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Can Fear, Pain, and Muscle Tension Discriminate Vaginismus from Dyspareunia/Provoked Vestibulodynia? Implications for the New DSM-5 Diagnosis of Genito-Pelvic Pain/Penetration Disorder

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Abstract

Fear has been suggested as the crucial diagnostic variable that may distinguish vaginismus from dyspareunia. Unfortunately, this has not been systematically investigated. The primary purpose of this study, therefore, was to investigate whether fear as evaluated by subjective, behavioral, and psychophysiological measures could differentiate women with vaginismus from those with dyspareunia/provoked vestibulodynia (PVD) and controls. A second aim was to re-examine whether genital pain and pelvic floor muscle tension differed between vaginismus and dyspareunia/PVD sufferers. Fifty women with vaginismus, 50 women with dyspareunia/PVD, and 43 controls participated in an experimental session comprising a structured interview, pain sensitivity testing, a filmed gynecological examination, and several self-report measures. Results demonstrated that fear and vaginal muscle tension were significantly greater in the vaginismus group as compared to the dyspareunia/PVD and no-pain control groups. Moreover, behavioral measures of fear and vaginal muscle tension were found to discriminate the vaginismus group from the dyspareunia/PVD and no-pain control groups. Genital pain did not differ significantly between the vaginismus and dyspareunia/PVD groups; however, genital pain was found to discriminate both clinical groups from controls. Despite significant statistical differences on fear and vaginal muscle tension variables between women suffering from vaginismus and dyspareunia/PVD, a large overlap was observed between these conditions. These findings may explain the great difficulty health professionals experience in attempting to reliably differentiate vaginismus from dyspareunia/PVD. The implications of these data for the new DSM-5 diagnosis of Genito-Pelvic Pain/Penetration Disorder are discussed.

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Authors and Affiliations

  1. Department of Psychology, McGill University, Montreal, QC, H3A 1B1, Canada

    Marie-Andrée Lahaie, Rhonda Amsel & Yitzchak M. Binik

  2. Department of Obstetrics and Gynecology, Faculty of Medicine, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, QC, Canada

    Samir Khalifé

  3. Department of Psychology, Queen’s University, Kingston, ON, Canada

    Stephanie Boyer

  4. Department of Psychology, Ryerson University, Toronto, ON, Canada

    Marie Faaborg-Andersen

  5. Sex and Couple Therapy Service, McGill University Health Center, Montreal, QC, Canada

    Yitzchak M. Binik

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  1. Marie-Andrée Lahaie
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Lahaie, MA., Amsel, R., Khalifé, S. et al. Can Fear, Pain, and Muscle Tension Discriminate Vaginismus from Dyspareunia/Provoked Vestibulodynia? Implications for the New DSM-5 Diagnosis of Genito-Pelvic Pain/Penetration Disorder. Arch Sex Behav 44, 1537–1550 (2015). https://doi.org/10.1007/s10508-014-0430-z

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