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Sexual Pain Disorders in Women

  • Manu Lakshmi
  • Shah Dupesh Khan
Chapter

Abstract

Sexual pain disorders in women are extremely distressing and significantly impact a large population of women and their partners from an emotional, social and physical context of a relationship. Pain during sex was defined as early as the 1800s, long before current medical terminologies of dyspareunia and vaginismus even came into the practice [1, 2]. Studies indicate that the prevalence of sexual pain disorders (3–46%) seems to vary from culture to culture and also with respect to the setting in which a diagnosis is made. Several authors found discrepancies in the reported incidence of sexual pain disorders, which depended on whether the patient was self-reporting a particular problem or whether the clinician was actively questioning the patient on the sexual dysfunction [3, 4]. This is not surprising, since data indicates that only 52% of women actually ever receive a formal diagnosis of a sexual pain disorder [5]. Sexual pain disorders have been frequently underdiagnosed and undertreated.

References

  1. 1.
    Barnes R. A clinical history of the medical and surgical diseases of women. Philadelphia: Henry C Lea; 1874.Google Scholar
  2. 2.
    Sims JM. On vaginismus. Trans Obstet Soc London. 1861;3:356–67.Google Scholar
  3. 3.
    Bachmann GA, Leiblum SR, Grill J. Brief sexual inquiry in gynecologic practice. Obstet Gynecol. 1989;73:425–7.PubMedGoogle Scholar
  4. 4.
    Wijma B, Schei B, Swahnberg K, Hilden M, Offerdal K, Pikarinen U, Sidenius K, Steingrimsdottis T, Stoum H, Halmesmäki E. Emotional, physical, and sexual abuse in patients visiting gynecology clinics: a Nordic cross-sectional study. Lancet. 2003;361:2107–13.CrossRefGoogle Scholar
  5. 5.
    Harlow BL, Kunitz CG, Nguyen RH, Rydell SA, Turner RM, MacLehose RF. Prevalence of symptoms consistent with a diagnosis of vulvodynia: population-based estimates from 2 geographic regions. Am J Obstet Gynecol. 2014;210(1):40.e1–8.CrossRefGoogle Scholar
  6. 6.
    Moyal-Barracco M, Lynch PJ. 2003 ISSVD terminology and classification of vulvodynia: a historical perspective. J Reprod Med. 2004;49:772–7.PubMedGoogle Scholar
  7. 7.
    Bergeron S, Rosen NO, Morin M. Genital pain in women: beyond interference with intercourse. Pain. 2011;152(6):1223–5.CrossRefGoogle Scholar
  8. 8.
    American Psychiatric Association. Diagnostic and statistical manual for mental disorders. 4th edition (text revised) ed. Washington, DC: American Psychiatric Press; 2000.Google Scholar
  9. 9.
    Regier DA, Kuhl EA, Kupfer DJ. The DSM-5: classification and criteria changes. World Psychiatry. 2013;12(2):92–8.CrossRefGoogle Scholar
  10. 10.
    Reissing ED, Binik YM, Khalifé S. Does vaginismus exist? A critical review of the literature. J Nerv Ment Dis. 1999;187:261–74.CrossRefGoogle Scholar
  11. 11.
    Meana M, Binik YM, Khalifé S, Cohen D. Dyspareunia. Sexual dysfunction or pain syndrome? J Nerv Ment Dis. 1997;185:561–9.CrossRefGoogle Scholar
  12. 12.
    Van Lankveld JJ, Brewaeys AM, Ter Kuile MM, Weijenborg PTM. Difficulties in the differential diagnosis of vaginismus, dyspareunia and mixed sexual pain disorder. J Psychosom Obstet Gynaecol. 1995;16:201–9.CrossRefGoogle Scholar
  13. 13.
    Kruiff de MD, Ter Kuile MM, Weijenborg PTM, Van Lankveld JJDM. Vaginismus and dyspareunia: is there a difference in clinical presentation? J Psychosom Obstet Gynaecol. 2000;21:149–55.CrossRefGoogle Scholar
  14. 14.
    Reissing ED, Binik YM, Khalife S, Cohen D, Amsel R. Vaginal spasm, pain, and behavior: an empirical investigation of the diagnosis of vaginismus. Arch Sex Behav. 2004;33:5–17.CrossRefGoogle Scholar
  15. 15.
    Binik YM. The DSM diagnostic criteria for vaginismus. Arch Sex Behav. 2010;39:278–91.CrossRefGoogle Scholar
  16. 16.
    Basson R, Althof S, Davis S, Fugl- Meyer K, Goldstein I, Leiblum S, Meston C, Rosen R, Wagner G. Summary of the recommendations on sexual dysfunctions in women. J Sex Med. 2004;1:24–34.CrossRefGoogle Scholar
  17. 17.
    Abramov L, Wolman I, David MP. Vaginismus: an important factor in the evaluation and management of vulvar vestibulitis syndrome. Gynecol Obstet Investig. 1994;38:194–7.CrossRefGoogle Scholar
  18. 18.
    Meana M, Binik YM, Khalife S, Cohen DR. Biopsychosocial profile of women with dyspareunia. Obstet Gynecol. 1997;90(4 Pt 1):583–9.CrossRefGoogle Scholar
  19. 19.
    Cherner RA, Reissing ED. A comparative study of sexual function, behavior and cognitions of women with lifelong vaginismus. Arch Sex Behav. 2013;42:1605–14.CrossRefGoogle Scholar
  20. 20.
    Masheb RM, Lozano-Blanco C, Kohorn EI, Minkin MJ, Kerns RD. Assessing sexual function and dyspareunia with the Female Sexual Function Index (FSFI) in women with vulvodynia. J Sex Marital Ther. 2004;3(5):315–24.CrossRefGoogle Scholar
  21. 21.
    Smith KB, Pukall CF. Sexual function, relationship adjustment, and the relational impact of pain in male partners of women with provoked vulvar pain. J Sex Med. 2014;11(5):1283–93.CrossRefGoogle Scholar
  22. 22.
    Reed BD, Advincula AP, Fonde KR, Gorenflo DW, Haefner HK. Sexual activities and attitudes of women with vulvar dysesthesia. Obstet Gynecol. 2003;102(2):325–31.PubMedGoogle Scholar
  23. 23.
    Devor M, Seltzer Z. Pathophysiology of damaged nerves in relation to chronic pain. In: Wall PD, Melzack R, editors. Textbook of pain. 4th ed. New York: Churchill Livingstone; 1999. p. 129–64.Google Scholar
  24. 24.
    McKay M. Dysesthetic (essential) vulvodynia. Treatment with amytriptilyne. J Reprod Med. 1993;37:9–13.Google Scholar
  25. 25.
    Hilliges M, Falconer C, Ekman-Ordeberg G, Johansson O. Innervation of the human vaginal mucosa as revealed by PGP 9.5 immunohistochemistry. Acta Anat (Basel). 1995;153:119–26.CrossRefGoogle Scholar
  26. 26.
    Krantz KE. Innervation of the human vulva and vagina; a microscopic study. Obstet Gynecol. 1958;12:382–96.PubMedGoogle Scholar
  27. 27.
    Weijmar Schultz WC, van deWiel HB, Klatter JA, Sturm BE, Nauta J. Vaginal sensitivity to electric stimuli: theoretical and practical implications. Arch Sex Behav. 1989;18:87–95.CrossRefGoogle Scholar
  28. 28.
    Komisaruk BR, Whipple B. Functional MRI of the brain during orgasm in women. Annu Rev Sex Res. 2005;16:62–86.PubMedGoogle Scholar
  29. 29.
    Berkley KJ, Benoist JM, Gautron M, Guilbaud G. Responses of neurons in the caudal intralaminar thalamic complex of the rat to stimulation of the uterus, vagina, cervix, colon and skin. Brain Res. 1995;695:92–5.CrossRefGoogle Scholar
  30. 30.
    Melzack R. Evaluation of the neuromatrix theory of pain. The Prithvi Raj Lecture: presented at the third World Congress of World Institute of Pain, Barcelona, 2004. Pain Pract. 2005;5:85–94.CrossRefGoogle Scholar
  31. 31.
    Giesecke J, Reed BD, Haefner HK, Giesecke T, Clauw DJ, Gracely RH. Quantitative sensory testing in vulvodynia patients and increased peripheral pressure pain sensitivity. Obstet Gynecol. 2004;104:126–33.CrossRefGoogle Scholar
  32. 32.
    Granot M, Friedman M, Yarnitsky D, Zimmer EZ. Enhancement of the perception of systemic pain inwomen with vulvar vestibulitis. BJOG. 2002;109:863–6.CrossRefGoogle Scholar
  33. 33.
    Pukall CF, Strigo IA, Binik YM, Amsel R, Khalife S, Bushnell MC. Neural correlates of painful genital touch in women with vulvar vestibulitis syndrome. Pain. 2005;115:118–27.CrossRefGoogle Scholar
  34. 34.
    Glazer HI, Rodke G, Swencionis C, Hertz R, Young AW. Treatment of vulvar vestibulitis syndrome with electromyographic biofeedback of pelvic floor musculature. J Reprod Med. 1995;40(4):283–90.PubMedGoogle Scholar
  35. 35.
    Bergeron S, Brown C, Lord MJ, Oala M, Binik YM, Khalife S. Physical therapy for vulvar vestibulitis syndrome: a retrospective study. J Sex Marital Ther. 2002;28(3):183–92.CrossRefGoogle Scholar
  36. 36.
    Danielsson I, Torstensson T, Brodda-Jansen G, Bohm-Starke N. EMG biofeedback versus topical lidocaine gel: a randomized study for the treatment of women with vulvar vestibulitis. Acta Obstet Gynecol Scand. 2006;85(11):1360–7.CrossRefGoogle Scholar
  37. 37.
    Gentilcore-Saulnier E, McLean L, Goldfinger C, Pukall CF, Chamberlain S. Pelvic floor muscle assessment outcomes in women with and without provoked vestibulodynia and the impact of a physical therapy program. J Sex Med. 2010;7(2 Pt 2):1003–22.CrossRefGoogle Scholar
  38. 38.
    van der Velde J, Everaerd W. Voluntary control over pelvic floor muscles in women with and without vaginistic reactions. Int Urogynecol J Pelvic Floor Dysfunct. 1999;10:230–6.CrossRefGoogle Scholar
  39. 39.
    van der Velde J, Everaerd W. The relationship between involuntary pelvic floor muscle activity,muscle awareness and experienced threat in women with and without vaginismus. Behav Res Ther. 2001;39:395–408.CrossRefGoogle Scholar
  40. 40.
    van der Velde J, Laan E, Everaerd W. Vaginismus, a component of a general defensive reaction. An investigation of pelvic floor muscle activity during exposure to emotion-inducing film excerpts in women with and without vaginismus. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12:328–31.CrossRefGoogle Scholar
  41. 41.
    Sideri M, Jones RW, Wilkinson EJ, et al. Squamous vulvar intraepithelial neoplasia: 2004 modified terminology, ISSVD Vulvar Oncology Subcommittee. J Reprod Med. 2005;50:807–10.PubMedGoogle Scholar
  42. 42.
    Willhite LA, O’Connell MB. Urogenital atrophy: prevention and treatment. Pharmacotherapy. 2001;21:464–80.CrossRefGoogle Scholar
  43. 43.
    Bouchard C, Brisson J, Fortier M, Morin C, Blanchette C. Use of oral contraceptive pills and vulvar vestibulitis: a case-control study. Am J Epidemiol. 2002;156(3):254–61.CrossRefGoogle Scholar
  44. 44.
    Harlow BL, Vitonis AF, Stewart EG. Influence of oral contraceptive use on the risk of adult-onset vulvodynia. J Reprod Med. 2008;53(2):102–10.PubMedGoogle Scholar
  45. 45.
    Bohm-Starke N, Hilliges M, Falconer C, Rylander E. Increased intraepithelial innervation in women with vulvar vestibulitis syndrome. Gynecol Obstet Investig. 1998;46(4):256–60.CrossRefGoogle Scholar
  46. 46.
    Pukall CF, Binik YM, Khalifé S, Amsel R, Abbott FV. Vestibular tactile and pain thresholds in women with vulvar vestibulitis syndrome. Pain. 2002;96(1–2):163–75.CrossRefGoogle Scholar
  47. 47.
    Payne KA, Binik YM, Amsel R, Khalifé S. When sex hurts, anxiety and fear orient attention towards pain. Eur J Pain. 2005;9(4):427–36.CrossRefGoogle Scholar
  48. 48.
    Desrochers G, Bergeron S, Khalife S, Dupuis MJ, Jodoin M. Fear avoidance and self-efficacy in relation to pain and sexual impairment in women with provoked vestibulodynia. Clin J Pain. 2009;25(6):520–7.CrossRefGoogle Scholar
  49. 49.
    Rosen NO, Bergeron S, Glowacka M, Delisle I, Baxter ML. Harmful or helpful: perceived solicitous and facilitative partner responses are differentially associated with pain and sexual satisfaction in women with provoked vestibulodynia. J Sex Med. 2012;9(9):2351–60.CrossRefGoogle Scholar
  50. 50.
    Rosen NO, Bergeron S, Sadikaj G, Glowacka M, Delisle I, Baxter ML. Impact of male partner responses on sexual function in women with vulvodynia and their partners: a dyadic daily experience study. Health Psychol. 2014;33(8):823–31.CrossRefGoogle Scholar
  51. 51.
    Carter J, Fowler L, Carlson J, Twiggs LB. How accurate is the pelvic examination as compared to transvaginal sonography? A prospective, comparative study. J Reprod Med. 1994;39:32–4.PubMedGoogle Scholar
  52. 52.
    Basson R. Sexuality and sexual disorders. Clin Updates Women’s Health Care. 2003;11:1–94.Google Scholar
  53. 53.
    Pukall CF, Payne KA, Binik YM, Khalifé S. Pain measurement in vulvodynia. J Sex Marital Ther. 2003;29(Suppl 1):111–20.CrossRefGoogle Scholar
  54. 54.
    Foster DC, Kotok MB, Huang LS, Watts A, Oakes D, Howard FM, et al. Oral desipramine and topical lidocaine for vulvodynia: a randomized controlled trial. Obstet Gynecol. 2010;116(3):583–93.CrossRefGoogle Scholar
  55. 55.
    Nyirjesy P, Sobel JD, Weitz MV, Leaman DJ, Small MJ, Gelone SP. Cromolyn cream for recalcitrant idiopathic vulvar vestibulitis: results of a placebo controlled study. Sex Transm Infect. 2001;77:53–7.CrossRefGoogle Scholar
  56. 56.
    McKay M. Dysesthetic (“essential”) vulvodynia. Treatment with amitriptyline. J Reprod Med. 1993;38:9–13.PubMedGoogle Scholar
  57. 57.
    Munday PE. Response to treatment in dysaesthetic vulvodynia. J Obstet Gynaecol. 2001;21:610–3.CrossRefGoogle Scholar
  58. 58.
    Petersen CD, Giraldi A, Lundvall L, Kristensen E. Botulinum toxin type A-a novel treatment for provoked vestibulodynia? Results from a randomized, placebo controlled, double blinded study. J Sex Med. 2009;6(9):2523–37.CrossRefGoogle Scholar
  59. 59.
    Enck P, Benedetti F, Schedlowski M. New insights into the placebo and nocebo responses. Neuron. 2008;59:195–206.CrossRefGoogle Scholar
  60. 60.
    Landry T, Bergeron S, Dupuis MJ, Desrochers G. The treatment of provoked vestibulodynia: a critical review. Clin J Pain. 2008;24(2):155–71.CrossRefGoogle Scholar
  61. 61.
    Bergeron S, Khalife S, Glazer HI, Binik YM. Surgical and behavioral treatments for vestibulodynia: two-and-one-half year followup and predictors of outcome. Obstet Gynecol. 2008;111(1):159–66.CrossRefGoogle Scholar
  62. 62.
    Brotto LA, Basson R, Carlson M, Zhu C. Impact of an integrated mindfulness and cognitive behavioral treatment for provoked vestibulodynia (IMPROVED): a qualitative study. Sex Relat Ther. 2013;28(1–2):3–19.CrossRefGoogle Scholar
  63. 63.
    Rosenbaum TY, Owens A. The role of pelvic floor physical therapy in the treatment of pelvic and genital pain-related sexual dysfunction (CME). J Sex Med. 2008;5(3):513–23.CrossRefGoogle Scholar
  64. 64.
    Friedrich EG Jr. Vulvar vestibulitis syndrome. J Reprod Med. 1987;32:110–5.PubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Manu Lakshmi
    • 1
  • Shah Dupesh Khan
    • 2
  1. 1.Department of Reproductive MedicineThe Metromale Clinic & Fertility CenterChennaiIndia
  2. 2.The Metromale Clinic and Fertility CenterChennaiIndia

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