Abstract
Vulvar inflammatory dermatoses (VID; e.g., lichen sclerosus, lichen planus, vulvar dermatitis) can significantly impact sexual function. Both vulvar and non-vulvar inflammatory dermatoses (NVID; i.e., skin conditions not impacting vulvar skin, such as non-genital psoriasis and eczema/dermatitis) have yet to be fully characterized with regard to impact on genital self-image. A 20-min web-based survey was distributed September–November 2020 through social media ads, support groups, and online research recruitment services. Individuals in the USA over age 18 who were assigned female at birth and self-reported having been diagnosed with an inflammatory dermatosis were eligible. The primary outcome was the Female Genital Self-Image Scale (FGSIS). Secondary outcomes included the Female Sexual Function Index (FSFI), the Skindex-16 (a skin-related quality of life measure), the PROMIS Global-10 (assessing global physical/mental health), and sexual behavior histories. Participants (n = 348) reported mean age of 43.1 ± 15.5 (range = 19–81). Nearly one-third (n = 101; 29.0%) reported VID, 173 (50%) had NVID, and 74 (21%) experienced both vulvar and non-vulvar symptoms; they were analyzed as part of the VID group. The mean FGSIS score among participants with VID was 16.9 ± 4.1 and was significantly (p < .01) lower than that of participants with NVID (M = 21.2 ± 4.3), indicating lower genital self-image. Mental health (as measured by PROMIS-Global 10) was also impaired in VID. Rates of sexual dysfunction were high in both groups (> 60%). Findings suggest that in VID, lower genital self-image is correlated with poorer sexual function, quality of life, and global physical and mental health. Additional recommendations for VID management are proposed.
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References
Addis, I. B., Van Den Eeden, S. K., Wassel-Fyr, C. L., Vittinghoff, E., Brown, J. S., Thom, D. H., & Reproductive Risk Factors for Incontinence Study at Kaiser Study Group. (2006). Sexual activity and function in middle-aged and older women. Obstetrics and Gynecology, 107(4), 755–764. https://doi.org/10.1097/01.AOG.0000202398.27428.e2.
Alavi, A., Farzanfar, D., Rogalska, T., Lowes, M. A., & Chavoshi, S. (2018). Quality of life and sexual health in patients with hidradenitis suppurativa. International Journal of Women’s Dermatology, 4(2), 74–79. https://doi.org/10.1016/j.ijwd.2017.10.007
Allahdadi, K. J., Tostes, R. C. A., & Webb, R. C. (2009). Female sexual dysfunction: Therapeutic options and experimental challenges. Cardiovascular & Hematological Agents in Medicinal Chemistry, 7(4), 260–269.
Barchino-Ortiz, L., Suárez-Fernández, R., & Lázaro-Ochaita, P. (2012). Vulvar Inflammatory Dermatoses. Actas Dermo-Sifiliográficas (english Edition), 103(4), 260–275. https://doi.org/10.1016/j.adengl.2012.05.004
Bentham, G. L., Manley, K., Halawa, S., & Biddle, L. (2021). Conversations between women with vulval lichen sclerosus: A thematic analysis of online forums. BMC Women’s Health, 21(1), 71. https://doi.org/10.1186/s12905-021-01223-6
Brotto, L. A. (2009). Letter to the editor. Journal of Sex & Marital Therapy, 35(3), 161–163. https://doi.org/10.1080/00926230802716294
Brotto, L. A., Basson, R., Carlson, M., & Zhu, C. (2013). Impact of an integrated mindfulness and cognitive behavioural treatment for provoked vestibulodynia (IMPROVED): A qualitative study. Sexual and Relationship Therapy, 28(1–2), 3–19. https://doi.org/10.1080/14681994.2012.686661
Brotto, L. A., Basson, R., Smith, K. B., Driscoll, M., & Sadownik, L. (2015a). Mindfulness-based group therapy for women with provoked vestibulodynia. Mindfulness, 6(3), 417–432. https://doi.org/10.1007/s12671-013-0273-z
Brotto, L. A., Yong, P., Smith, K. B., & Sadownik, L. A. (2015b). Impact of a multidisciplinary vulvodynia program on sexual functioning and dyspareunia. The Journal of Sexual Medicine, 12(1), 238–247. https://doi.org/10.1111/jsm.12718
Cella, D., Riley, W., Stone, A., Rothrock, N., Reeve, B., Yount, S., Amtmann, D., Bode, R., Buysse, D., Choi, S., Cook, K., DeVellis, R., DeWalt, D., Fries, J. F., Gershon, R., Hahn, E. A., Lai, J.-S., Pilkonis, P., Revicki, D., … Hays, R. (2010). The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. Journal of Clinical Epidemiology, 63(11), 1179–1194. https://doi.org/10.1016/j.jclinepi.2010.04.011
Cheng, H., Oakley, A., Conaglen, J. V., & Conaglen, H. M. (2017). Quality of life and sexual distress in women with erosive vulvovaginal lichen planus. Journal of Lower Genital Tract Disease, 21(2), 145–149. https://doi.org/10.1097/LGT.0000000000000282
Chren, M.-M., Lasek, R. J., Quinn, L. M., Mostow, E. N., & Zyzanski, S. J. (1996). Skindex, a quality-of-life measure for patients with skin disease: Reliability, validity, and responsiveness. Journal of Investigative Dermatology, 107(5), 707–713. https://doi.org/10.1111/1523-1747.ep12365600
Chren, M.-M., Lasek, R. J., Sahay, A. P., & Sands, L. P. (2001). Measurement properties of Skindex-16: A brief quality-of-life measure for patients with skin diseases. Journal of Cutaneous Medicine and Surgery, 5(2), 105–110. https://doi.org/10.1177/120347540100500202
Corazza, M., Virgili, A., Minghetti, S., & Borghi, A. (2020). Dyspareunia in vulvar lichen sclerosus: An overview of a distressing symptom. Giornale Italiano Di Dermatologia e Venereologia, 155(3), 299–305. https://doi.org/10.23736/s0392-0488.17.05849-7
DeMaria, A. L., Hollub, A. V., & Herbenick, D. (2011). Using genital self-image, body image, and sexual behaviors to predict gynecological exam behaviors of college women. The Journal of Sexual Medicine, 8(9), 2484–2492. https://doi.org/10.1111/j.1743-6109.2011.02379.x
DeMaria, A. L., Hollub, A. V., & Herbenick, D. (2012). The female genital self-image scale (FGSIS): Validation among a sample of female college students. The Journal of Sexual Medicine, 9(3), 708–718. https://doi.org/10.1111/j.1743-6109.2011.02620.x
DeVellis, R. F. (2016). Scale development: Theory and applications (4th ed.). Thousand Oaks: SAGE Publications Inc.
Ermertcan, A. T. (2009). Sexual dysfunction in dermatological diseases. Journal of the European Academy of Dermatology and Venereology, 23(9), 999–1007. https://doi.org/10.1111/j.1468-3083.2009.03139.x
Felix, A., de Almeida, G., Nahas, F. X., Marcondes, G. B., dos Santos, A. G., Azevedo de Brito, M. J., & Ferreira, L. M. (2017). Brazilian Portuguese version of the Female Genital Self Image Scale (FGSIS) for women seeking abdominoplasty. Journal of Plastic, Reconstructive & Aesthetic Surgery. https://doi.org/10.1016/j.bjps.2017.07.007
Garg, A., Kirby, J. S., Lavian, J., Lin, G., & Strunk, A. (2017). Sex- and age-adjusted population analysis of prevalence estimates for hidradenitis suppurativa in the United States. JAMA Dermatology, 153(8), 760–764. https://doi.org/10.1001/jamadermatol.2017.0201
Goldstein, A. T., Marinoff, S. C., Christopher, K., & Srodon, M. (2005). Prevalence of vulvar lichen sclerosus in a general gynecology practice. The Journal of Reproductive Medicine, 50(7), 477–480.
Goldstein, G. R., & Goldstein, A. T. (2020). Vulvar dermatoses as a cause of dyspareunia. In Female sexual pain disorders (pp. 239–250). Wiley. https://doi.org/10.1002/9781119482598.ch29
Guerrero, A., & Venkatesan, A. (2015). Inflammatory vulvar dermatoses. Clinical Obstetrics and Gynecology, 58(3), 464–475. https://doi.org/10.1097/GRF.0000000000000125
Haefner, H. K., Aldrich, N. Z., Dalton, V. K., Gagné, H. M., Marcus, S. B., Patel, D. A., & Berger, M. B. (2014). The impact of vulvar lichen sclerosus on sexual dysfunction. Journal of Women’s Health, 23(9), 765–770. https://doi.org/10.1089/jwh.2014.4805
Handelzalts, J. E., Yaakobi, T., Levy, S., Peled, Y., Wiznitzer, A., & Krissi, H. (2017). The impact of genital self-image on sexual function in women with pelvic floor disorders. European Journal of Obstetrics & Gynecology and Reproductive Biology, 211, 164–168. https://doi.org/10.1016/j.ejogrb.2017.02.028
Hays, R. D., Bjorner, J. B., Revicki, D. A., Spritzer, K. L., & Cella, D. (2009). Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Quality of Life Research, 18(7), 873–880. https://doi.org/10.1007/s11136-009-9496-9
Hensel, D. J., Rosenberg, M., Luetke, M., Fu, T.-C., & Herbenick, D. (2020). Changes in solo and partnered sexual behaviors during the COVID-19 pandemic: Findings from a U.S. probability survey. MedRxiv. https://doi.org/10.1101/2020.06.09.20125609
Herbenick, D., & Reece, M. (2010). Outcomes assessment: Development and validation of the Female Genital Self-Image Scale. The Journal of Sexual Medicine, 7(5), 1822–1830. https://doi.org/10.1111/j.1743-6109.2010.01728.x
Herbenick, D., Reece, M., Schick, V., Sanders, S. A., Dodge, B., & Fortenberry, J. D. (2010). Sexual behavior in the United States: Results from a national probability sample of men and women ages 14–94. The Journal of Sexual Medicine, 7, 255–265. https://doi.org/10.1111/j.1743-6109.2010.02012.x
Herbenick, D., Schick, V., Reece, M., Sanders, S., Dodge, B., & Fortenberry, J. D. (2011). The female genital self-image scale (FGSIS): Results from a nationally representative probability sample of women in the United States. The Journal of Sexual Medicine, 8(1), 158–166. https://doi.org/10.1111/j.1743-6109.2010.02071.x
Hodges, K. R., Wiener, C. E., Vyas, A. S., & Turrentine, M. A. (2019). The Female Genital Self-image Scale in adult women with vulvar lichen sclerosus. Journal of Lower Genital Tract Disease, 23(3), 210–213. https://doi.org/10.1097/LGT.0000000000000481
Janse, I. C., Deckers, I. E., van der Maten, A. D., Evers, A. W. M., Boer, J., van der Zee, H. H., Prens, E. P., & Horváth, B. (2017). Sexual health and quality of life are impaired in hidradenitis suppurativa: A multicentre cross-sectional study. British Journal of Dermatology, 176(4), 1042–1047. https://doi.org/10.1111/bjd.14975
Jansuwan, A., Bunyavejchevin, S., & Ruanphoo, P. (2020). Reliability and validity of Thai-version of Female Genital Self-image Scale (FGSIS) questionnaire. Thai Journal of Obstetrics and Gynaecology. https://he02.tci-thaijo.org/index.php/tjog/article/view/247688
Kaya, A. E., Yassa, M., Dogan, O., Basbug, A., Pulatoglu, C., & Caliskan, E. (2019). The Female Genital Self-Image Scale (FGSIS): Cross-cultural adaptation and validation of psychometric properties within a Turkish population. International Urogynecology Journal, 30(1), 89–99. https://doi.org/10.1007/s00192-018-3688-1
Kays, K. M., Keith, T. L., & Broughal, M. T. (2013). Best practice in online survey research with sensitive topics. In N. Sappleton (Ed.), Advancing research methods with new technologies (pp. 157–168). Guangzhou: IGI Global. https://doi.org/10.4018/978-1-4666-3918-8.ch009
Kolotkin, R. L., Binks, M., Crosby, R. D., Østbye, T., Gress, R. E., & Adams, T. D. (2006). Obesity and sexual quality of life. Obesity, 14(3), 472–479. https://doi.org/10.1038/oby.2006.62
Konuk, N., Koca, R., Atik, L., Muhtar, S., Atasoy, N., & Bostanci, B. (2007). Psychopathology, depression and dissociative experiences in patients with lichen simplex chronicus. General Hospital Psychiatry, 29(3), 232–235. https://doi.org/10.1016/j.genhosppsych.2007.01.006
Lansdorp, C. A., van den Hondel, K. E., Korfage, I. J., van Gestel, M. J., & van der Meijden, W. I. (2013). Quality of life in Dutch women with lichen sclerosus. British Journal of Dermatology, 168(4), 787–793. https://doi.org/10.1111/bjd.12137
Laumann, E. O., Paik, A., & Rosen, R. C. (1999). Sexual dysfunction in the United States: Prevalence and predictors. JAMA, 281(6), 537. https://doi.org/10.1001/jama.281.6.537
Leeners, B., Hengartner, M. P., Ajdacic-Gross, V., Rössler, W., & Angst, J. (2015). Dyspareunia in the context of psychopathology, personality traits, and coping resources: Results from a prospective longitudinal cohort study from age 30 to 50. Archives of Sexual Behavior, 44(6), 1551–1560. https://doi.org/10.1007/s10508-014-0395-y
Lehmiller, J. J., Garcia, J. R., Gesselman, A. N., & Mark, K. P. (2021). Less sex, but more sexual diversity: Changes in sexual behavior during the COVID-19 coronavirus pandemic. Leisure Sciences, 43(1–2), 295–304. https://doi.org/10.1080/01490400.2020.1774016
Lipson, S. K., Lattie, E. G., & Eisenberg, D. (2018). Increased rates of mental health service utilization by US college students: 10-year population-level trends (2007–2017). Psychiatric Services, 70(1), 60–63. https://doi.org/10.1176/appi.ps.201800332
Luetke, M., Hensel, D., Herbenick, D., & Rosenberg, M. (2020). Romantic relationship conflict due to the COVID-19 pandemic and changes in intimate and sexual behaviors in a nationally representative sample of American adults. Journal of Sex & Marital Therapy, 46(8), 747–762. https://doi.org/10.1080/0092623X.2020.1810185
Lundqvist, E. N., Wahlin, Y. B., Bergdahl, M., & Bergdahl, J. (2006). Psychological health in patients with genital and oral erosive lichen planus. Journal of the European Academy of Dermatology and Venereology, 20(6), 661–666. https://doi.org/10.1111/j.1468-3083.2006.01559.x
Maaty, A., Gomaa, A., Mohammed, G., Youssef, I., & Eyada, M. (2013). Assessment of female sexual function in patients with psoriasis. The Journal of Sexual Medicine, 10(6), 1545–1548. https://doi.org/10.1111/jsm.12119
Machin, S. E., McConnell, D. T., & Adams, J. D. (2010). Vaginal lichen planus: Preservation of sexual function in severe disease. BMJ Case Reports. https://doi.org/10.1136/bcr.08.2009.2208
Masheb, R. M., Kerns, R. D., Lozano, C., Minkin, M. J., & Richman, S. (2009). A randomized clinical trial for women with vulvodynia: Cognitive-behavioral therapy vs. supportive psychotherapy. Pain, 141(1), 31–40. https://doi.org/10.1016/j.pain.2008.09.031
McClelland, S. I. (2010). Intimate justice: A critical analysis of sexual satisfaction. Social and Personality Psychology Compass, 4(9), 663–680. https://doi.org/10.1111/j.1751-9004.2010.00293.x
Meeuwis, K., Hullu, J. D., Jager, M. D., Massuger, L., Kerkhof, P. V. D., & Rossum, M. V. (2010). Genital psoriasis: A questionnaire-based survey on a concealed skin disease in the Netherlands. Journal of the European Academy of Dermatology and Venereology, 24(12), 1425–1430. https://doi.org/10.1111/j.1468-3083.2010.03663.x
Meeuwis, K., Hullu, J., IntHout, J., Hendriks, I., Sparreboom, E., Massuger, L., Kerkhof, P., & Rossum, M. (2015). Genital psoriasis awareness program: Physical and psychological care for patients with genital psoriasis. Acta Dermato Venereologica, 95(2), 211–216. https://doi.org/10.2340/00015555-1885
Meston, C. M., Freihart, B. K., Handy, A. B., Kilimnik, C. D., & Rosen, R. C. (2020). Scoring and interpretation of the FSFI: What can be learned from 20 years of use? The Journal of Sexual Medicine, 17(1), 17–25. https://doi.org/10.1016/j.jsxm.2019.10.007
Meyer-Bahlburg, H. F. L., & Dolezal, C. (2007). The Female Sexual Function Index: A methodological critique and suggestions for improvement. Journal of Sex & Marital Therapy, 33(3), 217–224. https://doi.org/10.1080/00926230701267852
Michiletti, L., Preti, M., Bogliatto, F., Zanotto-Valentino, M. C., Ghiringhello, B., & Massobrio, M. (2000). Vulval lichen planus in the practice of a vulval clinic. British Journal of Dermatology, 143(6), 1349–1350.
Molina-Leyva, A., Jiménez-Moleón, J. J., Naranjo-Sintes, R., & Ruiz-Carrascosa, J. C. (2015). Sexual dysfunction in psoriasis: A systematic review. Journal of the European Academy of Dermatology and Venereology, 29(4), 649–655. https://doi.org/10.1111/jdv.12845
Nieuwenhof, H. P. V. D., Meeuwis, K. A. P., Nieboer, T. E., Vergeer, M. C. M., Massuger, L. F. A. G., & Hullu, J. A. D. (2010). The effect of vulvar lichen sclerosus on quality of life and sexual functioning. Journal of Psychosomatic Obstetrics & Gynecology, 31(4), 279–284. https://doi.org/10.3109/0167482X.2010.507890
Pakpour, A. H., Zeidi, I. M., Ziaeiha, M., & Burri, A. (2014). Cross-cultural adaptation of the Female Genital Self-Image Scale (FGSIS) in Iranian female college students. Journal of Sex Research, 51(6), 646–653. https://doi.org/10.1080/00224499.2013.821441
Pazmany, E., Bergeron, S., Oudenhove, L., Verhaeghe, J., & Enzlin, P. (2013). Body image and genital self-image in pre-menopausal women with dyspareunia. Archives of Sexual Behavior, 42(6), 999–1010. https://doi.org/10.1007/s10508-013-0102-4
Rivera, S., Dykstra, C., Flood, A., Herbenick, D., & DeMaria, A. L. (2022). “Worse than disappointing:” Pre-diagnostic healthcare challenges of women with inflammatory vulvar dermatoses. Journal of Lower Genital Tract Disease, 26(1), 53–59. https://doi.org/10.1097/LGT.0000000000000632
Rosen, R. D., C. Brown, J. Heiman, S. Leiblum, C. Meston, R. Shabsigh, D. Ferguson R. (2000). The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex & Marital Therapy, 26(2), 191–208. https://doi.org/10.1080/009262300278597
Sadownik, L. A., Smith, K. B., Hui, A., & Brotto, L. A. (2017). The impact of a woman’s dyspareunia and its treatment on her intimate partner: A qualitative analysis. Journal of Sex & Marital Therapy, 43(6), 529–542. https://doi.org/10.1080/0092623X.2016.1208697
Sargeant, H. A., & O’Callaghan, F. V. (2007). The impact of chronic vulval pain on quality of life and psychosocial well-being. Australian and New Zealand Journal of Obstetrics and Gynaecology, 47(3), 235–239. https://doi.org/10.1111/j.1479-828X.2007.00725.x
Sarhan, D., Mohammed, G., Gomaa, A., & Eyada, M. (2016). Female genital dialogues: Female genital self-image, sexual dysfunction, and quality of life in patients with vitiligo with and without genital affection. Journal of Sex & Marital Therapy, 42(3), 267–276. https://doi.org/10.1080/0092623X.2015.1010678
Simpson, R. C., Littlewood, S. M., Cooper, S. M., Cruickshank, M. E., Green, C. M., Derrick, E., Yell, J., Chiang, N., Bell, H., Owen, C., Javed, A., Wilson, C. L., McLelland, J., & Murphy, R. (2012). Real-life experience of managing vulval erosive lichen planus: A case-based review and U.K. multicentre case note audit. British Journal of Dermatology, 167(1), 85–91. https://doi.org/10.1111/j.1365-2133.2012.10919.x
Sullivan, A. K., Straughair, G. J., Marwood, R. P., Staughton, R. C. D., & Barton, S. E. (1999). A multidisciplinary vulva clinic: The role of genito-urinary medicine. Journal of the European Academy of Dermatology and Venereology, 13(1), 36–40. https://doi.org/10.1111/j.1468-3083.1999.tb00841.x
Thareja, S., Florek, A. G., Cices, A., Nardone, B., West, D. P., & Schlosser, B. J. (2016). Impact of lichen sclerosus, lichen planus, and vulvodynia on quality of life for patients using the vulvar-specific Skindex-29 patient reported outcome measure. Journal of the American Academy of Dermatology, 74(5, Supplement 1), AB57. https://doi.org/10.1016/j.jaad.2016.02.228
Thorstensen, K. A., & Birenbaum, D. L. (2012). Recognition and management of vulvar dermatologic conditions: Lichen sclerosus, lichen planus, and lichen simplex chronicus. Journal of Midwifery & Women’s Health, 57(3), 260–275. https://doi.org/10.1111/j.1542-2011.2012.00175.x
Twenge, J. M., Sherman, R. A., & Wells, B. E. (2017). Declines in sexual frequency among American adults, 1989–2014. Archives of Sexual Behavior, 46(8), 2389–2401. https://doi.org/10.1007/s10508-017-0953-1
Wehbe-Alamah, H., Kornblau, B. L., Haderer, J., & Erickson, J. (2012). Silent no more! The lived experiences of women with lichen sclerosus. Journal of the American Academy of Nurse Practitioners, 24(8), 499–505. https://doi.org/10.1111/j.1745-7599.2012.00715.x
Wiegel, M., Meston, C., & Rosen, R. (2005). The Female Sexual Function Index (FSFI): Cross-validation and development of clinical cutoff scores. Journal of Sex & Marital Therapy, 31(1), 1–20. https://doi.org/10.1080/00926230590475206
Wilson, B. D. M., & Meyer, I. H. (2021). Nonbinary LGBTQ adults in the United States. The Williams Institute, UCLA School of Law. https://williamsinstitute.law.ucla.edu/wp-content/uploads/Nonbinary-LGBTQ-Adults-Jun-2021.pdf
Yıldız, Ş, Cengiz, H., Kaya, C., Alay, İ, Öztürk, E., Tunca, A. F., Erdoğan, A., & Yaşar, L. (2020). Evaluation of genital self-image and sexual dysfunction in women with vulvar lichen planus or lichen sclerosus. Journal of Psychosomatic Obstetrics & Gynecology. https://doi.org/10.1080/0167482X.2020.1857359
Zgueb, Y., Ouali, U., Achour, R., Jomli, R., & Nacef, F. (2019). Cultural aspects of vaginismus therapy: A case series of Arab-Muslim patients. The Cognitive Behaviour Therapist. https://doi.org/10.1017/S1754470X18000119
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Sydney Rivera and Andrea L. DeMaria conceived of the study. Material preparation, data collection, and analysis were performed by Sydney Rivera, Anna Flood, and Andrea L. DeMaria. The first draft of the manuscript was written by Sydney Rivera. Chandler Dykstra, Debby Herbenick, Anna Flood, and Andrea L. DeMaria contributed to literature review and manuscript revision. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Rivera, S., Flood, A., Dykstra, C. et al. Genital Self-Image, Sexual Function, and Quality of Life Among Individuals with Vulvar and Non-Vulvar Inflammatory Dermatoses. Arch Sex Behav 51, 3965–3979 (2022). https://doi.org/10.1007/s10508-022-02353-0
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DOI: https://doi.org/10.1007/s10508-022-02353-0