Search

To investigate the relationship among sexual functioning, sexual script flexibility, and sexual satisfaction in individuals diagnosed with prostate cancer.Cross-sectional online survey.Sixty-one men diagnosed with localized prostate cancer.Online survey of sexual functioning, sexual script flexibility, and sexual satisfaction. Ordinal logistic regression investigated predictors of sexual satisfaction.Greater sexual script flexibility was associated with a greater likelihood of being sexually satisfied.Helping patients explore different ways of being sexual after treatment could help with sexual satisfaction maintenance.Patients' sexual satisfaction may benefit from discussions of issues related to sexuality and ways to work around treatment-related sexual dysfunction with healthcare providers.

BACKGROUND: A set of enduring conditions have been reported in the literature involving persistent sexual dysfunction after discontinuation of serotonin reuptake inhibiting antidepressants, 5 alpha-reductase inhibitors and isotretinoin.OBJECTIVE: To develop diagnostic criteria for post-SSRI sexual dysfunction (PSSD), persistent genital arousal disorder (PGAD) following serotonin reuptake inhibitors, post-finasteride syndrome (PFS) and post-retinoid sexual dysfunction (PRSD).METHODS: The original draft was designed using data from two published case series (Hogan et al., 2014 and Healy et al., 2018), which represent the largest public collections of data on these enduring conditions. It was further developed with the involvement of a multidisciplinary panel of experts.RESULTS: A set of criteria were agreed upon for each of the above conditions. Features of PSSD, PFS and PRSD commonly include decreased genital and orgasmic sensation, decreased sexual desire and erectile dysfunction. Ancillary non-sexual symptoms vary depending on the specific condition but can include emotional blunting and cognitive impairment. PGAD presents with an almost mirror image of unwanted sensations of genital arousal or irritability in the absence of sexual desire. A new term, post-SSRI asexuality, is introduced to describe a dampening of sexual interest and pleasure resulting from a pre-natal or pre-teen exposure to a serotonin reuptake inhibitor.CONCLUSIONS: These criteria will help in both clinical and research settings. As with all criteria, they will likely need modification in the light of developments.

The COVID-19 pandemic and the mitigation measures put in place have resulted in universal disruption in the usual ways of life for individuals. The current study sought to investigate how aspects of sexual health (well-being and functioning) and relationship satisfaction changed or remained stable during the pandemic. During two separate time points (Time 1 including Time 1 and a retrospective baseline, Time 2), participants completed online measures of sexual well-being (sexual pleasure, partnered and solitary orgasm frequency, sexual distress), sexual functioning, and relationship satisfaction. Participants reported slight declines in sexual pleasure, frequency of orgasms with a partner, and frequency of solitary orgasms from pre-COVID-19 (retrospective baseline) to Time 1, with no significant differences in sexual distress and relationship satisfaction. For individuals with vulvas, sexual functioning improved from Time 1 to Time 2, whereas no significant differences in sexual functioning were observed for individuals with penises. Aspects of sexual health and relational satisfaction did not sufficiently change across time points to be considered meaningful health outcome changes. Given that minimal disruptions were noted in pre-COVID-19 to COVID-19 sexuality, these results highlight the potential resiliency of individuals’ sexuality when facing sudden changes in their daily lives. Implications of COVID-19’s effects on sexual well-being and relationship satisfaction research are broadly discussed. Supplementary Information The online version contains supplementary material available at 10.1007/s10508-021-02212-4.

Background There is limited information about the physical indicators and biopsychosocial predictors of self-reported pain during intercourse and pain during a gynecological examination at 12- and 24-month following childbirth. Aim This longitudinal study aimed to (i) Compare the findings from gynecological exams at 12- and 24-month postpartum for women with minimal vs clinically significant pain during intercourse; (ii) Assess the biomedical and psychosocial correlates of self-reported pain during intercourse and the vestibular pain index (VPI) from the cotton-swab test at 12- and 24-month postpartum; (iii) Establish the relationship between self-reported pain during intercourse and the cotton-swab test. Methods Women (N = 97 at 12 months postpartum and N = 44 at 24-month postpartum) recruited from a local women’s hospital completed online surveys in their first trimester of pregnancy and at 12- and 24-month postpartum to assess pain during intercourse and biopsychosocial variables. Those with clinically significant (pain ≥4/10 on a visual analogue scale) were matched with those reporting minimal pain (pain Main Outcome Measures (i) Findings from the gynecological examination (ii) Numerical rating scale for the VPI; (iii) Visual analogue scale of pain during intercourse. Results The majority of women in both pain groups had normal physical findings in the gynecological exam. Greater sexual distress and pain catastrophizing at 12- and 24-month postpartum were significantly associated with greater pain during intercourse at each time-point, respectively. Greater pain catastrophizing at 12 months postpartum was significantly associated with greater pain during the cotton-swab test at that time-point. Lower relationship satisfaction at 12 months postpartum was associated with greater VPI ratings at 24 months postpartum. Pain during intercourse and the VPI were moderately and positively correlated. Clinical Implications Addressing psychosocial variables may interrupt the maintenance of postpartum pain. Following an initial assessment, self-reported pain intensity may be a suitable proxy for repeated examinations. Strengths & Limitations This study is the first to describe the physical findings and psychosocial predictors of pain during intercourse and the VPI at 12- and 24-month postpartum. The homogenous and small sample may limit generalizability. Conclusion There were no observable physical indicators of clinically significant postpartum pain during intercourse. Psychosocial variables were linked to women’s greater postpartum pain during intercourse and VPI ratings.

Laser Doppler imaging is a valid method of assessing genital response, detecting increases in genital blood flow to sexual, but not nonsexual stimuli. Although laser Doppler imaging provides a direct measure of genital blood flow, its discrete perfusion images provide a discontinuous assessment of genital response, limiting some study designs. The aims of this study were to investigate the measurement properties of laser Doppler flowmetry, a direct and continuous measure of blood flow, as well as examine the time course of genital response using flowmetry. A sample of 45 cisgender women attended two experimental sessions wherein they viewed sexual and nonsexual stimuli (e.g., neutral, anxiety, humor) while their genital responses were assessed using laser Doppler flowmetry. As expected, laser Doppler flowmetry was a valid measure of genital response-detecting increases in genital blood flow elicited by the sexual stimuli only-and was sensitive to varying degrees of genital response elicited by low, moderate, and high-intensity sexual stimuli. The measure also exhibited convergent validity with genital response assessed via laser Doppler imaging, test-retest reliability across testing sessions, and internal consistency as well as high sexual concordance with self-reported sexual arousal. Descriptive analyses showed that genital blood flow assessed using laser Doppler flowmetry was highly responsive, with initial, peak, and return to baseline responses occurring within timeframes appropriate for repeated measurement within a single session. Laser Doppler flowmetry is a valid, reliable, and sensitive measure of women's genital response that can be usefully applied in sexual psychophysiology research.

Background Persistent genital arousal disorder (PGAD), a condition of unwanted, unremitting sensations of genital arousal, is associated with a significant, negative psychosocial impact that may include emotional lability, catastrophization, and suicidal ideation. Despite being first reported in 2001, PGAD remains poorly understood. Aim To characterize this complex condition more accurately, review the epidemiology and pathophysiology, and provide new nomenclature and guidance for evidence-based management. Methods A panel of experts reviewed pertinent literature, discussed research and clinical experience, and used a modified Delphi method to reach consensus concerning nomenclature, etiology, and associated factors. Levels of evidence and grades of recommendation were assigned for diagnosis and treatment. Outcomes The nomenclature of PGAD was broadened to include genito-pelvic dysesthesia (GPD), and a new biopsychosocial diagnostic and treatment algorithm for PGAD/GPD was developed. Results The panel recognized that the term PGAD does not fully characterize the constellation of GPD symptoms experienced by patients. Therefore, the more inclusive term PGAD/GPD was adopted, which maintains the primacy of the distressing arousal symptoms and acknowledges associated bothersome GPD. While there are diverse biopsychosocial contributors, there is a common underlying neurologic basis attributable to spontaneous intense activity of the genito-pelvic region represented in the somatosensory cortex and its projections. A process of care diagnostic and treatment strategy was developed to guide the clinician, whenever possible, by localizing the symptoms as originating in any of five regions: (i) end organ, (ii) pelvis/perineum, (iii) cauda equina, (iv) spinal cord, and (v) brain. Psychological treatment strategies were considered critical and should be performed in conjunction with medical strategies. Pharmaceutical interventions may be used based on their site and mechanism of action to reduce patients’ symptoms and the associated bother and distress. Clinical Implications The process of care for PGAD/GPD uses a personalized, biopsychosocial approach for diagnosis and treatment. Strengths and Limitations Strengths and Limitations: Strengths include characterization of the condition by consensus, analysis, and recommendation of a new nomenclature and a rational basis for diagnosis and treatment. Future investigations into etiology and treatment outcomes are recommended. The main limitations are the dearth of knowledge concerning this condition and that the current literature consists primarily of case reports and expert opinion. Conclusion We provide, for the first time, an expert consensus review of the epidemiology and pathophysiology and the development of a new nomenclature and rational algorithm for management of this extremely distressing sexual health condition that may be more prevalent than previously recognized. Goldstein I, Komisaruk BR, Pukall CF, et al. International Society for the Study of Women’s Sexual Health (ISSWSH) Review of Epidemiology and Pathophysiology, and a Consensus Nomenclature and Process of Care for the Management of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD). J Sex Med 2021;18:665–697.

Transgender individuals face many barriers to healthcare access, including providers’ lack of knowledge on transgender-specific healthcare needs. Physicians and medical students report a lack of tr...

Background Persistent genital arousal disorder (PGAD) is a highly distressing, understudied condition characterized by persistent genital arousal (eg, genital sensations, sensitivity) in the absence of sexual desire. Currently, there is limited information about the prevalence of PGAD based on its proposed diagnostic criteria (“PGAD criteria”). Aim This study sought to assess the prevalence of PGAD criteria in 2 North American samples: a large, non-clinical sample of Canadian undergraduate students (Study 1), and a nationally representative sample from the U.S. (Study 2). Methods The incoming class of undergraduate students (N = 1,634) enrolled in the Introduction to Psychology course at a Canadian university and a nationally representative sample of U.S. participants (N = 1,026) responded to questions about each PGAD criterion, and distress associated with these experiences. Outcomes 5 self-report questions were developed based on each of the Leiblum and Nathan 2001 PGAD criteria, and a measure of associated distress was included. The U.S. sample (Study 2) also responded to questions about medical comorbidities and their knowledge of the term “PGAD.” Results 1.1% (n = 4; Study 1) to 4.3% (n = 22; Study 2) of men and 0.6% (n = 7; Study 1) to 2.7% (n = 14; Study 2) of women reported experiencing all 5 PGAD criteria at a moderate to high frequency. Even greater proportions of participants reported experiencing all 5 criteria at any frequency (6.8–18.8%). Although ratings of associated distress varied, participants who were distressed by these symptoms most frequently endorsed the first PGAD criterion: physiological genital arousal in the absence of sexual excitement or desire. These results are similar to previously reported rates of PGAD. Clinical Implications A non-trivial number of individuals may experience PGAD, and it should be screened for by healthcare practitioners. Strengths & Limitations This study is the first to use 2 large, non-clinical samples to assess the prevalence of PGAD symptoms. However, barriers to reporting symptoms, such as shame or embarrassment, may have resulted in underestimates of prevalence in the present sample. Conclusion The prevalence of the 5 PGAD criteria in 2 large non-clinical samples ranged from similar to higher than rates reported in previous research. However, distress ratings associated with each of the 5 criteria varied, with most respondents describing them primarily as neutral or non-distressing.

Purpose of Review Persistent genital arousal disorder (also referred to as genitopelvic dysesthesia or PGAD/GD) is a distressing and largely underrecognized condition characterized by persistent, unwanted genital arousal (sensations, sensitivity, vasocongestion) in the absence of subjective/cognitive arousal and sexual desire. The purpose of this review is to summarize recent findings on biological and psychosocial factors in PGAD/GD as they pertain to the assessment and treatment of this condition. These findings will be considered within a biopsychosocial framework, for the purposes of considering next steps for clinical and research efforts. Recent Findings A small number of studies have recently examined potential biological aetiologies for PGAD/GD: pharmacological agents, spinal pathology and peripheral nerve involvement. Recent studies have also found that PGAD/GD is associated with a significant negative impact on psychosocial wellbeing and daily functioning as compared to symptom-free individuals. In addition, these results highlight cognitive/affective responses to symptoms (e.g. catastrophizing of symptoms) that may influence outcomes. However, biological and psychological research are rarely integrated in these studies, despite the interrelationship between these factors. Summary Although PGAD/GD was first described in the scientific literature almost two decades ago, most research on PGAD/GD is presented in the form of case studies. Prospective treatment trials that integrate biopsychosocial factors are needed in order to provide effective and efficient care to this population. This research would be facilitated by the development of a patient-reported outcome measure, as well as greater education/awareness among healthcare providers and the public about this distressing condition.

This study examined whether low self-efficacy and heightened perceived stress were associated with dyspareunia at two timepoints during COVID-19. Sixty-two participants (31 with and 31 without dyspareunia) completed a longitudinal online survey. Self-efficacy declined during the pandemic, and individuals with dyspareunia reported lower self-efficacy compared to those without dyspareunia. Although stress was greater for those with dyspareunia, both groups reported stress reductions over time. Lower stress was associated with increases in self-efficacy. This study is the first to examine longitudinal trends of dyspareunia during the COVID-19 pandemic and illuminates psychological factors that may influence the experience of dyspareunia.

Introduction Chronic vulvar pain is a multidimensional condition with great variability in clinical presentation among affected women. In a companion article, part 1, we reviewed and recommended assessment and measurement tools for vulvar pain and related outcomes with a view toward improving consistency and comparison across studies. Yet methodological challenges to conducting research with this population remain and can further hinder conclusions regarding etiology and treatment. Aim To discuss methodological challenges to conducting vulvar pain research alongside recommended solutions. Methods The expert authors reviewed the scientific evidence related to the study of vulvar pain and made decisions regarding methodological challenges and mitigation strategies via discussion and consensus. Main Outcome Measure We articulated key challenges to conducting research in this area and formulated recommendations for mitigating these challenges. Results Challenges to the field include selection and sample biases, heterogeneity of the condition, inclusion of the partner, and neglect of the multidimensional aspects of vulvar pain. 2 key recommendations are more careful and detailed tracking and characterization of research samples and greater multidisciplinary collaboration to better capture the complexity of chronic vulvar pain. Clinical Implications This methodological critique points to several challenges to clinical research with populations struggling with chronic vulvar pain and makes suggestions for how to mitigate these issues. Strength & Limitations Comments in this expert review raise awareness regarding core challenges to the study of vulvar pain and can inform study design of clinical research with this population. The content of this review is based on expert knowledge and opinion rather than a formal systematic review or extended consultation process. Conclusion A careful reflection upon methodological challenges facing clinical research of vulvar pain and ways to mitigate such challenges is crucial for improving the quality, generalizability, and uptake of research findings.

To review recently published literature on vulvodynia classification, comorbidities, chronicity, and interpersonal factors, and to outline critical gaps between research findings and clinical practice. The classification of vulvodynia varies in terms of its specificity and degree of focus on pain and psychosocial correlates, with recent conceptualizations supporting a biopsychosocial framework. The presence of comorbidities in those with vulvodynia is associated with poorer symptom outcomes and psychosocial wellbeing, as well as longer-term symptom presentation. Longitudinal research has indicated that the course of vulvodynia can vary, with some women experiencing complete pain remission, pain remission with relapse, or pain persistence. There has been a significant increase in psychosocial research in vulvodynia, with much attention on the role of interpersonal factors in the experience of pain and in sexual and relationship satisfaction. Partner dynamics and sexual motivation have figured prominently in this area of research. The field of vulvodynia research has grown exponentially over the past few years, with an increase in attention to factors and issues outside pathophysiological processes in the vulva. Despite empirically-based recommendations for treatment options, treatment algorithms remain inconsistent and are based on poorly supported treatment options.

Introduction Although postpartum sexual concerns are common, limited data exist on postpartum sexual response. Furthermore, the physiological process of vaginal birth may negatively impact genital response compared with unlabored cesarean section (C-section), but this hypothesis has yet to be tested. Aim To (i) compare genital and subjective sexual response and sexual concordance by mode of delivery with inclusion of a control group, (ii) compare groups on self-reported sexual function over the past month, (iii) examine the relationship between laboratory measurement of sexual response and self-reported sexual function, and (iv) investigate association between obstetrical factors and breastfeeding and between sexual response and self-reported sexual function. Methods 3 groups of cisgender women were recruited from the community: primiparous women who delivered via vaginal birth within the past 2 years (VB group; n = 16), primiparous women who delivered via unlabored C-section within the past 2 years (CS group, n = 15), and age-matched nulliparous women (NP group, n = 18). Laser Doppler imaging was used to assess genital response while participants watched a neutral and erotic film. Main Outcome Measures The main outcome measures were change in flux units from neural to erotic video as a measure of genital response, subjective sexual arousal rated continuously throughout films, perceived genital response rated after films, and Female Sexual Function Index (FSFI). Results Women in the VB group had significantly lower change in flux units than women in the CS (P = .005, d = 1.39) and NP (P Clinical Implications Results underscore the importance of balancing objective and subjective indices of sexual response and function, especially considering the biopsychosocial nature of postpartum sexuality. Strengths & Limitations The present study is the first to apply modern sexual psychophysiological methodology to the study of postpartum sexuality. Cross-sectional methodology limits the ability to make causal inferences, and the strict inclusion criteria limits generalizability. Conclusion Physiological changes as a result of labor and delivery may have a detrimental impact on genital response; however, these physiological differences may not impact women's subjective experience of postpartum sexuality.

Background Persistent genital arousal disorder (PGAD) is characterized by symptoms of distressing physiological sexual arousal (Persistent genital arousal [PGA] symptoms such as genital vasocongestion, sensitivity, or both) that occur in the absence of sexual desire. There continues to be a lack of systematic research on this condition. Little is known about the common medical comorbidities and psychological, sexual, or relationship well-being of individuals who experience PGA symptoms. Aims To compare these biopsychosocial factors in an age-matched sample of women with and without symptoms of PGA. A secondary aim was to examine what symptom factors (associated distress, symptom severity) and cognitive factors (eg, catastrophizing of vulvar sensations) were associated with psychosocial outcomes in women with symptoms of PGA. Methods Age-matched samples of women with (n = 72) and without (n = 72) symptoms of PGA completed a comprehensive online survey. Main Outcome Measures Participants self-reported their medical histories and completed validated measures of psychosocial functioning (depressive and anxiety symptoms, catastrophizing of vulvar sensations, sexual functioning and distress, and relationship functioning). Results Women with symptoms of PGAD reported significantly greater depressive and anxiety symptoms, sexual distress, and suicidal ideation, as well as significantly poorer relationship functioning than women without PGA symptoms. Catastrophizing of vulvar sensations was related to PGA symptom ratings (greater severity, distress) and psychosocial outcomes (greater depression, anxiety, and sexual distress). Clinical Implications The results of this study highlight medical and psychosocial difficulties associated with PGA symptoms, which should be assessed and addressed as essential components of treatment. Strengths & Limitations This study seeks to address the paucity of research on the well-being of women with PGA symptoms by undertaking a comparison of age-matched samples using validated questionnaires. This study is limited by its self-report, cross-sectional design. Conclusion PGA symptoms are associated with significant health and psychological difficulties. These results highlight the need for continued research in this area to improve identification and treatment for this population.

Vibrator use is thought to be associated with positive sexual functioning for women with female or male partners. Vibrator use that is discrepant across contexts (i.e. the individual uses a vibrato...

OBJECTIVE The aim of the study was to document treatment-seeking experiences of women with chronic vulvar pain, comfort communicating about pain, and test the clinical utility of the screening version of the Vulvar Pain Assessment Questionnaire, screening version (VPAQscreen). MATERIALS AND METHODS Patients scheduled for an appointment with the Program in Vulvar Health at Oregon Health and Science University were invited to complete the VPAQscreen and answer descriptive questions about previous treatment-seeking experiences and communication with health care providers. Clinicians provided provisional diagnoses based on VPAQscreen summaries, final diagnoses based on gynecological examination, and commented on alignment with clinical observations. Patients gave feedback on the accuracy and helpfulness of the VPAQscreen summary, characteristics of the questions asked, and whether their comfort communicating increased. RESULTS Participants reported previously seeing approximately 5 medical doctors and 2 other health care providers and perceived them as lacking knowledge of vulvar pain syndromes. Providers indicated that VPAQscreen summaries aligned with clinical presentations and suggested provisional diagnoses with more than 80% accuracy. Participants reported that VPAQscreen summaries were helpful and accurate in summarizing symptoms. Most reported that the number, range, and readability of VPAQscreen questions were good or excellent. More than half reported that completing the VPAQscreen increased comfort when speaking with their Oregon Health and Science University physician. CONCLUSIONS Patients with vulvar pain often endure a lengthy process of consulting multiple clinicians before securing care. The VPAQscreen was more than 80% accurate in predicting diagnosis at this specialty clinic and was useful in assisting patients with expressing symptoms. The applicability of the VPAQscreen in general practice is unknown, although it shows promise.

Provoked vestibulodynia (PVD) is a recurrent vulvovaginal pain condition that has potentially negative consequences for women and their partners’ sexual functioning and overall quality of life. Res...

Genital lubrication and blood flow are theoretically related outcomes of women’s sexual response that prepare the genitals for sexual activity. Despite its importance for sexual function, few experimental studies have directly assessed genital lubrication or empirically demonstrated how genital lubrication and blood flow relate during sexual arousal. In this study, 36 women viewed stimuli that varied by sexual activity intensity (nonsexual, low-intensity sexual, and high-intensity sexual) while their genital responses were assessed using concurrent measures of genital lubrication (using litmus test strips) and genital blood flow (using laser Doppler imaging). Both measures detected a genital response to high-intensity sexual stimuli relative to nonsexual; however, only the laser Doppler imager was sensitive to varying degrees of genital response elicited by stimuli of different sexual activity intensities. The two measures of genital response were suitable for repeated measurement within a single session. Genital lubrication and blood flow were positively correlated for the high-intensity sexual stimuli. Implications for the assessment of women’s genital response and understanding women’s sexual arousal are discussed.

Sex research is viewed as being particularly susceptible to volunteer bias, especially those studies that involve genital response measurement. Willingness to participate in sex research may be aff...

Background Previous studies have demonstrated the deleterious effects of pain anxiety (ie, the degree to which one fears pain), stress, and solicitous partner responses (ie, expressions of sympathy and attention to one’s partner’s pain) on pain and pain-related disability, but little is known about whether these variables moderate the robust pain–pain-related disability relationship in individuals with provoked vestibulodynia (PVD). Aim We investigated whether pain anxiety, stress, and solicitous partner responses moderated the relationship between penetrative pain and pain-related sexual disability in women with PVD symptoms. Methods Participants with PVD symptoms (N = 65, age range = 18–73 years) completed an online survey assessing pain anxiety (Pain Anxiety Symptoms Scale-20), perceived stress (Perceived Stress Scale), solicitous partner responses (WHYMPI Solicitous Responses Scale), penetrative pain (Female Sexual Function Index), and pain-related sexual disability (Pain Disability Index). Moderated regression analyses were performed using pain anxiety, stress, and solicitous partner responses as moderators of the relationship between penetrative pain, and pain-related sexual disability. Outcomes Outcomes in the current study included the moderating effect of pain anxiety, perceived stress, and solicitous partner responses on the relationship between penetrative genital pain and pain-related disability in sexual behavior. Results Higher genital pain from penetrative intercourse and higher pain anxiety significantly predicted higher pain-related sexual disability, but perceived stress was not significantly related to sexual disability. Solicitous partner responses were significantly positively correlated with pain-related sexual disability. None of the moderators significantly moderated the pain–pain-related sexual disability relationship. Clinical Implications For women with PVD, pain anxiety and solicitous partner responses to their pain may exacerbate their pain-related sexual disability, signifying that pain anxiety and solicitous partner responses represent important targets of therapeutic intervention for women with PVD. Strengths and Limitations The present study extended past research on the relationships between psychological and behavioral factors and pain in women with PVD symptoms by demonstrating the deleterious relationship between pain anxiety, solicitous responses, and pain-related sexual disability. However, the study was correlational in nature, which precludes conclusions about the effect of pain anxiety, and solicitous partner responses on pain-related sexual disability. Conclusion High pain anxiety and frequent solicitous partner responses to an individual’s pain predicted higher pain-related sexual disability, suggesting that it may be possible to improve the quality of life of PVD sufferers through interventions that aim to decrease pain anxiety, and solicitous partner responses, in addition to interventions that aim to decrease pain per se.

Provoked Vestibulodynia (PVD) is the most common vulvodynia subtype (idiopathic chronic vulvar pain). Functional magnetic resonance imaging (fMRI) studies indicate that women with PVD exhibit altered function in a number of pain modulatory regions in response to noxious stimulation, such as in the secondary somatosensory cortex, insula, dorsal midcingulate, posterior cingulate, and thalamus. However, previous neuroimaging studies of PVD have not examined periods of time before and after noxious stimulation or investigated functional connectivity among pain modulatory regions. Fourteen women with PVD and 14 matched Control participants underwent five fMRI runs with no painful stimuli interleaved randomly with five runs with calibrated, moderately painful heat stimuli applied to the thenar eminence. As recent findings indicate that pain processing begins before and continues after painful stimulation, 2-min periods were included in each run before and after the stimulus. Functional brain connectivity was assessed during both trials of Pain and No Pain stimulation for each group using structural equation modeling (SEM). Analyses of variance (ANOVAs) on connectivity values demonstrated significant main effects of study condition, and group, for connectivity among pain modulatory regions. Most of the differences between the Pain and No Pain conditions found only in the PVD group take place before (i.e., thalamus to INS, ACC to S1, thalamus to S1, and thalamus to S2) and after pain stimulation (i.e., INS to amygdala, PPC to S1, and thalamus to S2). Such differences were not observed in the Control group. These findings further support previous results indicating that women with PVD have altered pain processing compared to pain-free women.

Background Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia (PGAD/GPD) is characterized by sensations of physiological genital sexual arousal (and/or other types of genitopelvic dysesthesia) that occur in the absence of subjective feelings of sexual desire. Aims The aim of this study was to compare relationship, sexual, and psychological well-being in partnered individuals with and without distressing symptoms of PGAD/GPD. Methods The sample (N = 65 individuals with vulvas and vaginas, N = 11 individuals with penises) of 152 partnered individuals (N = 76 with and 76 without PGAD/GPD symptoms) participated in a one-time anonymous online survey. Outcomes The questionnaires assessed relationship satisfaction (Couple Satisfaction Index-Short Form, CSI); sexual satisfaction (Global Measure of Sexual Satisfaction, GMSEX); sexual functioning (Female Sexual Functioning Index, FSFI, or International Index of Erectile Functioning, IIEF); sexual distress (Sexual Distress Scale, SDS); and psychological well-being, as determined by the presence of depression and/or anxiety symptoms (Hospital Anxiety and Depression Scale, HADS). Results Among individuals with vulvas and vaginas, those with PGAD/GPD symptoms reported significantly lower relationship and sexual satisfaction, greater sexual distress, and more symptoms of depression and anxiety than their counterparts in the control group. In addition, these individuals with PGAD/GPD symptoms also reported significantly worse sexual functioning (arousal, orgasm, satisfaction, and pain), and they were significantly more distressed about each aspect of their sexual functioning difficulties compared to those in the control group. Among the small sample of individuals with penises (N = 11), descriptive analyses revealed that total sexual functioning scores did not differ across the PGAD/GPD symptom and control groups. In addition, 64.5% of the total sample with PGAD/GPD symptoms managed unwanted genital arousal by avoiding sex with their partner, while 55.3% managed their symptoms by having sex with their partner, and some individuals with PGAD/GPD used both strategies. Clinical Implications The finding that PGAD/GPD symptoms impact relationships indicates that treatment for PGAD/GPD should include consideration of the well-being of one’s intimate relationship(s). Strengths & Limitations This study added to the small literature on experiences of PGAD/GPD in relationships, and it was the first to assess sexual satisfaction. Limitations include the small sample of individuals with penises, and the cross-sectional, correlational design, which does not allow for causal conclusions to be drawn. Conclusion Results emphasize the importance of continued research of this population (and their partners) in order to improve diagnosis, intervention, and recognition within the medical community.

Background Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a highly distressing yet poorly understood condition characterized by persistent genito-pelvic sensations, often described as “genital arousal,” which occur in the absence of sexual desire. PGAD/GPD is associated with significant impairment in psychosocial and daily functioning; however, there are currently no empirically validated treatment algorithms for PGAD/GPD. Pelvic floor physical therapy exercises have been found to be effective at reducing other forms of genito-pelvic discomfort, such as vulvodynia, and may also be beneficial to those experiencing PGAD/GPD. Many individuals with PGAD/GPD report difficulty finding a health care provider who is knowledgeable about PGAD/GPD; therefore, pelvic floor education and exercises in an online format may have the potential to reach more individuals in need. Objective This study examined the feasibility of an online pelvic floor group education program; descriptively assessed outcomes related to distress, discomfort, catastrophizing, and mood; and obtained feedback from participants in order to inform the development of improved online group programs. Methods Fourteen women with current symptoms of PGAD/GPD attended an online, 8-session pelvic floor group education program. Participants completed questionnaires of symptoms (ie, symptom distress, discomfort) and psychosocial well-being (ie, depression, anxiety, symptom catastrophizing) prior to the group sessions (Time 1), immediately after the final group session (Time 2), and 6 months following the final group session (Time 3). Participants also completed an anonymous feedback questionnaire immediately following the group program. Results Overall, participants who attended a larger number of the group sessions (>5 sessions, n=7) appeared to report lower baseline (Time 1) symptoms and psychosocial impairment than those who attended fewer sessions ( Conclusions Online interventions provide an opportunity to reach international participants who may otherwise struggle to access a knowledgeable provider for their PGAD/GPD symptoms. Addressing barriers may help to increase participants’ abilities to engage in the program. Future programs may seek to integrate a greater focus on relaxation strategies and cognitive-affective strategies for managing PGAD/GPD symptoms.

BACKGROUND Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a highly distressing yet poorly understood condition characterized by persistent genito-pelvic sensations, often described as “genital arousal,” which occur in the absence of sexual desire. PGAD/GPD is associated with significant impairment in psychosocial and daily functioning; however, there are currently no empirically validated treatment algorithms for PGAD/GPD. Pelvic floor physical therapy exercises have been found to be effective at reducing other forms of genito-pelvic discomfort, such as vulvodynia, and may also be beneficial to those experiencing PGAD/GPD. Many individuals with PGAD/GPD report difficulty finding a health care provider who is knowledgeable about PGAD/GPD; therefore, pelvic floor education and exercises in an online format may have the potential to reach more individuals in need. OBJECTIVE This study examined the feasibility of an online pelvic floor group education program; descriptively assessed outcomes related to distress, discomfort, catastrophizing, and mood; and obtained feedback from participants in order to inform the development of improved online group programs. METHODS Fourteen women with current symptoms of PGAD/GPD attended an online, 8-session pelvic floor group education program. Participants completed questionnaires of symptoms (ie, symptom distress, discomfort) and psychosocial well-being (ie, depression, anxiety, symptom catastrophizing) prior to the group sessions (Time 1), immediately after the final group session (Time 2), and 6 months following the final group session (Time 3). Participants also completed an anonymous feedback questionnaire immediately following the group program. RESULTS Overall, participants who attended a larger number of the group sessions (>5 sessions, n=7) appeared to report lower baseline (Time 1) symptoms and psychosocial impairment than those who attended fewer sessions ( CONCLUSIONS Online interventions provide an opportunity to reach international participants who may otherwise struggle to access a knowledgeable provider for their PGAD/GPD symptoms. Addressing barriers may help to increase participants’ abilities to engage in the program. Future programs may seek to integrate a greater focus on relaxation strategies and cognitive-affective strategies for managing PGAD/GPD symptoms.

As a rite of passage to womanhood, 2 million girls undergo female genital circumcision (FGC)-the tradition of cutting, and often removing parts of the vulva-every year. The current study is the first to focus on the connection between peripheral nerve damage and chronic neuropathic pain in women with FGC. We used mixed methods-quantitative, qualitative, and physiological-to study chronic pain in Somali-Canadian women (N = 14). These women have the most extensive form of FGC, which includes removal of the glans clitoris, labia minora, medial portion of the labia majora, and stitching together the remaining parts of the labia majora. Our results indicate a multifaceted pain experience in women with FGC. Although they report good overall health and very low pain levels on the short form of the McGill Pain Questionnaire, pressure-pain quantitative sensory testing of the vulvar region applied through vulvalgesiometers shows pain thresholds consistent with those reported by women with chronic vulvar pain. Furthermore, qualitative interviews reveal a considerable amount of often debilitating pain in daily life. These results challenge the use of assessment tools offering elicited verbal pain language and highlight the importance of culturally sensitive ways of conceptualizing, measuring, and managing pain.

Introduction Persistent genital arousal disorder (PGAD) is a highly distressing and poorly understood condition characterized by unwanted sensations of genital arousal in the absence of subjective sexual desire. Research has shown that some individuals with PGAD also report orgasm, urinary, and pain symptoms, with 1 recent study specifically comparing a “painful persistent genital arousal symptom” group to a “non-painful persistent genital arousal symptom” group on various indicators given the highly frequent report of comorbid genitopelvic pain in their sample. Aim To review literature on PGAD focusing on the presence of pain symptoms. Methods A literature review through May 2018 was undertaken to identify articles that discuss pain characteristics in individuals with persistent sexual arousal syndrome, persistent genital arousal disorder, symptoms of persistent genital arousal, and restless genital syndrome. Main Outcome Measure A review of pain/discomfort associated with persistent genital arousal, and the proposal of a new theoretical framework of genitopelvic dysesthesias. Results PGAD is a distressing condition that is associated with a significant, negative impacts on psychosocial and daily functioning. Although it is clear that unwanted and persistent genital arousal is the hallmark symptom of PGAD, symptoms of pain and discomfort are also frequently reported. Based on the results of this review, a model of genitopelvic dysesthesias is proposed, with subcategories of unpleasant sensations that are based on patients' primary complaint: arousal, arousal and pain, or pain (and other sensations). Conclusion The proposed model can provide an important framework for conceptualizing conditions characterized by unpleasant genitopelvic sensations. A model such as this one can benefit highly misunderstood conditions that are questioned in terms of their legitimacy and severity—such as PGAD—by conceptualizing them as sensory disorders, which in turn can reduce stigma, unify research efforts, and potentially improve access to care. Pukall CF, Jackowich R, Mooney K, et al. Genital Sensations in Persistent Genital Arousal Disorder: A Case for an Overarching Nosology of Genitopelvic Dysesthesias? Sex Med Rev 2019;7:2–12.

Group differences in touch and pain thresholds-and their neural correlates-were studied in women with provoked vestibulodynia (PVD; N = 15), a common subtype of vulvodynia (chronic vulvar pain), and pain-free control women (N = 15). Results from quantitative sensory testing and self-report measures indicated that, as compared with control participants, women with PVD exhibited allodynia (ie, pain in response to a normally nonpainful stimulus) and hyperalgesia (ie, an increased response to a normally painful stimulus) at vulvar and nonvulvar sites. In addition, brain imaging analyses demonstrated reduced difference scores between touch and pain in the S2 area in women with PVD compared with control participants, supporting previous findings of allodynia in women with PVD. There were no significant reductions in difference scores between touch and pain for regions related to cognitive and affective processing of painful stimuli. The results of this study contribute important information to the general pain and vulvodynia literatures in elucidating the specific sensorimotor neural mechanisms that underlie hyperalgesia in a chronic pain population. These results have implications for differentiating neural processing of touch and pain for women with and without PVD. Future research should attempt to examine alterations related to hyperalgesia in commonly comorbid conditions of PVD.

Three scientific societies, the International Society for the Study of Vulvovaginal Disease (ISSVD), the International Society for the Study of Women Sexual Health (ISSWSH), and the International Pelvic Pain Society (IPPS) developed the "2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia" (referred to as the "2015 consensus terminology").The terminology included 11 descriptors of vulvodynia. However, the definitions of the descriptors were not included in the 2015 consensus terminology publications. The objective of this article was to provide these definitions.The ISSVD led a discussion on the definitions for the 11 vulvodynia descriptors, with participation from the ISSWSH and IPPS. The definitions were created through a consensus process.The definitions are described and the rationale for their choice is elucidated.The definitions of vulvodynia descriptors were determined by a multistaged process of discussion among health care providers with expertise in the pathophysiology, evaluation, and treatment of vulvodynia. The definitions were approved by the ISSVD, ISSWSH, and IPPS. It is recommended that these definitions of vulvodynia descriptors as well as the 2015 consensus terminology be used for the classification of vulvodynia.

The objective of this paper was to develop a measure of sexual script flexibility when approaching a sexual problem in a relationship. A series of online studies were conducted with individuals in relationships. As one subscale on the two-factor model had poor convergent and discriminant validity, a final single factor scale with 6-items was retained. The single factor scale demonstrated good model fit, high internal reliability, adequate convergent and discriminant validity, and moderate test re-test reliability. These results support the SexFlex scale as a reliable and psychometrically sound assessment of an individual.s flexibility in approaching a sexual problem.

The objective of this paper was to conduct an overview of the existing literature on sexual problems and relational factors in self-identified bisexual individuals. Given the limited research inclu...

Physicians play a critical role in addressing sexual health in medical practice, including pain during intercourse. Vulvodynia is a prevalent cause of pain, however, related training is limited and variable. In addition, physician attitudes toward pain and sexuality may affect behaviour and therefore patient outcomes. This study's objectives were to: 1) determine whether post-graduate trainees hold more positive attitudes toward women presenting with vulvovaginal pain with (versus without) an identifiable cause; and 2) examine attitudinal predictors of comfort treating vulvodynia and attitudes toward patients with this presentation. Residents in Canadian Obstetrics and Gynecology (OBGYN) and Family Medicine (FM) programs participated in an online survey (N=99). Respondents completed questionnaires related to demographics, sexuality-related training, sexual attitudes, and comfort treating and attitudes toward vulvovaginal pain and its symptoms. Residents reported significantly more positive attitudes toward patients with visible pathology versus no identifiable cause for vulvovaginal pain, regardless of medical specialty, p

Background Media representations of sexuality after childbirth depict vaginal birth as harmful and cesarean delivery as protective, although research does not support these depictions. The objective of the current study was to investigate perceptions of the effects of mode of delivery on sexuality. Methods Nulliparous participants who were able to and interested in giving birth (N = 1428) completed an online survey about their preferences for mode of delivery and their perceptions of childbirth as they specifically relate to sexuality. Participants provided demographic information, rated how influential different sources of information about childbirth were, and completed the Attitudes Toward Women's Genitals Scale. Results Up to half (16-48%), the participants agreed with different statements about vaginal birth as harmful to, and cesarean delivery as protective of, future sexuality. Participant characteristics that were independently predictive of endorsing these beliefs were: self-identifying as heterosexual, holding negative attitudes toward women's genitals, and reporting that reality media, nonreality media, and online media sources are influential sources of childbirth information. Participants who rated health care professionals as an influential source of information were less likely to endorse these beliefs. Conclusion Given that there is no clear evidence in the empirical literature to support the claim that vaginal births are harmful and cesarean delivery is protective to one's future sexual life, it is important to dispel the existing misconceptions. Various media sources likely play a role in the perpetuation of this misinformation.

Provoked vestibulodynia (PVD) is an idiopathic vulvar pain condition characterized by burning pain at the vaginal opening in response to contact or pressure. Previous research has established some of the psychosocial difficulties experienced by these patients, but direct comparisons with other pain conditions are needed. The purpose of this study was to compare women with PVD to those with postherpetic neuralgia and pain-free control participants.Participants were invited to complete an anonymous online survey consisting of sociodemographic questions and a range of validated measures.Women with PVD and postherpetic neuralgia (PHN) did not differ in terms of pain catastrophizing or pain anxiety, but women with PHN reported greater pain disability than those with PVD. Participants in both pain groups reported significantly more symptoms of stress, depression, anxiety, and sleep disturbances than pain-free controls; women with PHN reported more symptoms of depression than those with PVD, with no other differences between pain groups. Groups did not differ on relationship adjustment, but participants with PVD reported poorer sexual functioning than the other groups.These results indicate that women with PVD and PHN experience similar mental health difficulties, but women with PHN experience more severe impact on their day-to-day functioning and mood. These results support the classification of PVD as a chronic pain condition, as both the pain groups differed from pain-free control participants on a range of measures. Finally, the presence of mental health difficulties and poorer sexual functioning highlights the importance of conducting biopsychosocial pain assessments.

Research exploring the impact of circumcision on the sexual lives of men has failed to consider men’s attitudes toward their circumcision status, which may, in part, help to explain inconsistent findings in the literature. The current study explored the potential relationship between attitudinal factors toward one’s circumcision status, timing of one’s circumcision, and sexual correlates. A total of 811 men (367 circumcised as neonates, 107 circumcised in childhood, 47 circumcised in adulthood, and 290 intact) aged 19–84 years (M = 33.02, SD = 12.54) completed an online survey. We assessed attitudes toward one’s circumcision status, three domains of body image (Male Genital Image Scale, Body Exposure during Sexual Activities Questionnaire, Body Image Satisfaction Scale), and self-reported sexual functioning (International Index of Erectile Function). Men who were circumcised as adults or intact men reported higher satisfaction with their circumcision status than those who were circumcised neonatally or in childhood. Lower satisfaction with one’s circumcision status—but not men’s actual circumcision status—was associated with worse body image and sexual functioning. These findings identify the need to control for attitudes toward circumcision status in the study of sexual outcomes related to circumcision. Future research is required to estimate the number of men who are dissatisfied with their circumcision status, to explore the antecedents of distress in this subpopulation, and to understand the extent of negative sexual outcomes associated with these attitudes.

Objectives: Vulvodynia (idiopathic chronic vulvar pain) is a prevalent condition associated with significant and negative impacts in many areas of function. Despite the increased research interest in vulvodynia in recent years, recommendations for outcome measures for use in clinical trials are missing. The purpose of this paper, therefore, was to provide recommendations for outcome measures for vulvodynia clinical trials so that consistent measures are used across trials to facilitate between-study comparisons and the conduct of large multicenter trials, and to improve measurement of the multiple dimensions of vulvodynia. Methods: Given that provoked vestibulodynia (PVD)—characterized by provoked pain localized to the vaginal opening—is the most common subtype of vulvodynia and the current main focus of clinical trials, this paper focused on recommended outcome measures in PVD clinical trials. The framework used to guide the selection of outcome measures was based on the one proposed by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). Results: The IMMPACT framework provided a well-suited guideline for outcome measure recommendations in PVD clinical trials. However, given the provoked presentation of PVD and the significant impact it has on sexuality, modifications to some of the IMMPACT recommendations were made and specific additional measures were suggested. Discussion: Measures that are specific to vulvovaginal pain are ideal for adoption in PVD clinical trials, and many such measures currently exist that allow the relevant IMMPACT domains to be captured.

Objective* the primary aim was to describe the pain characteristics of persistent genito-pelvic postpartum pain (PPP) and compare these characteristics by mode of delivery. The secondary aim was to incorporate psychosocial variables into the conceptualization of PPP by exploring the relationship among postpartum depressive symptoms, fatigue, and PPP. Design cross-sectional study design. Setting online survey. Participants 106 women recruited from the community who gave birth within twelve months prior to completing the survey. Measurements and findings questionnaire regarding sociodemographic information, pregnancy and childbirth variables, depressive symptoms (Edinburgh Postnatal Depression Scale), and fatigue (Fatigue Symptom Checklist). Women who were ≥3 months postpartum and indicated they were still experiencing any genito-pelvic pain from childbirth were provided questions about their current pain experience. Twenty-seven (25.5%) women were between 3–12 months postpartum and currently experiencing PPP. The intensity of pain was mild, and had multiple locations and triggers. Compared to women whose acute pain resolved after childbirth, women with PPP were more likely to have had a Caesarean section (15.2% versus 33.3%). Other birth-related (i.e., epidural/spinal anesthesia use during vaginal birth) and psychosocial variables (income) also differentiated women with PPP from women whose gentio-pelvic pain resolved. Postpartum fatigue independently predicted PPP (Odds ratio=4.7), while postpartum depressive symptoms did not. Key conclusions PPP was quite prevalent in this sample, and while the intensity of pain was on average, mild, the pain was widespread in terms of location and triggers. Multiple biopsychosocial factors differentiated women with persistent postpartum pain from those women whose pain resolved. Implications for practice PPP is a common health concern for new mothers in the first year postpartum, and may be best addressed by health care professionals using a multidimensional approach, which focuses on the psychosocial aspects of pain.