The effect of pain-related fear on sexual arousal in women with superficial dyspareunia

A systematic review of relationship adjustment and sexual satisfaction among women with provoked vestibulodynia

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.

Visual attention to erotic images in women reporting pain with intercourse

The coupling of sex and pain creates an interesting theoretical conundrum of clinical significance: Are women with dyspareunia distracted from sexual stimuli, or are they hypervigilant to sexual stimuli because these stimuli elicit thoughts and expectations of pain? This study measured attention to sexual stimuli in women reporting persistent pain with intercourse, women reporting low sexual desire, and women reporting no sexual problems. Participants viewed a series of erotic images, each containing an object intended to distract from the erotic scene regions, while an eye tracker recorded their eye movements. Women with pain looked for shorter periods of time and fewer times at the sexual scene region than did both women with low sexual desire (p = .024 and p = .018, respectively) and the no-dysfunction control group (p < .001 and p = .003, respectively). Women with pain also looked at the context (nonsexual) scene region significantly more times and for longer periods than did the no-dysfunction control women (p = .013 and p = .042, respectively). Results are interpreted to be potentially supportive of the cognitive distraction hypothesis associated with sexual dysfunction, with an additional component of cognitive avoidance of sexual stimuli for the women reporting sexual pain.

Disorders in sexual desire and sexual arousal in women, a 2010 state of the art

In this contribution, female sexual desire and arousal disorders are viewed from the perspective of incentive motivation and information processing models of sexual response. The effects of hormones, somatic disease, and medication on sexual arousability are discussed, as well as the influence of psychological factors, such as stimulus meaning, mood and cognition, and relational context on female sexual desire and arousal. Specific topics to attend to during the anamnesis of sexual desire and arousal problems, and empirically evaluated psychological and pharmacological treatments for these problems are discussed.

The sensitivity of continuous laboratory measures of physiological and subjective sexual arousal for diagnosing women with sexual arousal disorder

INTRODUCTION

Past findings on the diagnostic sensitivity of vaginal photoplethysmography are limited by testing among women with heterogeneous sexual dysfunctions and by the use of statistical techniques that are unable to assess how changes in subjective arousal are associated with changes in physiological arousal.

AIMS

The aims of this study were to: (i) test the sensitivity of vaginal photoplethysmography and continuous measures of subjective sexual arousal in differentiating between women with and without sexual arousal or orgasm dysfunction; and (ii) examine the diagnostic utility of measuring the synchrony between genital and subjective sexual responses.

METHODS

Sexual arousal was assessed in sexually healthy women (n = 12), women with orgasm disorder (OD; n = 12), and 38 women who met the criteria for the three subcategories of sexual arousal dysfunction described by Basson et al. (i.e., genital sexual arousal disorder [GAD; n = 9], subjective sexual arousal disorder [SAD; n = 13], and combined genital and subjective arousal disorder [CAD; n = 16]).

MAIN OUTCOME MEASURES

Physiological sexual arousal was assessed using vaginal photoplethysmography, and subjective sexual arousal was measured continuously and using a Likert-scale in response to sexual videos.

RESULTS

Women with GAD showed the lowest and women with CAD showed the highest levels of vaginal pulse amplitude response to erotic stimuli. Women with sexual arousal disorder showed significantly lower levels of subjective sexual arousal to erotic stimuli than did sexually healthy women. Relations between subjective and physiological measures of sexual arousal were significantly weaker among women with sexual arousal disorder than sexually healthy women or women with OD.

CONCLUSION

Preliminary support was provided for the diagnostic utility of measuring the synchrony between subjective and genital arousal in women with sexual arousal disorder. Findings do not support the sensitivity of using vaginal photoplethysmography, or continuous or Likert-scale measures of subjective arousal for differentiating between subtypes of women with sexual arousal disorder.

Cognitive behavioral therapy for sexual dysfunctions in women

Sexual dysfunctions in women are classified into disorders of desire, arousal, orgasm, and pain (including dyspareunia and vaginismus). As the cognitive behavioral treatment (CBT) procedures differ among these sexual disorders, the treatments for each disorder are reviewed separately. The efficacy of CBT differs depending on the specific sexual dysfunction to be treated. It is concluded that only a few CBT treatments for women's sexual dysfunction have yet been empirically investigated in a methodologically sound way and little is known about which of the treatment components are most effective.

Agreement of self-reported and genital measures of sexual arousal in men and women: a meta-analysis

The assessment of sexual arousal in men and women informs theoretical studies of human sexuality and provides a method to assess and evaluate the treatment of sexual dysfunctions and paraphilias. Understanding measures of arousal is, therefore, paramount to further theoretical and practical advances in the study of human sexuality. In this meta-analysis, we review research to quantify the extent of agreement between self-reported and genital measures of sexual arousal, to determine if there is a gender difference in this agreement, and to identify theoretical and methodological moderators of subjective-genital agreement. We identified 132 peer- or academically-reviewed laboratory studies published between 1969 and 2007 reporting a correlation between self-reported and genital measures of sexual arousal, with total sample sizes of 2,505 women and 1,918 men. There was a statistically significant gender difference in the agreement between self-reported and genital measures, with men (r = .66) showing a greater degree of agreement than women (r = .26). Two methodological moderators of the gender difference in subjective-genital agreement were identified: stimulus variability and timing of the assessment of self-reported sexual arousal. The results have implications for assessment of sexual arousal, the nature of gender differences in sexual arousal, and models of sexual response.

Automatic and deliberate affective associations with sexual stimuli in women with superficial dyspareunia

Current views suggest that in women with superficial dyspareunia the prospect of penile-vaginal intercourse automatically activates fear-related associations. The automatic activation of negative associations is assumed to interfere with the development of sexual arousal. In turn, this may further aggravate the dyspareunia-related complaints. To assess whether automatic negative associations are involved in this sexual pain disorder, women with superficial dyspareunia (n = 35) and a control group (n = 35) completed a modified pictorial Affective Simon Task (AST). Questioning the role of dysfunctional automatic associations in superficial dyspareunia, the AST indicated that symptomatic women displayed relatively positive rather than negative automatic associations with sexual stimuli. At the self-report level, however, affective associations with sex cues were significantly more negative for women with dyspareunia than for controls. This discrepancy between "reflective" and "reflexive" affective associations with sexual stimuli in women with dyspareunia points to the relevance of conscious appraisal and deliberate rather than automatic processes in the onset and maintenance of dyspareunia.

Effects of appraisal of sexual stimuli on sexual arousal in women with and without superficial dyspareunia

This study examined the effects of appraisal of sexual stimuli on sexual arousal in women with superficial dyspareunia (n = 50) and sexually functional women (n = 25). To elicit different appraisals of an erotic film fragment, participants received an instruction prior to viewing it, with a focus on genital pain or on sexual enjoyment. A neutral instruction served as a control condition. Assignment to instruction condition was randomized. Genital arousal (vaginal pulse amplitude) and self-report ratings of affect and genital sensations were obtained in response to the erotic stimulus. As predicted, appraisal of the erotic stimulus affected genital responding, albeit marginally significant. Follow-up tests indicated that women who received the genital pain instruction responded with marginally significant lower genital arousal levels than women who received the sexual enjoyment instruction (d = 0.67). A significant instruction effect for negative affect was found, signifying that negative affect ratings were highest after the genital pain instruction and lowest after the sexual enjoyment instruction (d = 0.80). A marginally significant group by instruction interaction effect was observed for positive affect, indicating that women with dyspareunia reported significantly less positive affect than controls after the sexual enjoyment instruction (d = 1.48). Whereas women with dyspareunia reported overall marginally significant more negative affect than controls (d = 0.48), there were no differences in genital responsiveness between groups. These results provided preliminary evidence for the modulatory effects of appraisal of sexual stimuli on subsequent genital responding and affect in women with and without sexual complaints.

Cognitive-affective correlates and predictors of superficial dyspareunia

This study investigated the role of cognitive-affective variables related to sexuality, chronic pain, individual and relational well-being in superficial dyspareunia. Although symptomatic women (n = 80) differed from complaint-free controls (n = 62) on all variables, sexuality related measures had the most important contribution into the prediction of group membership. Dyspareunia subgroups based on the presence/absence of a concomitant diagnosis of provoked vestibulodynia were only distinguishable on pain intensity but not on variables related to sexuality and psychological well-being. The present findings underscore the relevance of psychosexual factors in women with superficial dyspareunia.

Appetitive and aversive classical conditioning of female sexual response

INTRODUCTION

There is only limited evidence for appetitive classical conditioning of female sexual response, and to date modulation of female sexual response by aversive conditioning has not been studied.

AIM

The aim of this article is to study appetitive and aversive classical conditioning of sexual responses in women.

MAIN OUTCOME MEASURES

Vaginal pulse amplitude was assessed by vaginal photoplethysmography and ratings of affective value were obtained.

METHOD

Two differential conditioning experiments were conducted. In Experiment 1, on appetitive conditioning, neutral pictures served as conditional stimuli (CSs) and genital vibrotactile stimulation as the unconditional stimulus (US). In Experiment 2, on aversive conditioning, erotic pictures served as CSs and a pain stimulus as US. In both experiments, only one CS (the CS+) was followed by the US during the acquisition phase. Conditioned responses were assessed during the extinction phase.

RESULTS

In Experiment 1, during the extinction phase, as expected vaginal pulse amplitude was higher in response to the CS+ than during the CS-. Also, the CS+ was rated as marginally more positive than the CS-. In Experiment 2, during the extinction phase, as expected vaginal pulse amplitude was lower in response to the CS+ than during the CS-, and the CS+ was rated as more negative than the CS-.

CONCLUSIONS

The results provide evidence for appetitive classical conditioning of sexual response in women, and are the first to show attenuation of sexual response in women by aversive conditioning.

Preliminary evidence that acute and chronic daily psychological stress affect sexual arousal in sexually functional women

It is assumed that psychological stress may inhibit sexual arousal in women. Research on the effect of (acute and chronic) psychological stressors on genital and subjective sexual arousal, however, is scarce. To investigate whether psychological stressors indeed inhibit sexual responding, sexually functional women were randomly assigned to an experimental condition (n=30) in which acute psychological stress was induced by a frustrating computer task or a control condition (n=29). After the acute psychological stress or control induction women were exposed to an erotic stimulus. Genital sexual arousal was assessed using vaginal photoplethysmography. Self-report ratings of subjective sexual arousal were collected after the erotic stimulus. Furthermore, women were post hoc divided into a 'low' and a 'high' chronic stress group, based on their pre-assessment scores on a chronic daily stress questionnaire. As predicted, it was found that women in the acute stress condition responded with lower levels of genital and subjective sexual arousal to an erotic stimulus than women in the control condition. In addition, women with high levels of chronic stress responded with lower levels of genital sexual arousal to an erotic stimulus than women with low levels of chronic stress. Chronic stress did not affect the level of subjective sexual arousal.

Simultaneous Measurement of Pelvic Floor Muscle Activity and Vaginal Blood Flow: A Pilot Study

INTRODUCTION

Dyspareunia, defined as persistent or recurrent genital pain associated with sexual intercourse, is hypothesized to be related to pelvic floor hyperactivity and to diminished sexual arousal. Empirical research to support these hypotheses is scarce and concentrates mostly on the role of either pelvic floor activity or genital arousal in female dyspareunia. Currently, however, there is no measurement device to assess pelvic floor activity and genital response simultaneously.

AIM

The aim of this study was to investigate the validity of a new device that enables simultaneous measurement of pelvic floor activity and genital response in women.

MAIN OUTCOME MEASURES

Genital arousal measured as vaginal pulse amplitude, and vaginal surface electromyogram (EMG).

METHOD

Thirty sexually functional women participated. To investigate the accuracy of genital response measurement with the adapted photoplethysmograph, and the sensitivity of the device for involuntary changes in pelvic floor activity, vaginal pulse amplitude and vaginal surface EMG were monitored during exposure to emotional, including erotic, films. In addition, vaginal surface EMG was monitored during instructed pelvic floor contractions.

RESULTS

The genital data obtained during emotional films proved accurate measurement of genital response. EMG values during the emotional films indicated limited sensitivity of the device for small, involuntary changes in pelvic floor activity due to emotional state. The EMG measurements during the instructed pelvic floor contractions proved sensitivity of the new probe to voluntary pelvic floor activity.

CONCLUSION

It is concluded that following improvement of the sensitivity of the EMG measurement for small, involuntary changes in pelvic floor activity, the device will be a valuable tool in research on superficial dyspareunia.