Article

Pain Experienced During Vaginal and Anal Intercourse with Other-Sex Partners: Findings from a Nationally Representative Probability Study in the United States: Pain During Intercourse

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Abstract

Introduction: Recent U.S. nationally representative data indicate that about 30% of women and 5% of men reported pain occurring during their most recent sexual event; however, little is known about the severity, duration, or context of such pain, or its prevalence during vaginal vs. anal intercourse. Aims: To document the prevalence and characteristics of pain during vaginal and anal intercourse among U.S. women and men (ages 18+) at their most recent other-sex sexual event, including the self-reported severity, duration, and location of their pain; how participants addressed their pain; and partner communication related to the pain. Methods: Data from a subsample of 1,738 women and men in the 2012 National Survey of Sexual Health Behavior, a nationally representative probability survey of Americans ages 18+ collected via the Internet, were analyzed. Main outcome measures: Participants responded to items about their background characteristics; whether they had vaginal or anal intercourse during their most recent sexual experience; the severity, duration, and location of any pain experienced during said sexual event; and whether they responded to or communicated about the pain. Results: About 30% of women and 7% of men reported pain during vaginal intercourse events, and most of the reports of pain were mild and of short duration. About 72% of women and 15% of men reported pain during anal intercourse events, with more of these events including moderate or severe pain (for the women) and of mixed duration. Large proportions of Americans do not tell their partner when sex hurts. Conclusion: Pain is a relatively common, and often not discussed, aspect of both vaginal and anal intercourse events occurring between women and men. Individual and clinical implications are discussed.

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... In one study, about 8% of young women indicated that they never felt able to tell a partner when they did not want to have sex, and an additional 30% felt able to do so only some of the time (Rickert, Sanghavi, and Wiemann, 2002). Compared to men, fewer women report finding sex arousing or pleasurable (Herbenick et al., 2010a(Herbenick et al., , 2010b, and far more women than men (about 30% vs. 7%) report sex as painful (Herbenick, Schick, Sanders, Reece, & Fortenberry, 2015). Sex may also be consensual but not wanted (e.g., Peterson & Muehlenhard, 2007), wanted but "bad" (Littleton, Tabernik, Canales, & Backstrom, 2009), pressured or coerced (Byers, 1996;Jeffrey & Barata, 2017), chronically painful (Ayling & Ussher, 2008), or beyond one's own ability to stop or control (e.g., Skarner, Mansson, & Svensson, 2017), with women more often reporting each of these. ...
... Our findings add to a body of literature that, as described earlier, demonstrates a privileging of men's sexual pleasure, with women more often reporting lower levels of sexual pleasure and arousal, less frequent orgasm (Herbenick et al., 2010b), more frequent pain (Herbenick et al., 2015) and, described here, more common experiences of frightening sex. Indeed, scholars have long described how women's economic and political insubordination impacts their sexual lives and opportunities (e.g., Tiefer, 2001), making them vulnerable to sex that feels scary, painful, or beyond one's ability to control or consent to (e.g., Bay-Cheng, 2010;Gavey, 2012;Tiefer, 2001). ...
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Using data from a U.S. probability survey of individuals aged 14 to 60, we aimed (1) to assess the proportion of respondents who ever reported scary sexual situations and (2) to examine descriptions of sexual experiences reported as scary. Data were cross-sectional and collected via the GfK KnowledgePanel®. Scary sexual situations were reported by 23.9% of adult women, 10.3% of adult men, 12.5% of adolescent women, and 3.8% of adolescent men who had ever engaged in oral, vaginal, or anal sex. Themes included sexual assault/rape, incest, being held down, anal sex, choking, threats, multiple people, novelty/learning, among others.
... This pattern of associations between sex and pain continues throughout women's lives and is particularly prominent in activities involving penetration. Nationally representative data from the U.S. show that about 30% of women reported pain during vaginal intercourse and 72% of women reported pain during anal intercourse, whereas 7% and 15% of men, respectively, experience pain during the same activities (Herbenick et al., 2015). Rates of reported pain vary. ...
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Gender differences in sexuality have gained considerable attention both within and outside of the scientific community. We argue that one of the main unacknowledged reasons for these differences is simply that women experience substantially worse sex than men do. Thus, in examinations of the etiology of gender differences in sexuality, a confound has largely been unacknowledged: Women and men are treated to different experiences of what is called “sexuality” and “having sex.” We discuss four arenas in which women’s experience of sexuality may often be worse than men’s: (a) anatomical differences, (b) sexual violence, (c) stigma, and (d) masculine cultures of sexuality. Then we consider how each disparity might explain well-known gender differences in sexuality.
... All women reported painful experiences of anal intercourse-even the three women who also reported pleasurable experiences with it, which is consistent with previous studies that have reported the prevalence of pain related to heterosexual anal intercourse. For instance, in the U.S. context, about 72% of women, contrasting with 15% of men, reported having experienced some degree of pain in their most recent anal-penile sexual interaction (Herbenick et al., 2015); in the Croatian context, 79% of the women surveyed reported having experienced pain in their first experience of it (Štulhofer & Ajduković, 2013). Also congruent with previous findings about gendered emotion work regarding anal sex in intimate relationships (Fahs & Swank, 2016), a few women described tolerating and enduring pain, with a sense of inevitability and resignation towards their own pain and discomfort: "It's always really painful," said Fleur (18), adding, "like it makes my eyes sting and you tear up a little bit 'cause he does, he just shoves it in, you know. ...
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In this article, we explore the gendered dynamics of coercion described by 18 women we interviewed about their experiences of unwanted and nonconsensual heterosexual anal sex. Several women referred to what they believed to be the normative status of heterosexual anal sex. In many cases, the socially coercive effects of perceived norms intertwined with threads of interpersonal coercion, leaving women feeling pressured to agree to, or little room to refuse, anal sex they did not want. We discuss the ways that new sexual norms can translate into new pressures for women within the gendered framework of heterosexual relationships.
... Data presented here are from the 2012 National Survey of Sexual Health Behavior (NSSHB); from which previous data have been published [26][27][28]. The NSSHB is a population-based cross-sectional survey of adult women and men in the United States collected during October and November 2012, via national probability research panel samples, established by the Knowledge Panel of GfK Research (GfK) (Menlo Park, California). ...
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This study assessed the prevalence of sexual behaviors among a nationally representative sample of Latino men and women in the United States (US) (N = 432) including Spanish language data collection. Prior studies of sexual health among US Latinos have consisted of convenience samples, and focused mainly on assessing risk behaviors. We consider a broader range of sexual behaviors, subjective sexual experiences (e.g. pleasure and arousal), and STI testing behaviors. Analyses by language dominance and gender indicate a higher variability in sexual behaviors for English-dominant participants and a link between overall STI testing to regular medical examinations, especially women. Higher rates of pleasure, orgasms and arousal was reported by Spanish-dominant men and women, relative to the English-dominant group. Results represent a nuanced examination of internal differentiation among US Latinos and provides applicable data for reducing sexual health disparities in this population.
... One potential explanation may be related to the finding that nearly half of women who engage in consensual anal sex report negative experiences (Rogala & Tydén, 2003). In a recent nationally representative sample, it was found that 72% of women reported pain during anal sex (Herbenick, Schick, Sanders, Reece, & Fortenberry, 2015). If consensual anal sex is regarded as a negative experience for many women (although certainly not the case for many consenting women), it is not surprising that anal rape is associated with more negative outcomes than other nonconsensual penetration experiences. ...
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Little is known based on the stratification and localization of penetration type of rape: oral, vaginal, and/or anal. The current study examined associations between type of rape and mental and sexual health symptoms in 865 community women. All penetration types were positively associated with negative mental and sexual health symptoms. Oral and/or anal rape accounted for additional variance in anxiety, depression, some trauma-related symptoms, and dysfunctional sexual behavior than the association with vaginal rape alone. Findings suggest that penetration type can be an important facet of a rape experience and may be useful to assess in research and clinical settings.
... Although individuals may engage in anal sex for their own pleasure or intimacy enhancement, anal sex and anal fingering have been described as holding little or no appeal for many people, at least among predominantly heterosexual-identified samples (Herbenick et al., 2017). Additionally, receptive anal sex is often characterized as painful, particularly for women (Herbenick, Schick, Sanders, Reece, & Fortenberry, 2015;Stulhofer & Ajdukovic, 2011), and associated with pressure or coercion, again particularly for women (Marston & Lewis, 2014;Maynard, Carballo-Dieguez, Ventuneac, Exner, & Mayer, 2009). Any of these reasons may help to explain the lack of a statistical relationship with KCM. ...
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Using data from the 2014 National Survey of Sexual Health & Behavior, a probability survey of Americans aged 14+, we assessed the prevalence and correlates of kissing, cuddling, and massage during 1493 individuals’ most recent sexual event from the past year. Most respondents reported kissing (87%) and cuddling (70%); fewer (23%) reported massage. Each was significantly associated with age, education, and relationship structure. Respondents younger than 30 were significantly more likely to indicate they did not kiss because kissing would have been too intimate with their partner. Only cuddling was significantly associated with event-level emotional intimacy and sexual pleasure.
... 3 Of particular relevance to the current paper, recent research suggests that many women continue to have sexual intercourse despite pain 20,21 and do not discuss their experiences of pain with their partners. 14,22 For example, in a sample of 1,566 young Swedish women ages 18 to 22 years, 33% reported not telling the partner about their pain and 22% feigned enjoyment. 22 Understanding why women avoid pain-related discussions, and whether communication might assist in making experiences less painful and possibly more pleasurable, is important personally and politically to increase the likelihood that sex is mutually enjoyable and to integrate women's rights to pleasure into the public discourse about sex. ...
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... Their frequency can vary from 1 Hz to 4500 Hz 11 . The interferential current produces low impedance to the skin and it penetrates deeper into the tissue, reduces pain and promotes muscle relaxation 12,13 . ...
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... Some theorists and researchers have written of the impossibility of sex as portrayed in pornography and in movies, where women appear physically "ready" to have sex immediately upon approach (which belies the findings of Masters and Johnson 1966). A recent research study reports that a large percentage of women having sexual intercourse with men experience pain (Herbenick et al. 2015). Others have written about the pressure young women feel to perform sex acts that are painful and that they did not want in spite of their consent (Fahs and Gonzalez 2014). ...
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... However, anal sex remained infrequent overall in any given year (though much more frequent among gay and bisexual men) (Dodge et al., 2016;Herbenick et al., 2010a). Anal sex has generally been rated as unappealing among US adults (Herbenick et al., 2017), and several qualitative studies examining anal intercourse between women and men found thatalthough anal sex behaviors were pleasurable to some-anal sex was often marked by pressure, coercion, lack of communication, fear, and pain among women (e.g., Fahs & Gonzalez, 2014;Fahs et al., 2015;Herbenick et al., 2015Herbenick et al., , 2019aHerbenick et al., , 2019bJozkowski et al., 2014). Given these experiences, it is perhaps not surprising to have observed a decrease in anal intercourse between the 2009 and 2018 NSSHB, but that does not explain other decreases across all partnered sexual behaviors queried. ...
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Solo and partnered sexual behaviors are relevant to health, well-being, and relationships. Recent research shows that sexual frequency has declined in the U.S. and in other countries; however, measurement has been imprecise. We used data from 14- to 49-year-old participants in the 2009 and 2018 waves of the National Survey of Sexual Health and Behavior (NSSHB), a confidential U.S. nationally representative survey that is conducted online. We aimed to: (1) assess changes in frequency of past-year penile-vaginal intercourse and (2) examine combinations of past-year sexual behaviors for each of the two waves. We hypothesized that we would observe lower frequency of penile-vaginal intercourse (PVI) from 2009 to 2018 and that we would observe greater engagement in sexual repertoires involving non-coital partnered behaviors (e.g., partnered masturbation, oral sex) in 2018 as compared to 2009. Participants were 4155 individuals from the 2009 NSSHB (Adolescents: 406 females, 414 males; Adults: 1591 women, 1744 men) and 4547 individuals from the 2018 NSSHB (Adolescents: 416 females, 411 males; Adults: 2007 women, 1713 men). Compared to adult participants in the 2009 NSSHB, adults in the 2018 NSSHB were significantly more likely to report no PVI in the prior year (28% in 2018 vs. 24% in 2009). A similar difference in proportions reporting no PVI in the prior year was observed among 14–17-year-old adolescents (89% in 2018 vs. 79% in 2009). Additionally, for both adolescents and adults, we observed decreases in all modes of partnered sex queried and, for adolescents, decreases in solo masturbation.
... Fewer non-verbal (but not verbal) pleasure displays were, in turn, associated with lower sexual satisfaction (Babin, 2013), suggesting that low desire expression-or even disinterest suppressionmay undermine sexual well-being. On the more extreme end, about 30% of women reported pain during their last sexual experience, but less than half (43%) of them told their partner (Herbenick et al., 2015). Our work integrates and extends these findings by investigating whether desire regulation during sex is associated with lower sexual and relationship satisfaction in daily life. ...
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Romantic partners often regulate their emotions and affection to achieve certain goals, but research has yet to explore how partners regulate their expression of sexual desire during sex and its implications for couples’ well-being. In two multi-part dyadic diary studies of primarily mixed-gender couples in longer-term relationships residing in North America, we examined three questions. First, is amplifying desire and suppressing disinterest during sex associated with both partners’ daily sexual and relationship satisfaction? Second, do these associations differ by level of sexual desire and gender? Third, tested in our second sample, can these associations be explained by feelings of sexual inauthenticity? Across both samples (N total = 225 couples, 450 participants), amplifying desire was associated with lower sexual satisfaction, while suppressing disinterest was not associated with daily satisfaction. Importantly, sexual desire played a role in the links between desire regulation during sex and satisfaction: on days when people were low in sexual desire, amplification was associated with both partners’ lower sexual satisfaction, while suppression was associated with a partner’s higher relationship satisfaction. In addition, amplification (on low desire days) and suppression (regardless of desire level) were associated with lower sexual authenticity which, in turn, was linked to lower relationship satisfaction. The findings suggest that desire regulation during sex plays an important role in couples’ daily sexual satisfaction and relationship satisfaction—in part because it feels sexually inauthentic—with the implications of this regulation being particularly strong when people feel low sexual desire.
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Historically, the reasons people have sex have been assumed to be few in number and simple in nature-to reproduce, to experience pleasure, or to relieve sexual tension. Several theoretical perspectives suggest that motives for engaging in sexual intercourse may be larger in number and psychologically complex in nature. Study 1 used a nomination procedure that identified 237 expressed reasons for having sex, ranging from the mundane (e.g., "I wanted to experience physical pleasure") to the spiritual (e.g., "I wanted to get closer to God"), from altruistic (e.g., "I wanted the person to feel good about himself/herself") to vengeful (e.g., "I wanted to get back at my partner for having cheated on me"). Study 2 asked participants (N = 1,549) to evaluate the degree to which each of the 237 reasons had led them to have sexual intercourse. Factor analyses yielded four large factors and 13 subfactors, producing a hierarchical taxonomy. The Physical reasons subfactors included Stress Reduction, Pleasure, Physical Desirability, and Experience Seeking. The Goal Attainment subfactors included Resources, Social Status, Revenge, and Utilitarian. The Emotional subfactors included Love and Commitment and Expression. The three Insecurity subfactors included Self-Esteem Boost, Duty/Pressure, and Mate Guarding. Significant gender differences supported several previously advanced theories. Individual differences in expressed reasons for having sex were coherently linked with personality traits and with individual differences in sexual strategies. Discussion focused on the complexity of sexual motivation and directions for future research.
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Introduction: Most research on men's use of commercial lubricants during sexual activities is in the context of condom use and often specifically among men who have sex with men. Less is known about men's use of lubricants associated with a broader range of sexual experiences. Aims: The aims of this study are to document the prevalence of commercial lubricant use among adult U.S. men (age 18+), to document men's use of lubricants across solo and partnered sexual behaviors, and to assess men's perceptions of the contributions lubricants have to the sexual experience. Methods: Data are from the 2012 National Survey of Sexual Health and Behavior, which involved the administration of an online questionnaire to a nationally representative probability sample of U.S. adults ages 18 and older. Main outcome measures: Sociodemographic characteristics, recent and lifetime commercial lubricant use, lubricant use during specific sexual behaviors, frequency of lubricant use, and reasons for lubricant use. Results: Most men in the United States (70%, N = 1,014) reported having used a commercial lubricant, with men older than 24 and those in a relationship more likely to report lubricant use. About one in four men had used a lubricant in the past 30 days. Intercourse was the most common behavior during which men used lubricant, though solo masturbation and partnered sexual play were also frequently linked to lubricant use. The most common reasons for lubricant use included "to make sex more comfortable," "for fun," "curiosity," and "my partner wanted to." Conclusions: Most American men have used a lubricant; lubricant use is common across all age groups, and some of the most common reasons why men report using lubricants have to do with sexual enhancement, comfort, and pleasure. Clinicians may find these data helpful to their efforts to educate patients about lubricant use, comfort during sex, and sexual enhancement.
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Background and aims Female genital pain is a debilitating problem that negatively affects several aspects of the life of women. Several studies present figures of prevalence indicating that the problem affects nearly 20% of young women. However, many women fail to consult health care and the estimated prevalence therefore remains insecure. Historically, genital pain was commonly viewed as either physiological or psychosexual. Although the current field of research and clinical expertise in general agree upon a biopsychosocial conceptualization, less is known about the manifestation of the problem in everyday life and the experience of seeking health care among afflicted women. The objectives of the present study was to examine genital pain in a general female population living in Sweden cross-sectionally in terms of prevalence, sexual function, sexual satisfaction and help seeking, and to identify possible predictors of genital pain among women. Methods The study was a population-based study using a postal questionnaire administered to 4052 women (age 18--35). Of these 944 (response rate: 23%) took part in the study. Results Genital pain of six months duration was reported by 16.1% of the women. Women with pain more commonly reported fungal infections, other pain problems, sexual dysfunctions and symptoms of anxiety than pain-free women and in addition lower sexual satisfaction. There were no differences in sexual frequency. Pain was most commonly reported during sexual intercourse, but many women also experienced pain during non-sexual activities, with pain durations of several hours after the pain eliciting activity was interrupted. Of those reporting pain, 50% had sought care for their pain. The most common was to counsel a doctor and to receive topical treatment. However, the experienced effects of the treatments were on average low. In the explanatory model, fungal infections, and sexual dysfunctions were associated with genital pain. Conclusions The study had a low response rate, but still indicates that genital pain is common and negatively affects several aspects of women’ life, not just sexual activities. Although many women report pro-longed pain experiences, many fail to consult health care and among those who seek care the effects of treatment are on average poor. There are strong associations between sexual dysfunctions (lack of sexual arousal, vaginal muscle tension hindering intercourse) and genital pain that, based on previous findings in this field of research, might be viewed in terms of circular maintaining processes. Implications Female genital pain is not just limited to the sexual context, but often negatively affects several situations in women’ life. The size of the problem calls for immediate development of preventive interventions and treatment programs that focus on sexual education and to encourage a healthy sexuality among women and their partners. There is a need to identify methods in order to assemble evidence based interventions of female genital pain. Such methods are currently lacking, resulting in poor treatment options for women with pain.
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We conducted a literature review of patients' conditions described under persistent genital arousal disorder and restless genital syndrome, vulvodynia and male genital skin pain of unknown aetiology (penoscrotodynia). Our aim is to improve the understanding of the condition, unify nomenclature and promote evidence-based practice. The most prominent symptom in persistent genital arousal disorder and restless genital syndrome is the spontaneous, unwelcomed, intrusive and distressing vulval sensation. There are similarities between the clinical presentation of vulvodynia, penoscrotodynia, persistent genital arousal disorder and restless genital syndrome patients. The aetiology of persistent genital arousal disorder and restless genital syndrome, similar to vulvodynia, could be better explained in terms of neuro-vascular dysfunction, genital peripheral neuropathy and/or dysfunctional micro-vascular arterio-venous shunting. Erythromelalgia lends itself to explain some cases of restless genital syndrome, who have concurrent restless leg syndrome; and therefore draw parallels with red scrotum syndrome. The published literature support the concept of classifying restless genital syndrome as a sub-type of vulvodynia than sexual dysfunction.
Article
In a sample of men who have sex with men (N = 404), 55 (14%) experienced anodyspareunia, frequent and severe pain during receptive anal sex. Most men with anodyspareunia described their pain as life-long, experienced psychological distress as a result, and avoided anal sex for periods of time. Men with anodyspareunia reported that psychological factors were the primary contributing cause of their pain. The findings contradict the myth that pain is a necessary consequence of receptive anal sex and show that anodyspareunia is similar to dyspareunia in women in terms of prevalence, mental health consequences, and contributing factors. Clinical criteria were developed to assist clinicians in diagnosing anodyspareunia.
Article
Introduction Entry dyspareunia is a sexual health concern which affects about 21% of women in the general population. Characterized by pain provoked during vaginal penetration, introital dyspareunia has been shown by controlled studies to have a negative impact on the psychological well-being, sexual function, sexual satisfaction, and quality of life of afflicted women. Many cognitive and affective variables may influence the experience of pain and associated psychosexual problems. However, the role of the partner's cognitive responses has been studied very little. Aim The aim of the present study was to examine the associations between partners' catastrophizing and their perceptions of women's self-efficacy at managing pain on one side and women's pain intensity, sexual function, and sexual satisfaction on the other. Methods One hundred seventy-nine heterosexual couples (mean age for women = 31, SD = 10.0; mean age for men = 33, SD = 10.6) in which the woman suffered from entry dyspareunia participated in the study. Both partners completed quantitative measures. Women completed the Pain Catastrophizing Scale and the Painful Intercourse Self-Efficacy Scale. Men completed the significant-other versions of these measures. Main Outcome Measures Dependent measures were women's responses to (i) the Pain Numeric Visual Analog Scale; (ii) the Female Sexual Function Index; and (iii) the Global Measure of Sexual Satisfaction scale. Results Controlled for women's pain catastrophizing and self-efficacy, results indicate that higher levels of partner-perceived self-efficacy and lower levels of partner catastrophizing are associated with decreased pain intensity in women with entry dyspareunia, although only partner catastrophizing contributed unique variance. Partner-perceived self-efficacy and catastrophizing were not significantly associated with sexual function or satisfaction in women. Conclusions The findings suggest that partners' cognitive responses may influence the experience of entry dyspareunia for women, pointing toward the importance of considering the partner when treating this sexual health problem. Lemieux AJ, Bergeron S, Steben M, and Lambert B. Do romantic partners' responses to entry dyspareunia affect women's experience of pain? The roles of catastrophizing and self-efficacy. J Sex Med 2013;10:2274–2284.
Article
Introduction Provoked vestibulodynia (PVD) is a common cause of painful intercourse. Despite the fact that PVD is associated with high levels of pain and negative impact on women's sexuality, research has not examined associations between affected women's pain sensitivity and their sexual and relationship satisfaction. Aims This study aimed to examine sexual and relationship functioning/satisfaction and vestibular pain sensitivity among PVD‐affected women, and potential associations between these variables. Methods Participants were 17 women with PVD and 17 matched controls. Women were assessed via a gynecological examination, structured interview, and the Female Sexual Function Index (FSFI), Golombok Rust Inventory of Sexual Satisfaction (GRISS), and Dyadic Adjustment Scale (DAS). Additionally, women completed a quantitative sensory testing session to assess vestibular pain thresholds and associated pain ratings; specifically, vestibular pressure‐pain and heat pain thresholds were measured. Main Outcome Measures Gynecological and intercourse pain ratings; FSFI; GRISS; DAS; vestibular pressure‐pain threshold; and vestibular heat pain thresholds. Results PVD‐affected women reported significantly decreased sexual function in comparison with controls. While no differences in relationship satisfaction were found between groups, women with PVD did report less sexual satisfaction on the FSFI. PVD‐affected women also reported significantly higher vestibular pain ratings associated with the gynecological examination and heat pain tolerance procedures, and lower pressure‐pain threshold, heat pain threshold, and heat pain tolerance at the vestibule in comparison with controls. Among women with PVD, lower heat pain threshold was associated with less sexual satisfaction, and higher pain ratings related to intercourse and heat pain tolerance, respectively, were associated with lower sexual function and satisfaction. Conclusions The results indicate that women with PVD experience negative sexual effects and increased pain sensitivity. This study also suggests that some aspects of pain may be related to lower levels of sexual function and satisfaction among affected women. Smith KB, Pukall CF, and Chamberlain SM. Sexual and relationship satisfaction and vestibular pain sensitivity among women with provoked vestibulodynia. J Sex Med 2013;10:2009–2023.
Article
With a prevalence of 15-21 %, dyspareunia is one of the most commonly reported sexual dysfunctions in pre-menopausal women under the age of 40. Studies to date have focused primarily on clinical samples, showing that women with dyspareunia report overall sexual impairment, anxiety, and feelings of sexual inadequacy. However, little is known about their body image and genital self-image and few studies have sampled women exclusively from the general population. The aim of the present, controlled study was to investigate body image and genital self-image in a community sample of pre-menopausal women with self-reported dyspareunia. In total, 330 women completed an online survey, of which 192 (58 %) had dyspareunia and 138 (42 %) were pain-free control women. In comparison to pain-free control women, women with dyspareunia reported significantly more distress about their body image and a more negative genital self-image. Moreover, findings from a logistic regression, in which trait anxiety was controlled for, showed that a more negative genital self-image was strongly and independently associated with an increased likelihood of reporting dyspareunia. These results suggest that, in women with dyspareunia, body image and genital self-image are significantly poorer and would benefit from more attention from both clinicians and researchers.
Article
Lichen sclerosus is a chronic skin disease, probably immune-mediated, with a strong genetic component. It shows a predilection for external genitalia. It is most common in postmenopausal women, although it has been documented at all ages and in both sexes. The exact prevalence of lichen sclerosus is unknown. However, in recent years much progress has been made in defining its etiology and epidemiology, and we now know that it is far more frequent than previously thought. The purpose of this review is to focus more attention on the relationship between LS and sexual dysfunction, and on a few important aspects of managing perimenopausal patients diagnosed with LS. Lichen sclerosus is a chronic, debilitating condition that may progress to cause significant physical and psychological complications. The disease calls for lifetime follow-up.
Article
This study examined the prevalence and correlates of heterosexual anal intercourse in two national probability samples of young Croatian adults aged 18-25 years, which were collected in 2005 and 2010. The lifetime prevalence of anal intercourse increased from 27% to 36%. In multivariate analysis, reporting four or more lifetime sexual partners was the only correlate of the experience of anal intercourse that was significant among both women (odds ratios [ORs] = 1.78-3.27, P < 0.05) and men (ORs = 3.14-4.63, P < 0.01). Information about condom use at most recent anal intercourse was collected in the 2010 study wave only. Age (OR = 0.80, P < 0.05), female gender (OR = 0.29, P < 0.01), holding more negative attitudes towards condoms (OR = 0.28-0.32, P < 0.05) and reporting condom use at most recent vaginal intercourse (OR = 11.45, 95% Confidence interval [CI] = 5.68-23.06) were associated with using a condom at most recent anal intercourse. Given the substantial prevalence of anal intercourse among young heterosexual adults and considerable sexually transmitted infection/HIV risks associated with the practice, sex education programmes should promote the discussion of health risks associated with anal eroticism.
Article
Mounting evidence suggests anal intercourse amongst both heterosexual and homosexual persons is an increasingly prevalent form of sexual expression, yet associated problems presenting to psychosexual services are a relative rarity. What constitutes ‘normal’ sexual satiety within the realms of anal sexuality remains an enigma to many, both therapists and clients alike. The term anodyspareunia has been proposed to denote a novel sexual dysfunction comprising the perception of pain during receptive anal sex; this has been evaluated in men who have sex with men (MSM) and likened to female dyspareunia. This paper reviews some of the common aspects of anal sexuality and explores the evidence surrounding the conceptualisation of anoreceptive pain as a sexual dysfunction in detail, arguing against the use of heterosexually derived frameworks when working with gay men. Alternative ways of approaching anoreceptive pain are discussed. The lack of good quality evidence on the aetiology and sequelae of pain during anoreceptive intercourse in persons of any gender or sexual orientation is clear and the call for further research is imperative.
Article
The objective of the study was to determine the prevalence and characteristics of vulvodynia among women in southeast Michigan. A population-based study of adult women was conducted, using telephone recruitment and completion of a self-administered survey. Weighted estimates of vulvodynia prevalence and characteristics were determined. Over a year, 2542 women were recruited and 2269 (89.3%) completed the self-administered survey. The weighted prevalence of vulvodynia was 8.3% (95% confidence interval, 7.0-9.8) or approximately 101,000 women in the targeted population. Prevalence remained stable through age 70 years and declined thereafter. Among sexually active women, the prevalence was similar at all ages. Of 208 women meeting vulvodynia criteria, 101 (48.6%) had sought treatment, and only 3 (1.4%) had been diagnosed with vulvodynia (unweighted values). Previous vulvodynia symptoms had resolved in 384 women (16.9%) after a mean duration of 12.5 years. Vulvodynia is common, although rarely diagnosed. Prevalence remains high among sexually active women of any age.
Article
Anal sex is becoming increasingly prevalent among heterosexual women and men. Although pain related to receptive anal intercourse is not uncommon, little is known about its phenomenology. This article aims to assess the prevalence and correlates of pain during anoreceptive intercourse, including anodyspareunia, its most severe form, among young women. An online survey focusing on anal eroticism was carried out in March and April 2010 on a convenience sample of 2,002 women 18-30 years of age. Participants who reported 2 or more episodes of anal intercourse in the past year were asked about the level and frequency of pain at anoreceptive penetration; those who reported unbearable (too painful to continue) or strong pain at every such occasion were classified as anodyspareunic. The experience of receptive anal intercourse was reported by 63.2% (n = 1,265) of participants. Although almost half (48.8%) had to discontinue their first anoreceptive intercourse because of pain or discomfort, a majority of women (62.3%; n = 788) continued anal sex. Of the 505 participants who reported 2 or more episodes of anal intercourse in the past year, the women (8.7%; n = 44) who reported severe pain during every anoreceptive penetration were classified as anodyspareunic; all others were classified as non-anodyspareunic. For more than two thirds of women with anodyspareunia, the current pain level remained unchanged from their first experience with anal sex. Inability to relax was the most frequent self-hypothesized cause of pain among the anodyspareunic and nonanodyspareunic groups. Compared with other women, those with anodyspareunia reported substantially lower levels of sexual satisfaction (odds ratio = .95; p < .001) and were less sexually assertive (odds ratio = .80; p < .01). The findings that a substantial proportion of women reported pain at first and subsequent anoreceptive intercourse highlight a need for more information and education about anal eroticism.
Article
Male patients can present with a genital skin burning sensation that bears similarities to vulvodynia. The classification of vulvodynia by International Society for the Study of Vulvovaginal Disease of vulvodynia provides a blueprint for nomenclature and classification of Dysaesthetic penoscrotodynia (DPSD). Recognizing DPSD as generalized, localized, provoked, unprovoked and mixed will enable precise and objective communication between practitioners. Learning from research on the aetiology and management of vulvodynia can improve the care of patients suffering with DPSD. Scope remains for better acknowledgement of DPSD within the medical profession and improvement in its public profile in order to enhance patient care.
Article
The main objective of this article was to conduct a systematic review of the literature examining relationship adjustment and sexual satisfaction among women with provoked vestibulodynia (PVD). Although only a small number of studies have included partners, the literature regarding partner's relationship adjustment and sexual satisfaction was also examined. Relevant articles were identified by a literature search conducted between August 2008 and May 2010. Studies were included if they contained at least one group or subset of participants with PVD or dyspareunia (i.e., painful sexual intercourse), and if they assessed relationship adjustment or sexual satisfaction as a primary outcome measure. Within this review, the methodological quality of 33 studies was systematically rated, and effect sizes were calculated when possible. Methodological type and quality greatly varied across the studies, as did the pain samples included and the outcomes reported. Nevertheless, the results of controlled studies indicate that PVD is associated with decreased sexual satisfaction. The controlled results also suggest, however, that PVD is not necessarily associated with general relationship maladjustment for women and their partners. Future research, using various methodologies, is needed to further understand intimate relationships among women with PVD and the impact that this condition may have on couples.
Article
Recurrent painful intercourse or dyspareunia is a highly prevalent health problem associated with impairments in sexual function and psychosocial well-being. Despite its particularly high prevalence in young women, little is known about how young women experience the onset of dyspareunia and how they attempt to manage or address the problem. To explore the subjective experience of early dyspareunia symptoms in young women so as to model its cognitive, emotional, behavioral, and help-seeking trajectory. Using a qualitative methodology broadly based on grounded theory, 14 young women reporting recurrent entry and/or deep pain with intercourse underwent in-depth semistructured interviews asking them to describe their personal experience with dyspareunia symptoms. The Female Sexual Function Index was used to screen women with symptoms of dyspareunia. The main outcome measure was a semistructured interview inquiring about the cognitions and emotions associated with the experience of pain with intercourse, causal attributions for the pain, interference with personal, relational, and sexual well-being, and help-seeking decisions. The model/theory that emerged suggested a sequence of experiences that began with confusion about the onset of pain and a relatively fruitless search for causal attributions. Attempts to self-manage the pain via a number of cognitive and behavioral strategies provided little relief. Deleterious consequences on sexual function, well-being, and relationships ensued, and women reported a number of barriers to help-seeking. The findings from this study suggest that a lack of public health information about dyspareunia and the reluctance of health care providers to inquire about sexual problems may contribute to many young women delaying treatment for a serious sexual health problem with potentially negative biopsychosocial outcomes.
Article
Although studies of specific groups of individuals (e.g., adolescents, "high risk" samples) have examined sexual repertoire, little is known, at the population level, about the sexual behaviors that comprise a given sexual encounter. To assess the sexual behaviors that men and women report during their most recent sexual event; the age, partner and situational characteristics related to that event; and their association with participants' evaluation of the sexual event. During March-May 2009, data from a United States probability sample related to the most recent partnered sexual event reported by 3990 adults (ages 18-59) were analyzed. Measures included sexual behaviors during the most recent partnered sexual event, event characteristics (i.e., event location, alcohol use, marijuana use, and for men, erection medication use), and evaluations of the sexual experience (pleasure, arousal, erection/lubrication difficulty, orgasm). Great diversity exists in the behaviors that occur during a single sexual event by adults, with a total of 41 combinations of sexual behaviors represented across this sample. Orgasm was positively related to the number of behaviors that occurred and age was related to greater difficulty with erections and lubrication. Men whose most recent event was with a relationship partner indicated greater arousal, greater pleasure, fewer problems with erectile function, orgasm, and less pain during the event compared with men whose last event was with a nonrelationship partner. Findings demonstrate that adults ages 18 to 59 engage in a diverse range of behaviors during a sexual event and that greater behavior diversity is related to ease of orgasm for both women and men. Although both men and women experience sexual difficulties related to erectile function and lubrication with age, men's orgasm is facilitated by sex with a relationship partner whereas the likelihood of women's orgasm is related to varied sexual behaviors.
Article
In the contemporary U.S., men and women are living longer and healthier lives. As such, many people spend greater portions of their lives as sexually active individuals. Yet, little is known about the myriad of ways that older adults experience their sexual lives. This study sought to assess the context and frequency of sexual behaviors, condom use, sexual pleasure, and sexual experience of men and women over age 50. Information regarding the sexual experiences of a nationally representative sample of men and women over age 50 within the past year was examined. Sexual behavior over the past year was assessed in relation to several situational and contextual characteristics (e.g., event location, type of partner, health status, condom use). Participants were also asked about their experience (i.e., pleasure, arousal, pain, lubrication/erectile difficulties, and orgasm) during their most recent partnered sexual event. Bivariate or ordinal logistic regression models were used to investigate the relationship of age, health and partner status to sexual frequency and experience. Although sizable proportions (20-30%) of both men and women remained sexually active well into their 80s age was related to a lower likelihood of solo and most partnered sexual behaviors. When controlling for age, relationship status, and health remained significant predictors of select sexual behaviors. The participant's evaluation of their most recent sexual experience in terms of arousal, erectile difficulty, and orgasm all declined with age. Health status was related to men's evaluation of the experience. Relationship status was the most consistent predictor of women's evaluation of the experience. Condom use rates remained low for participants across age groups. Many older adults continue be sexually active well into advanced age (80+). Thus, providers need to be attentive to the diverse sexual health needs of older adults.
Article
Given the efficacy of latex condoms for preventing pregnancy, HIV, and most STI, their promotion remains central to global sexual health efforts. To inform the development of accurate and appropriately-targeted interventions, there is a need for contemporary condom use rates among specific populations. The purpose of this study was to establish rates of condom use among sexually active individuals in the U.S. population. Data were collected via a national probability sample of 5,865 U.S. adolescents and adults aged 14 to 94 years. Condom use was assessed during the most recent partnered vaginal or anal sexual event and over the past 10 vaginal and anal intercourse events. Condom use by men during past 10 vaginal intercourse events was slightly higher (21.5%) than that reported by women (18.4%), and consistent with rates of condom use reported during most recent vaginal intercourse by men (24.7%) and women (21.8%). Adolescent men reported condom use during 79.1% of the past 10 vaginal intercourse events, adolescent women reported use during 58.1% of the same. Condom use during past 10 anal intercourse events was higher among men (25.8%) than women (13.2%); the same was observed for most recent anal intercourse event (26.5% for insertive men, 44.1% for receptive men, and 10.8% for receptive women). Generally, condom use was highest among unmarried adults, higher among adolescents than adults, and higher among black and Hispanic individuals when compared with other racial groups. These data indicate clear trends in condom use across age, gender, relationship status, and race/ethnicity. These contemporary rates of condom use will be helpful to those who lead efforts to increase condom use among individuals who may be at risk for sexually transmitted infections or who desire to prevent pregnancy.
Article
Little research addresses the role of anal sexuality and anal sexual behaviors as a widely practiced but relatively less frequent element of a heterosexual sexual repertoire. However, the importance of anal sex in sexual health is increasingly well-defined by epidemiological and clinical studies. This article reviews existing data on a range of heterosexual anal sex practices and provides conceptual and methodological recommendations for new research.
Article
While vibrating products have been recommended by clinicians for the treatment of male sexual dysfunctions, knowledge is lacking with regard to the prevalence of vibrator use among men in the United States, the characteristics of men who use vibrators, and whether there are relations between vibrator use and sexual function among men. To establish lifetime and recent prevalence rates for vibrator use by men in the United States, to document the characteristics of men who use vibrators and their reasons for using vibrators, and to explore relations between men's vibrator use and sexual function. During April 2008, data were collected from a population-based cross-sectional survey of 1,047 men aged 18-60 years in the United States. Analyses were conducted using post-stratification data weights. Measures included sociodemographics, health status and health-related behaviors, sexual behaviors, vibrator use, and sexual function. For both solo and partnered sexual activities, the prevalence of men who had incorporated a vibrator into sexual activities during their lives was 44.8%, with 10.0% having done so in the past month, 14.2% in the past year, and 20.5% over 1 year ago. Men who had used vibrators, particularly those with more recent use, were more likely to report participation in sexual health promoting behaviors, such as testicular self-exam. Men who had used vibrators recently also scored higher on four of the five domains of the International Index of Erectile Function (erectile function, intercourse satisfaction, orgasmic function, and sexual desire). Among men in the United States, vibrator use during solo and partnered sexual interactions is common and is associated with a wide array of positive sexual health characteristics. Future research should continue to explore ways in which men incorporate vibrators into solo sexual acts, partnered sexual play, and sexual intercourse.
Article
To compare biopsychologic profiles of women with dyspareunia with a matched no-pain control sample, and to determine whether dyspareunia subtypes based on physical findings have different psychosocial profiles from matched controls. One hundred and five women with dyspareunia and 105 matched no-pain control women underwent standard gynecologic examination, endovaginal ultrasound, and colposcopy. They also completed a structured interview inquiring about pain other than dyspareunia, sexual function, and history of abuse, the Brief Symptom Inventory, the Sexual Opinion Survey, and the Locke-Wallace Marital Adjustment Scale. In comparison with women who do not experience pain with intercourse, the dyspareunia sample was found to have more physical pathology on examination, and they reported more psychologic symptomatology, more negative attitudes toward sexuality, higher levels of impairment in sexual function, and lower levels of marital adjustment. They did not report more current or past physical or sexual abuse. However, when the undifferentiated dyspareunia sample was divided into subtypes based on physical findings from the gynecologic examinations, the pattern of significant differences from controls varied according to dyspareunia subtype. Elevated psychologic symptomatology and relationship maladjustment were confined to the subtype with no discernible physical findings who reported levels of sexual function not significantly different from matched controls. The vulvar vestibulitis subtype suffered the highest levels of sexual impairment, although this subtype was not characterized by higher levels of psychologic symptoms than controls. As an undifferentiated group, women with dyspareunia have more physical pathology, psychologic distress, sexual dysfunction, and relationship problems. However, this pattern of differences appears to vary depending on the presence and type of physical findings evident on examination. Dyspareunia is a heterogeneous disorder requiring comprehensive gynecologic and psychosocial assessment to determine differentiated treatment strategies.
Article
To investigate the extent to which depressive symptomatology, anxiety, and marital adjustment mediate pain ratings in women suffering from dyspareunia. Seventy-six women with dyspareunia were administered the depression and anxiety scales of Derogatis's Brief Symptom Inventory and the McGill Pain Questionnaire. They also underwent a manual-visual gynecological examination, an ultrasound, and a colposcopy in an attempt to identify potential evidence and type of organicity. Depressive symptomatology, anxiety, and marital adjustment together accounted for a significant amount of the variance in pain ratings, although only anxiety and marital adjustment were independent predictors of pain ratings in the entire group of women with dyspareunia. When multiple regression analyses were then applied to different diagnostic subgroups of dyspareunia, the independent predictors of pain rating varied depending on the findings from the gynecological examinations. Affect and marital adjustment appear to be significant predictors of dyspareunic pain rating, although the independent contribution of psychosocial variables may vary depending on the presence and type of organic findings.
Article
Sexual dysfunctions are highly prevalent, affecting about 43% of women and 31% of men. Hypoactive sexual desire disorder has been reported in approximately 30% of women and 15% of men in population-based studies, and is associated with a wide variety of medical and psychologic causes. Sexual arousal disorders, including erectile dysfunction in men and female sexual arousal disorder in women, are found in 10% to 20% of men and women, and is strongly age-related in men. Orgasmic disorder is relatively common in women, affecting about 10% to 15% in community-based studies. In contrast, premature ejaculation is the most common sexual complaint of men, with a reporting rate of approximately 30% in most studies. Finally, sexual pain disorders have been reported in 10% to 15% of women and less than 5% of men. In addition to their widespread prevalence, sexual dysfunctions have been found to impact significantly on interpersonal functioning and overall quality of life in both men and women.
Article
To explore the psychological, interpersonal and sexual correlates of vulvar vestibulitis via qualitative and quantitative analysis. Sixty-nine women diagnosed with vestibulitis were recruited from a vulvar/vaginal disease clinic to complete a comprehensive quantitative and qualitative questionnaire designed to assess general health concerns, mental health, sexual functioning and interpersonal relationships. The majority of participants reported drastic changes in sexuality associated with the onset of vestibulitis. Upon developing vestibulitis, 88% reported decreased interest in sexual activity, 87% indicated that they were less willing to participate in sexual activity, and 94% maintained that they were less able to participate in sexual activity. High levels of frustration and symptoms of depression also were frequently reported. Vulvar vestibulitis is associated with significant changes in sexuality, intimate relationships and psychological well-being. When treating women with vestibulitis, medical professionals should consider the psychological and sexual aspects of the disease in addition to physical concerns.
Prevalence and demographic characteristics of vulvodynia in a population-based sample
  • Reed Br Harlow
  • Sd
  • A Sen
  • Edwards Lj Rm Legocki
  • N Arato
  • Haefner
  • Hk
Reed BR, Harlow SD, Sen A, Legocki LJ, Edwards RM, Arato N, Haefner HK. Prevalence and demographic characteristics of vulvodynia in a population-based sample. Am J Obstet Gynecol 2012;206:170.e1–9.