Marieke Brauer

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.

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.

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.

The role of pain‐related fear in the etiology and/or maintenance of superficial dyspareunia is still unclear. The objective of this experiment was to investigate the effects of pain‐related fear on sexual arousal in women with superficial dyspareunia (n=48) and women without sexual complaints (n=48). To induce pain‐related fear, participants were told that they had a 60% chance of receiving painful stimuli while being exposed to one of two erotic film clips. Genital arousal was assessed using vaginal photoplethysmography. Self‐reported ratings of genital sensations and affect were collected after both erotic stimulus presentations. Elevated levels of skin conductance and higher ratings of experienced threat during the pain threat condition indicated that fear was successfully elicited. Pain‐related fear impeded genital arousal in all women. Women of both groups reported significantly less positive affect and more negative affect when threatened. Although women with dyspareunia did not differ in their genital responsiveness from women without sexual complaints, they experienced overall significantly more negative affect than the control group. The present results indicate that pain‐related fear reduces genital and subjective sexual responding in women with and without sexual problems. We conclude that emotional appraisal of the sexual situation determines genital responsiveness in both sexually dysfunctional and functional women.

The role of sexual arousal in the etiology and/or maintenance of superficial dyspareunia is still unclear. Lack of sexual arousal may be both the cause and the result of anticipated pain. This study compared genital and subjective sexual responses to visual sexual stimuli of women with dyspareunia and women without sexual complaints. We investigated whether women with dyspareunia were less genitally and subjectively responsive to noncoital (oral sex) as well as coital visual sexual stimuli than women without sexual problems, or whether they exhibited a conditioned anxiety response such that sexual arousal responses were lower only to stimuli that may induce fear of pain (i.e., coitus). A total of 50 women with dyspareunia and 25 women without sexual problems were shown two sexual stimuli, one depicting oral sex and the other one depicting coitus. Genital arousal was assessed as vaginal pulse amplitude using vaginal photoplethysmography. Self-reported ratings of subjective sexual arousal were collected after each erotic stimulus presentation. Women with dyspareunia had comparable levels of genital arousal to two different visual sexual stimuli as women without sexual complaints. Contrary to expectation, there was an indication that women with dyspareunia reacted with higher levels of genital arousal to the explicitly depicted coitus stimulus than controls, whereas controls had higher genital responses to the oral sex stimulus. With respect to subjective sexual arousal, it was found that women with dyspareunia reported less positive feelings in response to both erotic stimuli than controls. We conclude that, with adequate visual sexual stimulation, women with dyspareunia showed equal levels of genital sexual arousal to visual sexual stimuli as women without sexual complaints. Therefore, there was no evidence for impaired genital responsiveness associated with dyspareunia. Also, we found no evidence for a conditioned anxiety reaction in response to exposure to a coitus scene.