Vulvar pleasure in chronic vulvar pain conditions: Impacts on pain-related anxiety, pain catastrophizing, and sexual function

Abstract

ABSTRACT Introduction Vulvar pain conditions are associated with pain-related anxiety and other psychosocial symptoms, which can have far-ranging effects on personal well-being and interpersonal relationships. Despite their pain, some vulvar pain patients are still capable of experiencing vulvar pleasure. The relationships between vulvar pain conditions and vulvar pleasure is not well explored in existing literature. Objectives To examine the frequencies with which vulvar pain patients experience vulvar pleasure, and to investigate whether the ability to experience vulvar pleasure in patients with vulvar pain conditions impacts pain-related anxiety (PRA), pain catastrophization (PC), and sexual functioning (SF). Methods A prospective online study was conducted of 262 patients presenting to two urban vulvovaginal specialty clinics over the course of six months. Patients presenting for initial evaluation completed validated questionnaires for PRA via the Pain Anxiety Symptoms Scale-20 (PASS-20), PC via the Pain Catastrophizing Scale (PCS), and SF via the Female Sexual Function Index (FSFI), as well as a researcher-developed questionnaire evaluating vulvar pleasure. Results Of the 192 patients (mean age: 39, SD: 14, range: 16-78) who completed all questionnaires and had current vulvar pain, 93.2% had experienced vulvar pleasure at some point in their lives and 76.6% had experienced some vulvar pleasure since their vulvar pain began. Patients who were able to experience vulvar pleasure since their vulvar pain began scored lowest on every subscale of both the PASS-20 and PCS and highest on the total FSFI, compared to patients who had never experienced vulvar pleasure and to patients who had not experienced vulvar pleasure since their vulvar pain began. There were significant differences in cognitive pain-related anxiety (p = 0.02), in the helplessness component of pain catastrophizing (p = 0.04), and in overall female sexual functioning (p < 0.00001) among the three groups. Conclusions The experience of vulvar pleasure in vulvar pain conditions is associated with lower PRA and PC, specifically in the domains of anxiety cognitions and helplessness, and higher SF overall. This was a novel study given its focus on vulvar pleasure in the context of patients with vulvar pain conditions. Clinicians should consider incorporating education and promotion of vulvar pleasure in vulvar pain treatment regimens. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Dr. Goldstein is a consultant at Ipsen and a part-time employee at Daré Bioscience).