiety is a known contributor to the cycle of chronic pain. Rates of pain-related anxi...
Article
Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a distressing condition characterized by unwanted, persistent sensations of genital arousal that occur in the absence of corresponding subjective sexual arousal or desire. PGAD/GPD is associated with significant negative impacts on psychosocial well-being and daily function...
Article
Full-text available
Chronic pain associated with fibromyalgia (FM) affects a large portion of the population but the underlying mechanisms leading to this altered pain are still poorly understood. Evidence suggests that FM involves altered neural processes in the central nervous system and neuroimaging methods such as functional magnetic resonance imaging (fMRI) are u...
Article
Introduction Vulvar pain conditions are associated with pain-related anxiety and other psychosocial symptoms, which can have far-ranging effects on personal well-being and interpersonal relationships. Despite their pain, some vulvar pain patients are still capable of experiencing vulvar pleasure. The relationships between vulvar pain conditions and...
Chapter
Full-text available
Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia (PGAD/GPD) is a distressing disorder characterized by persistent or recurrent, unwanted or intrusive sensations of genital arousal that occur in the absence of subjective feelings of sexual desire and that persist for at least 3 months. Despite its association with functional interference...
Article
This study examined whether low self-efficacy and heightened perceived stress were associated with dyspareunia at two timepoints during COVID-19. Sixty-two participants (31 with and 31 without dyspareunia) completed a longitudinal online survey. Self-efficacy declined during the pandemic, and individuals with dyspareunia reported lower self-efficac...
Article
Background Previous studies have demonstrated the deleterious effects of pain anxiety (ie, the degree to which one fears pain), stress, and solicitous partner responses (ie, expressions of sympathy and attention to one's partner's pain) on pain and pain-related disability, but little is known about whether these variables moderate the robust pain–p...
Article
Full-text available
The COVID-19 pandemic and the mitigation measures put in place have resulted in universal disruption in the usual ways of life for individuals. The current study sought to investigate how aspects of sexual health (well-being and functioning) and relationship satisfaction changed or remained stable during the pandemic. During two separate time point...
Article
Full-text available
Background Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia (PGAD/GPD) is characterized by sensations of physiological genital sexual arousal (and/or other types of genitopelvic dysesthesia) that occur in the absence of subjective feelings of sexual desire. Aims The aim of this study was to compare relationship, sexual, and psychologic...
Article
Full-text available
Background: A set of enduring conditions have been reported in the literature involving persistent sexual dysfunction after discontinuation of serotonin reuptake inhibiting antidepressants, 5 alpha-reductase inhibitors and isotretinoin. Objective: To develop diagnostic criteria for post-SSRI sexual dysfunction (PSSD), persistent genital arousal...
Article
Full-text available
The most common subtype of vulvodynia (idiopathic chronic vulvar pain) is provoked vestibulodynia (PVD). Previous imaging studies have shown that women with vulvodynia exhibit increased neural activity in pain-related brain regions (e.g., the secondary somatosensory cortex, insula, dorsal midcingulate, posterior cingulate, and thalamus). However, d...
Article
Full-text available
Provoked Vestibulodynia (PVD) is the most common vulvodynia subtype (idiopathic chronic vulvar pain). Functional magnetic resonance imaging (fMRI) studies indicate that women with PVD exhibit altered function in a number of pain modulatory regions in response to noxious stimulation, such as in the secondary somatosensory cortex, insula, dorsal midc...
Article
Full-text available
Introduction Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a distressing condition characterized by persistent, unwanted sensations of genital arousal (eg, feelings of being on the verge of orgasm, and of lubrication, swelling, tingling, throbbing) that occur in the absence of sexual desire. Although PGAD/GPD is associ...
Conference Paper
Full-text available
Background: Corticomotor excitability can be assessed through motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS). While TMS has been used extensively to probe the distal extremity musculature, very little effort has been made to explore the more proximal motor representations, notably those of the pelvic floor muscle...
Article
Transgender individuals face many barriers to healthcare access, including providers’ lack of knowledge on transgender-specific healthcare needs. Physicians and medical students report a lack of training on and low confidence with transgender-related healthcare. Previous research has demonstrated the importance of self-efficacy and beliefs regardin...
Article
Background Persistent genital arousal disorder (PGAD), a condition of unwanted, unremitting sensations of genital arousal, is associated with a significant, negative psychosocial impact that may include emotional lability, catastrophization, and suicidal ideation. Despite being first reported in 2001, PGAD remains poorly understood. Aim To charact...
Article
Full-text available
Background: Previous findings from our group show that in the acute (ie, 6-10 weeks) post-injury period, women with concussions have a 70% greater risk of sexual dysfunction than those with extremity injuries. There are currently limited treatment options for the clinical management of concussions. Resilience is a protective, modifiable psychologi...
Article
Full-text available
Background: Persistent genital arousal disorder (PGAD) is a highly distressing, understudied condition characterized by persistent genital arousal (eg, genital sensations, sensitivity) in the absence of sexual desire. Currently, there is limited information about the prevalence of PGAD based on its proposed diagnostic criteria ("PGAD criteria"). A...
Article
As a rite of passage to womanhood, 2 million girls undergo female genital circumcision (FGC) - the tradition of cutting, and often removing parts of the vulva - every year. The current study is the first to focus on the connection between peripheral nerve damage and chronic neuropathic pain in women with FGC. We used mixed methods - quantitative, q...
Conference Paper
Full-text available
Introduction: Provoked vestibulodynia (PVD) is a chronic pain condition characterized by severe sharp and/or burning pain at the vulvar vestibule when pressure is applied to this area. Although it affects roughly one in five women, and has a negative impact on quality of life for approximately half of them, PVD remains poorly understood. The litera...
Article
Full-text available
Purpose of Review Persistent genital arousal disorder (also referred to as genitopelvic dysesthesia or PGAD/GD) is a distressing and largely underrecognized condition characterized by persistent, unwanted genital arousal (sensations, sensitivity, vasocongestion) in the absence of subjective/cognitive arousal and sexual desire. The purpose of this r...
Chapter
Vulvodynia is a prevalent condition associated with significant and negative effects across many areas of functioning. This chapter focuses on self‐report measures, which are critical assessment tools: the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). It provides several suggestions that can serve as a starti...
Chapter
In addition to self‐report measures of pain, objective measures have been used to assess and quantify pain and pelvic floor muscle (PFM) function in women with provoked vestibulodynia (PVD). This chapter focuses on objective measures used to test the sensation of the vestibule and the involvement of the pelvic floor musculature. The cotton‐swab tes...
Chapter
This final chapter consists of the editors’ wish lists for moving the field of female sexual pain disorders forward. It presents the wish list of Andrew Goldstein, Caroline Pukall, and Irwin Goldstein. Andrew Goldstein's wish is an increased awareness among healthcare providers of the different subcategories of vulvodynia (neuroproliferative, infla...
Chapter
Persistent genital arousal disorder (PGAD) is characterized by sensations of physiological genital arousal that occur in the absence of psychological sexual desire. The primary symptom characteristic of PGAD is the presence of persistent, intrusive, and unwanted sensations of genital arousal. The genital arousal is typically localized to the labia...
Article
Full-text available
Background Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a highly distressing yet poorly understood condition characterized by persistent genito-pelvic sensations, often described as “genital arousal,” which occur in the absence of sexual desire. PGAD/GPD is associated with significant impairment in psychosocial and da...
Preprint
BACKGROUND Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a highly distressing yet poorly understood condition characterized by persistent genito-pelvic sensations, often described as “genital arousal,” which occur in the absence of sexual desire. PGAD/GPD is associated with significant impairment in psychosocial and da...
Preprint
BACKGROUND Chronic pelvic pain (CPP) with various etiologies and mechanisms, affecting men and women, is a major challenge. Combinations of different classes of medications are often prescribed for CPP, with the expectation of improved outcomes. Although a number of combination trials have been reported, we are aware of no systematic synthesis of t...
Article
Background Chronic pelvic pain with various etiologies and mechanisms affects men and women and is a major challenge. Monotherapy is often unsuccessful for chronic pelvic pain, and combinations of different classes of medications are frequently prescribed, with the expectation of improved outcomes. Although a number of combination trials for chroni...
Article
Full-text available
Purpose of Review To review recently published literature on vulvodynia classification, comorbidities, chronicity, and interpersonal factors, and to outline critical gaps between research findings and clinical practice. Recent Findings The classification of vulvodynia varies in terms of its specificity and degree of focus on pain and psychosocial...
Article
Full-text available
Introduction Prostate cancer (PCa) is the most commonly diagnosed cancer among males globally, and it has one of the highest 5-year net survival rates of all cancers. Most diagnosed individuals, therefore, must live with the consequences of the disease and its treatments, including sexual side effects. Unfortunately, little is known about the sexua...
Article
Introduction: Chronic vulvar pain is a multidimensional condition with great variability in clinical presentation among affected women. In a companion article, part 1, we reviewed and recommended assessment and measurement tools for vulvar pain and related outcomes with a view toward improving consistency and comparison across studies. Yet methodo...
Article
Introduction: Although postpartum sexual concerns are common, limited data exist on postpartum sexual response. Furthermore, the physiological process of vaginal birth may negatively impact genital response compared with unlabored cesarean section (C-section), but this hypothesis has yet to be tested. Aim: To (i) compare genital and subjective s...
Article
Group differences in touch and pain thresholds-and their neural correlates-were studied in women with provoked vestibulodynia (PVD; N = 15), a common subtype of vulvodynia (chronic vulvar pain), and pain-free control women (N = 15). Results from quantitative sensory testing and self-report measures indicated that, as compared with control participa...
Article
Full-text available
Sexuality research is often regarded as more intrusive than other types of research, contributing to sample self-selection biases. Researchers have consistently found that volunteers and non-volunteers for sexuality studies differ on a number of sexuality-related variables. Despite a large number of studies examining volunteer biases, relatively fe...
Article
Full-text available
A number of devices have been developed to assess physiological sexual response. Some come into direct contact with the genitals (e.g., vaginal/clitoral/penile plethysmography [VPP/CPP/PPG], labial thermistors [LT]), whereas others capture images of the genitals remotely (e.g., thermal imaging [TI], laser Doppler imaging [LDI]). Researchers have sp...
Article
Vibrator use is thought to be associated with positive sexual functioning for women with female or male partners (Herbenick et al., 2009). Vibrator use that is discrepant across contexts (i.e., discrepant vibrator use means that the individual uses a vibrator in solitary but not partnered contexts), however, has only been examined in women who have...
Article
Objective: The aim of the study was to document treatment-seeking experiences of women with chronic vulvar pain, comfort communicating about pain, and test the clinical utility of the screening version of the Vulvar Pain Assessment Questionnaire, screening version (VPAQscreen). Materials and methods: Patients scheduled for an appointment with th...
Article
Background: Persistent genital arousal disorder (PGAD) is characterized by symptoms of distressing physiological sexual arousal (Persistent genital arousal [PGA] symptoms such as genital vasocongestion, sensitivity, or both) that occur in the absence of sexual desire. There continues to be a lack of systematic research on this condition. Little is...
Article
Provoked vestibulodynia (PVD) is a recurrent vulvovaginal pain condition that has potentially negative consequences for women and their partners’ sexual functioning and overall quality of life. Research has found that greater observed empathic responses during conversations about the impact of vulvodynia are associated with greater relational and s...
Article
Genital lubrication and blood flow are theoretically related outcomes of women’s sexual response that prepare the genitals for sexual activity. Despite its importance for sexual function, few experimental studies have directly assessed genital lubrication or empirically demonstrated how genital lubrication and blood flow relate during sexual arousa...
Article
Provoked Vestibulodynia (PVD) is the most common subtype of vulvodynia. Functional MRI studies have indicated that women with PVD exhibit increased BOLD responses in pain modulation regions²⁻⁴. However, few neuroimaging studies have examined either the periods of time before and after a noxious stimulus is applied, nor compared fMRI responses betwe...
Article
Background: Although promoting sexual health should be an integral part of midwifery practice, little is known about midwives' preparation to address their clients' sexual health concerns. Aims: To assess the formal and self-directed training on sexual health topics relevant to midwifery practice of Canadian midwives as well as the association b...
Article
Objectives Three scientific societies, the International Society for the Study of Vulvovaginal Disease (ISSVD), the International Society for the Study of Women Sexual Health (ISSWSH), and the International Pelvic Pain Society (IPPS) developed the "2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and V...
Chapter
This chapter will focus on three different categories of mental disorders related to sexuality and gender: sexual dysfunctions, gender dysphoria, and paraphilic disorders. In general, sexual dysfunctions are conditions that affect one’s ability to function sexually or to experience sexual pleasure; gender dysphoria is a condition in which distress...
Article
Introduction: The current study aims to validate a new imaging tool to assess men's sexual psychophysiological responding: laser Doppler imaging (LDI), which directly measures subcutaneous genital blood flow. In this study, we concurrently assessed genital sexual arousal in a sample of men using the LDI and the current gold standard of male sexual...
Article
Introduction: Persistent genital arousal disorder (PGAD) is a highly distressing and poorly understood condition characterized by unwanted sensations of genital arousal in the absence of subjective sexual desire. Research has shown that some individuals with PGAD also report orgasm, urinary, and pain symptoms, with 1 recent study specifically compa...
Article
Full-text available
Research has established that social support for relationships is an important predictor of well‐being. However, the underlying assumption that social support specifically for relationships is a separate construct from general social support has not been properly tested empirically, nor has the question of whether support processes vary by source (...
Article
Descending regulation of spinal cord responses to nociceptive signaling has a strong influence on pain perception. Prior studies using functional magnetic resonance imaging (fMRI) have indicated that in addition to reactive responses to nociceptive signals there is a continuous component to regulation, and that it may vary with differences in pain...
Chapter
Vulvodynia represents a unique challenge for health‐care professionals, as it intersects two poorly understood conditions: pain and sexual health problems. This chapter focuses on the psychosocial aspects of provoked vestibulodynia – the most common subtype of vulvodynia – highlighting its diagnosis and assessment, and emphasizing that measuring pa...
Article
Full-text available
Research exploring the impact of circumcision on the sexual lives of men has failed to consider men’s attitudes toward their circumcision status, which may, in part, help to explain inconsistent findings in the literature. The current study explored the potential relationship between attitudinal factors toward one’s circumcision status, timing of o...
Article
Background: Persistent genital arousal disorder (PGAD) is an understudied condition characterized by unwanted physiologic genital arousal in the absence of subjective sexual arousal. Markos and Dinsmore (Int J STD AIDS 2013;24:852-858) theorized that PGAD shares a number of similarities with vulvodynia (unexplained chronic vulvar pain [CVP]), incl...
Article
Background: Digital intravaginal palpation remains the favored method for clinical assessment of pelvic floor muscle (PFM) function in women; however, there is growing interest in using transperineal ultrasound imaging (TPUSI). TPUSI does not involve vaginal penetration, making it particularly relevant for PFM assessment in women with genito-pelvi...
Article
The objective of this paper was to conduct an overview of the existing literature on sexual problems and relational factors in self-identified bisexual individuals. Given the limited research including self-identified bisexuals, this paper provides an overview of the sexuality literature on same-gender and mixed-gender relationships to highlight ar...
Article
Background: The Vulvar Pain Assessment Questionnaire (VPAQ) was developed to assist in the assessment and diagnosis of chronic vulvar pain (vulvodynia). Aim: To further establish the psychometric properties of the VPAQ by examining factor structure, test-retest reliability, internal consistency, and scale normative data, and to gather feedback f...
Article
Physicians play a critical role in addressing sexual health in medical practice, including pain during intercourse. Vulvodynia is a prevalent cause of pain, however, related training is limited and variable. In addition, physician attitudes toward pain and sexuality may affect behaviour and therefore patient outcomes. This study's objectives were t...
Article
Background: Media representations of sexuality after childbirth depict vaginal birth as harmful and cesarean delivery as protective, although research does not support these depictions. The objective of the current study was to investigate perceptions of the effects of mode of delivery on sexuality. Methods: Nulliparous participants who were abl...
Article
The objective of this paper was to develop a measure of sexual script flexibility when approaching a sexual problem in a relationship. A series of online studies were conducted with individuals in relationships. As one subscale on the two-factor model had poor convergent and discriminant validity, a final single factor scale with 6-items was retain...
Poster
Poster presentation at the 2017 International Society for the Study of Women’s Sexual Health annual meeting.
Poster
Poster presentation at the 2017 International Society for the Study of Women’s Sexual Health annual meeting.
Presentation
Persistent genital arousal disorder (PGAD) is characterized by symptoms of physiological sexual arousal (genital vasocongestion, sensitivity) that are described as unwanted, distressing, and sometimes painful. Following a review of both bodies of literature, Markos and Dinsmore (2013) suggested that PGAD shares many similarities with vulvodynia. Th...
Presentation
Persistent genital arousal disorder (PGAD) is characterized by symptoms of physiological sexual arousal (genital vasocongestion, sensitivity) that are described as unwanted, distressing, and sometimes painful. Often women report embarrassment or discomfort disclosing their symptoms to health care providers. In addition, PGAD is not a recognized con...
Presentation
Persistent genital arousal disorder (PGAD) is characterized by symptoms of physiological sexual arousal (genital vasocongestion, sensitivity) that are described as unwanted, distressing, and sometimes painful. There is limited systematic research on PGAD, though Markos and Dinsmore (2013) have suggested that PGAD may share some similarities with vu...
Article
Persistent genital arousal disorder (PGAD; Leiblum & Nathan; 2001) is characterized by distressing symptoms suggestive of genital arousal in the absence of subjective feelings of arousal. Although awareness of PGAD is growing, there continues to be a lack of systematic research on it. This study characterized an online sample of women with symptoms...