The Relationship Between Pain Sensitivity and Vasocongestion Due to Sexual Arousal in Women with Provoked Vestibulodynia
Boyer, Stéphanie Camille
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Women with chronic vulvar pain report reduced sexual function in comparison to non-affected women, including decreased sexual arousal. Experimentally induced sexual arousal has been examined in women with and without chronic vulvar pain, with contradictory results: some studies have found that only subjective arousal is affected in women with versus without vulvar pain, while other research has suggested that only genital responsiveness is affected in women with pain. As a result of these inconsistent findings, the role of arousal mechanisms in the causation and maintenance of provoked vestibulodynia (PVD) remains unclear. Thirty women with (n = 15) and without PVD (n = 15) were recruited to examine the relationship among physiological and subjective arousal, pain sensitivity and psychological/sexual function. Laser Doppler imaging (LDI) directly measured blood flow to the external genitals in response to an erotic film, and pain sensitivity was assessed before and after imaging. The PVD group had significantly lower blood flow than the control group during the erotic film when baseline blood flow levels were controlled; there were, however, no group differences in ratings of subjective arousal during the erotic film. Vestibular pain thresholds were significantly lower in the PVD group before and after the erotic film compared to the control group. In contrast, pain intensity ratings were significantly higher pre-erotic film in the PVD group, but there was no group difference post-erotic film. Pain thresholds did not significantly change in either group following exposure to the erotic film. Lastly, the PVD group had significantly lower sexual and psychological function in comparison to the control group, and intercourse frequency and pain catastrophizing significantly predicted genital responsiveness in the PVD group. The results suggest that women with PVD show an attenuated physiological response to erotic stimuli in an experimental setting, in the absence of differences in subjective arousal. The findings thus support the role of arousal in the maintenance of PVD, potentially in interaction with other physical and psychological factors. The study also has implications for the assessment and treatment of PVD, whereby arousal processes should be explicitly and separately managed in women with this condition.